DESCRIPTION

Training level - involves intensive period of training and skills acquisition. Implies little or no previous experience in ICU

EXPERIENCE

Insufficient ICU or other relevant experience to meet the requirements of higher levels.

DIAGNOSTIC

May possess limited diagnostic skills at entry

MANAGEMENT

Resuscitation

Resuscitation skills as outlined in Annexure A

Procedural Skills

May possess limited skills at entry but is rapidly acquiring those necessary for progression to higher grades

General

Possesses only limited knowledge of ICU presentations.

DESCRIPTION

Competently functions in ICU unsupervised, though may still be required to consult for the diagnosis and management of some presentations.

EXPERIENCE

Greater than 12 months full-time (or part-time equivalent) ICU experience at SRMO or registrar level

OR

Greater than 6 months full-time (or part-time equivalent) ICU experience plus
Greater than 6 months full-time (or part-time equivalent) anaesthetic experience.

DIAGNOSTIC

Able to

a) interpret results of history, physical examination, pathology, radiological and ECG investigations in order to maximise patient therapy.

b) process information from a variety of sources - ICU flow charts, reports from nursing staff, ward rounds, monitoring equipment, etc.

c) work as an integral member in a team approach to patient care.

MANAGEMENT / PROCEDURES / DUTIES

Should have a sound knowledge and competence in the following critical conditions:

Cardiovascular:

- inotrope therapy
- recognition and management of acute arrhythmias
- post-operative management of vascular patients
- management of shock

Respiratory:

- acute respiratory failure
- acute asthma / CAL
- severe pneumonia
- ARDS
- tracheostomy care

Renal / Metabolic / Endocrine:

- acute renal failure and oliguria
- dialysis
- parenteral / enteral nutrition
- diabetes mellitus, especially hyperosmolar non-ketotic coma and ketoacidosis

Neurological

- head injury management
- management of raised intracranial pressure
- status epilepticus
- subarachnoid haemorrhage

Gastrointestinal

- gastrointestinal haemorrhage
- hepatic failure
- intra-abdominal sepsis
- pancreatitis

Trauma

- acute management
- complications

Procedural Skills

- central venous catheterisation by subclavian route
- arterial catheterisation
- arterial blood gases
- intercostal catheter insertion / pleural tap
- use of bag and mask in airway management / manual ventilation
- uncomplicated intubation
- establishing and maintaining CPAP
- defibrillation / cardioversion
- lumbar puncture
- insertions of indwelling catheter
- insertion of naso-gastric tube

Post-operative Management

- post-operative analgesia
- regional anaesthesia, especially epidural infusions
- sedatives and analgesic agents
- specific post-operative complications

- abdominal aortic aneurysm repair
- carotid endarterectomy
- total cystectomy
- craniotomy
- complicated or high-risk gastrointestinal surgery


Patient Monitoring and Physiology

- haemodynamic monitoring
- intracranial pressure monitoring
- respiratory physiology
- acid-base balance
- ventilators and ventilator management
- fluid and electrolyte management

General

- communication with family members
- transport of critically ill patients
- drug overdose management
- hypothermia
- antibiotic therapy and sepsis
- entering information into databases
- admission and discharge summaries, daily documentation in patients notes, and following up results of investigations.

Resuscitation

Resuscitation skills as defined in Annexure A

DESCRIPTION

Competently functions independently in the ICU sphere.
Able to supervise more junior staff.

EXPERIENCE

> 24 months full-time ( or its part-time equivalent) ICU experience at SRMO or Registrar level

OR

> 12 months full-time ( or its part-time equivalent) ICU experience plus
> 6 months full-time ( or its part-time equivalent) anaesthetic experience
[NB: total experience to excede 2 years]

DIAGNOSTIC

see Level 2

MANAGEMENT

Competence in the following
(implying a knowledge of indications, contraindications, plus complications and their Mx )

- as per conditions in level 2 plus
- oxygen therapy
- aspiration syndromes
- pancreatitis
- comatose patients
- severe obstetric emergencies ( eg PPH, eclampsia)
- shock

- hypovolaemic
- anaphylactic
- cardiogenic
- septic

- trauma

- head,
- facio-maxillary / upper airway
- spinal
- chest
- abdomina
- pelvic

Procedural Skills

as per Level 2 plus

- difficult endotracheal intubation
- cricothyrotomy
- tracheostomy
- pericardiocentesis
- central venous access (variety of approaches)
- Swan-Ganz catheter insertion
- pleural biopsy
- temporay pacemaker insertion
- suprapubic catheter insertion
- Sengstaken-Blackmore tube insertion
- blood component use

Pharmacology

- paralysing agents
- sedatives
- analgesics
- antibiotics
- anti-arrhythmics
- inotropes
- anti-emetics
- anti-convulsants
- anti-hypertensives
- anti-coagulants

Duties

- retrievals
- cardiac arrest team
- assess admission / discharge suitability of patients
- liaise with intensivist on duty

Resuscitation

Resuscitation skills as defined in Annexure A

LEVEL 1

- basic CPR
- bag/mask ventilation
- peripheral venous access
- ECG interpretation/recognition of arrhythmias
- emergency cardioversion (unconscious pt)
- use of first line anti-arrhythmic

LEVEL 2

- all items specified at level 1
- establish the uncomplicated airway and manually ventilate
- large bore peripheral venous cannula
- intraosseus cannula
- simple use of fluid and blood products
- intercostal catheter

LEVEL 3

- all items specified at levels 1 & 2
- maintenance of the established uncomplicated airway
- ability to recognise the complicated airway and to possess an appropriate complicated airway drill
- use of mechanical ventilation
- complicated venous access
- complicated use of fluid and blood products
- cardioversion of the conscious pt
- use of second line anti-arrhythmic
- use of transcutaneous pacemaker

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