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Critical Concepts Rotation: Acute & Critical Care Training for Senior Medical Students

Prepare senior medical students for resident physician roles by providing exposure to acute and critical care concepts. Focus is on diagnostic and management skills for various specialties. Clinical scenario exercise to enhance decision-making skills in emergency situations. Training emphasizes the importance of immediate actions and life-saving interventions. Follows primary survey approach prioritizing vital signs and critical assessments. Utilize diverse learning modalities to enhance learning experience and skills of senior students.

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Critical Concepts Rotation: Acute & Critical Care Training for Senior Medical Students

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  1. http://www.medschool.lsuhsc.edu/emergency_medicine/critical_concepts_rotation.aspxhttp://www.medschool.lsuhsc.edu/emergency_medicine/critical_concepts_rotation.aspx Twitter: @emednola FB: LSU-EM @ NOLA CRITICAL CONCEPTSLSU SCHOOL OF MEDICINESENIOR ROTATION 2011-12

  2. WELCOME TO CRITICAL CONCEPTS ROTATION OBJECTIVES: • Provide all senior students with exposure to acute and critical care concepts in a variety of learning modalities.  • Review and reinforce diagnostic and management skills in common and/or critical disease entities and procedures encountered in a range of specialties. • Prepare senior students for their new roles as resident physicians with direct patient care and health care team responsibilities.

  3. UNDERLYING PRINCIPLE • Every physician – regardless of specialty – should know how to manage acutely ill, undifferentiated patients with a variety of emergent conditions

  4. CLINICAL SCENARIOS JUNE 5, 2012 / JULY 1, 2012

  5. When suddenly … “Is there a doctor on the plane?/in the ward?” your picture here

  6. A 63 year old woman traveling alone in first class/admitted to the floor began shouting incoherently and wandering around about ten minutes ago. Suddenly, she slumps forward and becomes unresponsive. The flight attendant/nursehands you a medical bag. You are able to feel a weak radial pulse at approximately 110 beats/minute and note a respiratory rate of 8 breaths/minute.

  7. WHAT NOW?? • What would your immediate actions be • In the air? • If/when this happens to you on your first day of internship? • LIST 5 OF THE FOLLOWING: • Initial actions • Possible diagnoses • Management/treatment steps

  8. MANAGEMENT OF THE ACUTELY ILL PATIENT • Based on the principles of identifying and treating the immediate, life-threatening conditions first • All other considerations come second • KEEP IT SIMPLE

  9. PRIMARY SURVEY VITAL SIGNS = CRITICAL IMPORTANCE HR RR BP Temp Pulse Ox

  10. PRIMARY SURVEY A – airway evaluation • Are there any signs of obstruction? • FB • Masses • Trauma • TONGUE

  11. INTERVENTIONS • RELIEVE THE OBSTRUCTION before moving on • Finger sweep • Chin tilt/head lift or jaw thrust • Repositioning • Suctioning/hemorrhage control • FUTURE AIRWAY PROTECTION?

  12. PRIMARY SURVEY • B – breathing, oxygenation & ventilation • Is the patient able to sufficiently oxygenate and/or ventilate? • Look for • Agitation/restlessness • Tachypnea/use of accessory muscles • Bradypnea/apnea • Breath sounds on BOTH sides • Tracheal deviation? • JVD?

  13. PRIMARY SURVEY • Life threatening conditions requiring immediate intervention • Tension PTX • Flail chest • Respiratory failure/distress • Primary pulmonary issue • Consequence of underlying disorder

  14. INTERVENTION: • Assisted oxygenation/ventilation through • Supplemental O2 (how much & how?) • Proper bag-valve-mask • Non-invasive positive pressure ventilation • Intubation (RSI)

  15. PRIMARY SURVEY • C – circulatory status • Assess for PULSES (bilaterally) and heart tones • Any obvious bleeding? • Other s/s: • MS changes • Cool, pale extremities • Capillary refill • BP/HR – shock index

  16. PRIMARY SURVEY • Life threatening conditions requiring immediate intervention • Shock states: • Hypovolemic? • Cardiogenic? • Distributive? • Obstructive? • Active hemorrhage

  17. INTERVENTION • Venous access (large bore/CVC) • Administration of blood or fluid products in rapid boluses • Target to specific types of shock: • Cardiogenic – inotropes, BP support, procedures • Sepsis (distributive) – EGDT, source control • Obstructive (PE/tamponade) • Anaphylactic – epi, antihistamines

