Curriculum cardiac block aims

Day-To-Day Cardiac Options

Join Dr Walker - Cardiologist (Congenital)
Join Dr Cannon - Cardiologist (Transplant)
Congenital MDT Fri AM 08:00-11:00 @ CT Meeting Room
Cardiac Obstetric Clinic - Alt Mondays
Heart Failure MDT Fri AM 08:00 @ Ortho Board Room
echo lists
ct lists
mri lists
daily ward rounds

Induction Appraisal

Review Progress So Far
Review Previous ESSR
Agree Learning Objectives For Post Ahead
Identify Learning Opportunities for Post
Compile Personal Development Plan for Post

Aims

Who are the patient groups I want to be more comfortable with as a result of GJNH?

Cardiogenic Shock
Right Heart Failure
Surgical Thoracic Disease

What do I want to be more comfortable doing as a result of GJNH?

Emergency Induction of Anaesthesia for the patient groups above
FICE level echocardiography - Do FUSIC Modules
Basic valvular assessment - Theatre lists and unit
Pleural ultrasound - Unit ultrasounds
Using and interpreting cardiac output monitoring - Unit
Subclavian Access - Theatres
Basic troubleshooting MCS + Pacing - Unit
Troubleshooting/management of more specialist medical CV support (dobutamine/milrinone/nitric) - Unit

What additional experiences do I want to get in GJNH that aren't available elsewhere?

Time with the NSD team
For advanced heart failure management, pre and post transplant care, congenital disease
Time in cardiac and thoracic theatres
"Advanced Month" - Leadership experience, ward round management
?Floating Right Heart Catheters
?Double Lumen tubes
?CALS Course
This is available elsewhere, but I should get as much airway experience as I can, (plus chest drains if possible, although this is much more a surgical thing there it seems)

What do I have to do?

FFICM Prep
Evidence for HiLLO 14
Start a MSF
Do an ACAT
Get MCR

14

Intensive Care Medicine specialists recognise the special needs of, and are competent to provide the perioperative care to patients who have undergone cardiothoracic surgery, including providing pain relief and advanced organ system support utilising specialised techniques available to support the cardiovascular system.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

Assessing the perioperative risks associated with these patientsâ comorbidities, emergency anaesthesia and surgery and the implications of their concomitant drug therapies
The postoperative care of common acute and chronic medical conditions commonly found in these patients
Assessing the implications of the type and site of surgery for these patientsâ immediate postoperative management and the potential complications, which they can manage effectively whilst providing optimal analgesia
Considering the factors which influence the intensity, levels of care and the clinical environments where the necessary care can be safely delivered to these patients
Treating respiratory dysfunction and complications in these patients
Treat cardiovascular dysfunction and complications in these patients including understanding advanced monitoring techniques and provision of mechanical circulatory support
Assessing and managing other perioperative conditions and complications encountered by pre- and post-operative cardiothoracic surgery patients
Recognising and providing immediate treatment of perioperative emergencies and know when to seek senior help and support.

Old Curriculum Competency Mapping

6.2 Manages the care of the patient following cardiac surgery

Old Curriculum Greater Detail

Knowledge

Factors determining perioperative risk:
Importance of preoperative health status on postoperative outcomes
Indications for, and interpretation of pre-operative investigations Dangers of emergency anaesthesia and surgery
Perioperative implications of current drug therapy
Implications for postoperative care of common acute and chronic medical conditions (see 3.1 and 3.2)
Implications of type of anaesthesia (general/regional/local) for perioperative care
Implications of type / site of surgery for postoperative management and potential complications within the first 24 hours of surgery
Recognition, assessment and management of acute pain
Indications for and methods of perioperative anti-thrombotic treatment
Criteria for admission to, and discharge from ICU - factors influencing intensity and site of care (ward, high dependency unit (HDU), intensive care unit (ICU))
Assessment and management of commonly encountered perioperative conditions and complications including:
Respiratory:
Interpretation of symptoms and signs of respiratory insufficiency in the surgical patient; the unprotected airway; upper and lower airway obstruction including laryngeal trauma and oedema; pneumonia, collapse or consolidation, pulmonary infiltrates including acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) and their causative factors; TRALI; pulmonary oedema; pleural effusion, haemo/pneumothorax (simple and tension); use of chest drains; factors affecting patients following thoracotomy, lung resection, oesophagectomy and oro facial surgery
Management of bronchopleural fistula; post insertion management of tracheal and bronchial stents
Cardiovascular:
Interpretation of symptoms and signs of cardiovascular insufficiency in the surgical patient; recognition of bleeding; management of hypo/hypertension; pulmonary embolus; cardiac tamponade; surgery for congenital and acquired cardiac disease; management of patients following cardiac surgery (coronary grafting, valve replacement) and aortic surgery (arch, thoracic, abdominal); heart; principles of cardiac pacing
Management of pulmonary hypertension
Renal:
Causes of perioperative oliguria and anuria; prevention and management of acute renal failure
Neurological:
stroke (CVA);
causes of post-operative confusion.
Gastrointestinal:
post-operative alterations in gut motility;
perioperative nutrition;
post-operative nausea and vomiting
Haematology and oncology:
Management of severe acute haemorrhage and blood transfusion, principles of cell salvage;
correction of coagulation disorders and haemoglobinopathies,
care of the immunosuppressed or immunoincompetent patient,
complications of chemotherapy and radiotherapy
Interprets thromboelastography in post cardiac surgical patients
Metabolic & Hormonal:
Blood glucose control;
perioperative management of electrolyte disorders
Sepsis and Infection:
fever and hypothermia;
postoperative hypoperfusion and impaired oxygen delivery;
wound infection;
opportunistic and nosocomial infection;
perioperative infection risk and prophylactic antibiotics;
intestinal ischaemia;
antibiotic selection and prescribing
Management of cyanosis, hypo- and hypertension, hypothermia and shivering
Surgical interventions in patients with cardiac disease, perioperative management of the cardiovascular surgery patient and potential complications occurring within 24 hours of cardiac surgery

Skills

Consider the impact of long-term and chronic treatment on acute surgical care
Identify pre-operative health status and intercurrent disease, medications, allergies and their interaction with the nature of anaesthetic and surgery
Obtain relevant information from the patient, relatives and other secondary sources
Assess conscious level and conduct a careful systems review
Select and determine adequacy and route of administration of analgesia
Document, monitor and manage fluid balance, circulating volume, drains, systemic oxygen supply
Establish a plan for postoperative management
Identify life-threatening cardiorespiratory complications; manage hypovolaemia and impaired oxygen delivery
Differentiate and manage tension pneumothorax, cardiac tamponade and pulmonary embolus
Recognise and manage perioperative emergencies and seek assistance appropriately
Seek appropriate support and supervision in order to provide optimal patient care
Interpret pre-operative investigations, intra-operative findings and events/complications, and respond to them appropriately
Demonstrates management of intra-aortic balloon pump in surgical and non-surgical cardiac patients