Introduction to Intensive Care
Medicine for ACCS trainees
Sabine Eggert
Swansea
2012
Intensive Care Medicine
• Copenhagen 1952 – Ibsen: Technique of
positive pressure ventilation widely adopted
in polio epidemic with mortality reduction
from 90% to 25%.
(Manpower required - 1400 students)
• Positive-pressure ventilators developed
(Engstrom)
Intensive Care Medicine
Intensive Care Medicine
• 1970–1980’s – modern concept of critical
illness developed. Respiratory support only
run by anaesthetists
• 1999 - Awarded specialty status
• 2000 - IBITCM established
• 2002 - Dual CCT in ICM
• 2010 - FICM approved
• 2012 - Single CCT in ICM
Intensive Care Medicine
Principles
• Diffusion (Fick’s law)
• Filtration
• Absorption
Intensive Care Medicine
Change over time:
• Equipment
• Environment
• Patients are older, sicker with higher
expectations
Intensive Care Medicine
Help:
•
•
•
•
Colleagues
Nurses
ITU guidelines
Computer
Intensive Care Medicine
The ICM team:
Consultants (11)
Trainees (21)
Parent specialty doctors
Microbiologists, pathologists
Nursing staff
Technicians
Secretaries
Physiotherapists
Pharmacists
Dieticians
Receptionists
Cleaners
Intensive Care Medicine
Intensive Care Medicine
Swansea
• 28 ITU beds in Morriston Hospital
• No. of admissions: over 1100 per year
– 42% surgical, 58% medical
• Tertiary centre – trauma / vascular /
pancreatic disease / renal
• Other critical care areas:
• Burns unit
• Cardiac ITU
Intensive Care Medicine
Intensive Care Medicine
• Induction Meeting, Appraisal meetings
• 2 ACCS trainees on 1st on call rota
• Allocated to one section of the unit during
morning hand-over
• 2 consultant-led ward rounds
• Member of trauma and arrest team
• Ward referrals
Intensive Care Medicine
• Microbiology ward rounds
• Weekly audit / case presentations and
journal clubs
• Weekly team based “long stay” patient
reviews
• X ray teaching
• Bed side teaching
Intensive Care Medicine
Ward round
• System-based presentation:
CVS
Respiratory
Neurological
Renal
GI tract
Haematological/ Infections
• Problems
• Management plan
Intensive Care Medicine
Duties:
• Interventions
• Referrals
• Relatives
• Discharge summaries
• Death Certificates
Intensive Care Medicine
“ACCS paperwork”
• 6 DOPS
• 3 Mini Cex
• 4 CBD
• 1 MSF
• FICM documentation
• Educational Supervisor Report
Intensive Care Medicine
Single/Dual CCT’s:
• Entry routes: Anaesthetics, CMT, EM
ACCS
• Primary exam
• Primary FICM exam not running yet
(2014?)
Intensive Care Medicine
Single CCT:
•
•
•
•
•
Competitive entry at ST3 level
Primary exam in entry specialty
Annual interviews in ICM
National interview process
Soon: applications for ACCS ICM possible
Intensive Care Medicine
Stage 1 ICM training:
• Appointments into ST3 and ST4 ICM training
• At the end of ST4 every trainee will have had:
1 year Anaesthetics
1 year ICM
1 year AM
Intensive Care Medicine
Stage 2 ICM training:
• ST 5 year with specialty experience
(cardiac, neuro, paeds plus other)
• ST 6 special interest
• Compulsory FICM exam: ST 5/ ST6 level
Intensive Care Medicine
Stage 3 ICM training:
• 1 year of advanced ICM training
Intensive Care Medicine
Dual CCT’s:
•
•
•
•
CT of 2nd specialty
2 Applications (within 18 months)
Additional 18 months of training needed
Overlap of competencies
Intensive Care Medicine
Why dual CCT?
•
•
•
•
Broadens working opportunities
Increasing demand for ICM consultants
Anaesthetics: “peri-operative physician”
AM/EM: close links
Thank you!
Questions?