  18. PRIMARY SURVEY • D – disability assessment • Mental status/level of consciousness • Gross neurologic exam • Pupils • GCS if trauma

  19. INTERVENTION • Prompt imaging as warranted (trauma – hemorrhage or fracture; medical – CVA/mass) • Prompt Neuro specialist involvement if appropriate • Reversal/supportive care if toxidrome • Consider likelihood of airway protection (“GCS less than 8 = intubate”)

  20. PRIMARY SURVEY • E – FULL exposure • Every inch of the patient is surveyed and documented for obvious life threats • Occult traumatic injury • Infectious sources • Rashes/skin changes • Medications/patches

  21. INTERVENTIONS • Imaging/tests/treatment based on findings • Removal of any offending agent

  22. After stabilization … • Brief, targeted HPI/PMH etc. (“AMPLE”) • REASSESSMENT OF VITAL SIGNS and success of any intervention • Detailed testing • Longer-term treatment and management • Secondary survey: FULL PHYSICAL!

  23. GOALS • … in the care of the undifferentiated patient: • Identify life-threatening processes • Immediate stabilization • Consideration of most serious and most likely diagnoses • Initiation of definitive treatment and care • Utilization of all available resources when appropriate

  24. DON’T BE AFRAID … This is fun!

  25. ROTATION HOUSEKEEPING • Course structure and expectations; • 1 didactics week • 2 EM weeks • 1 ICU week • You are expected to be an active participant in all parts of the course, and a full member of each team • (consider yourselves acting interns)

  26. YOUR GOALS • What should you get out of this? • Expanded skills and knowledge base from 3rd year • Application of those skills/knowledge to more complicated/critically ill patients • Increased exposure to/experience with common and emergent procedures & interventions • More sophisticated understanding of disease complexity & health systems management

  27. WHO WHAT WHERE WHEN • Most of you are here: • We want to move you here: REPORTER HOW WHY WHAT NEXT? INTERPRETER MANAGER

  28. DIDACTICS WEEK • Please read assigned material on website prior to each session … come prepared to discuss! • Each of the 8 specialties has designed their own interactive module on what they perceive to be most important in managing their most criticalor common emergencies • Each module requires a faculty/preceptor signature

  29. ICU ROTATION • You are an active part of the ICU team and expected to have direct patient care and documentation duties • You shouldparticipate in family and team discussions of care plans • Details will differ between ICUs • Information on where/when to report to ICUs – see CC website under “Didactics Schedule & ICU Information”

  30. EM ROTATION • Again, you are expected to have direct patient care responsibilities as part of the EM team • Please read the assigned EM readings during your 2 week block • While on the EM portion of the rotation, you are expected to attend EM student lectures and labs

  31. SOCIAL MEDIA • Another part of the curriculum! • Information available on the website – there are several ways to have this information “pushed” to you • This content is testable!

  32. CASE & PROCEDURE LOGS • During your EM block, please log all patient encounters and procedures that you observe, assist with, and/or perform into E*Value • If you have forgotten your logon/password … please let Dr. Avegno know • This is a way to begin to build your medical portfolio

  33. RESPONSIBILITIES • BE ON TIME … for all sessions, rounds, and shifts • Adhere to the school honesty policy at all times • Be properly supervised in all educational and clinical settings and duties

  34. EVALUATION METHODS • Final grade is based on: • End of rotation on-line exam, derived from: • EM and specialty-specific reading (all online on website) • Social media content • Didactic session lectures and labs • Professionalism assessment during clinical rotation • H/HP/P/F system • Either component can be remediated if necessary

  35. ATTENDANCE POLICY • Students may miss 2 days of the rotation FOR INTERVIEWS ONLY: • During EM block – may miss 1 ED shift and one “free”day • During ICU block – if 2 ICU days are missed, they must be remediated the weekend before or after (in order to have a full week of ICU) • DIDACTICS DAYS MAY NOT BE MISSED • Please contact Dr. English or Dr. Avegno for attendance questions

  36. FORMS • Please turn in evaluation form to Jennifer Jeansonne, course coordinator, upon completion of the rotation (room 615)

  37. NOW … ENJOY THE COURSE!

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