History of Intensive Care

Size: px
Start display at page:

Download "History of Intensive Care"

Transcription

1 1 History of Intensive Care Jennifer Jones When the first World Congress of Intensive Care was held in London in June 1974, it was attended by more than 2,000 delegates from all parts of the globe and the astonished organisers had to hire extra space to accommodate them all. The success of the event illustrated the fact that, over the previous decade, the provision of care for critically ill patients in units separate from general wards had been accepted as an essential feature of hospitals throughout the world. How did this acceptance come about and what changes have taken place since? It had been recognised for many years that there were advantages in treating patients with the greatest need for care in one place. In the Crimean War, Florence Nightingale s insistence on keeping the sickest patients closest to the central nursing station may be regarded as an early example of the practice. Before the Second World War recovery rooms adjacent to operating theatres were introduced. Shock wards were established during the war to treat the most severely injured casualties, and coronary care units after the war demonstrated that mortality from acute myocardial ischemia could be reduced by treating the victims in a single area. Mechanical ventilation of the lungs was introduced to treat victims of poliomyelitis and tetanus. It was originally believed that negative pressure ventilation (NPV) was the physiological way to ventilate the lungs, and machines were designed to enclose the patient from the neck down 1

2 2 J. Jones in a box from which air was rhythmically pumped in and out to mimic expiration and inspiration. The first electrically driven device was the iron lung devised in the USA by Drinker and Shaw and introduced into clinical practice in 1928 [1]. In the USA, four large poliomyelitis units were set up to meet the country s needs for artificial respiration. Intermittent positive pressure ventilation (IPPV) combined with tracheostomy (which is very difficult to manage in combination with a tank respirator) was introduced during the poliomyelitis epidemic in Copenhagen in Lassen, who was in charge of the hospital for infectious diseases, which lacked enough tank respirators to deal with the influx of patients, asked an anaesthetist, Ibsen, if techniques used in the operating theatre could be applied to the management of patients with respiratory failure on the wards. To begin with, positive pressure ventilation was provided manually, using a to-and-fro breathing system, by relays of medical students [2]. Later, the students were superseded by the Engstrom ventilator. During the course of the Copenhagen epidemic, Astrup s work on blood gas analysis made it possible to assess the adequacy of alveolar ventilation and established the superiority of IPPV over NPV in this regard [3]. It also became clear that another and perhaps the greatest advantage of IPPV was the ease of access to the patient that it offered to nursing staff. Lassen s account of the epidemic stresses the need for humidification of inspired gas in preventing encrustation of respiratory secretions in a patient with a trachcostomy and physiotherapy in airway management, although both were improved in later years. The importance of the poliomyelitis epidemic in Copenhagen in the development of intensive care was, therefore, profound. It not only demonstrated the superiority of IPPV over NPV in respiratory support, but introduced the concept of a multidisciplinary approach to the management of very sick patients and involved anaesthetists in the provision of their care. Some intensive care specialists today might not consider the latter an advantage. The introduction of the Salk vaccine in 1955, which consists of injected inactivated poliomyelitis virus, and of the oral Sabin vaccine in 1957, which uses an attenuated live virus, has eradicated poliomyelitis from most countries in the world [4]. However, the demand for respiratory

3 History of Intensive Care 3 support continued to increase, driven by the needs of patients with tetanus and chest injuries and, perhaps most importantly, by the proliferation of cardiac surgery. As mechanical ventilators were increasingly used to support patients with acute pulmonary disease, their design became more sophisticated and more subtle modes of IPPV were introduced (see Chapters 7 and 8). Awareness of the dangers of IPPV grew at the same time. The introduction of positive end-expiratory pressure (PEEP) to improve arterial oxygenation rapidly showed that excessive intrathoracic pressures could be associated with barotrauma in the shape of pneumothorax or mediastinal emphysema or with a reduction in cardiac output, which could be overcome by expanding the circulating volume to improve venous return [5]. Methods of assessing best PEEP for optimising oxygen delivery to the tissues were explored [6]. More recently, it has been recognised that over-distension of the alveoli during IPPV with excessive tidal volumes may result in pulmonary damage, and lower than traditional tidal volumes have gained acceptance [7]. Ventilator-associated pneumonia is a common nosocomial infection which has been shown to be associated with prolonged intensive care stay and a marked increase in mortality [8]. The intensive care units set up in the 1960s and 1970s were, for the most part, small. A report from the British Medical Association [9], which confined itself to recommendations, envisaged that only 1% of acute hospital beds would need to be set aside for intensive care, although it clearly saw that such beds would need huge amounts of space, staff and services. Most of these intensive care units were run by anaesthetists, the majority of whom regarded intensive care as a hobby in addition to their sessions in the operating theatre and almost all of whom learned on the job. There was no recognition of intensive care as a specialty, no supervised training programmes and no literature. One of the most important sequels to the first World Congress of Intensive Care is that these points have been addressed. Intensive care is now recognised internationally as a specialty, training programmes are ubiquitous and there are a huge number of journals of critical care. Standards for space and facilities exist at national and international levels. The question of whether intensive care units should be open or closed

4 4 J. Jones has been settled in favour of the trained specialist intensivist, who is today running a much larger unit than those of the 20th century. Intensive care is expensive. No one least of all the paymasters wants to see it profligately dispensed to patients who cannot benefit. Numerous scoring systems have been devised to assess the severity of a patient s illness (of which Knaus Acute Physiology and Chronic Health Evaluation II (APACHE II) [10], is perhaps the most widely used) but, so far, none of them can be used to predict outcome in an individual case. The incorporation of APACHE II into the Intensive Care National Audit and Research Centre (ICNARC) system of audit in the UK [11] has made it possible to assess the performance of individual intensive care units, and has provided a useful monitor of standards of care. At the turn of the 20th and 21st centuries, a new approach to the management of sick patients, which has come to be known as outreach, was taken in Australia. In certain hospitals the cardiac arrest team was replaced by a medical emergency team of intensive care doctors and nurses who could be summoned by ward staff to attend patients who showed marked physiological abnormalities which might lead to a cardiac arrest [12]. When a paper published in the UK suggested that the care provided for sick patients in general wards was often inadequate [13], a similar concept, with modified call-out criteria, was introduced with support from the Department of Health and guidance from the Intensive Care Society [14]. Outreach schemes are based on the premise that early intervention in the development of critical illness can improve outcome. By nipping such illnesses in the bud, it might also obviate the need for a number of admissions to the intensive care unit. Outreach might, it was hoped, save lives and perhaps even money. The evidence collected so far is disappointing: outreach has not as yet fulfilled its promises of improved outcome or reduced costs [15]. In terms of organisation, then, the history of intensive care may be seen as one of steady progress and growing professionalism. Clinical progress is also evident in the development of respiratory support and in the understanding and management of the acute respiratory distress syndrome (ARDS) first described in 1967 [16]. With the introduction of haemofiltration, early recourse to renal replacement therapy in acute renal failure (ARF) has supplanted the practice of squeezing a urine output from failing kidneys with diuretics and dopamine infusions.

5 History of Intensive Care 5 It is also possible to trace fashions in the waxing and waning popularity of various treatment methods. To give an example, in the 1970s many intensivists believed that human albumin was the solution of choice in fluid resuscitation, and that furthermore, it was important to maintain a patient s serum albumin within the normal range as far as possible. A number of small comparative studies in North America, however, suggested that albumin conferred no advantage over (the much cheaper) Hartman s solution [17]. It was further demonstrated in a randomised prospective study of patients in an intensive care unit that outcomes were similar whether gelatine or albumin solution were employed. A meta-analysis of the small North American studies was interpreted as showing that patients were more likely to die if they received albumin during resuscitation, which discouraged many intensivists from using it at all [18]. The controversy seems to have been settled by a large randomised trial of albumin and balanced salt solution, which found that, for most patients, the use of albumin offers neither benefit nor harm [19]. Red blood cell transfusion has become less fashionable. Since the demonstration that oxygen delivery to the tissues in acute normovolaemic anaemia was optimal at haemoglobin (Hb) concentrations of 10 g/dl [20], most intensive care patients were transferred to maintain their Hb concentrations at this level. Since a large randomised Canadian study demonstrated that intensive care patients transfused to a Hb level of 8 g/dl enjoyed an outcome at least as good as those transfused to a level of 10 g/dl [21], most intensive care specialists have pursued a more conservative transfusion policy. The pulmonary artery catheter has also been a bone of contention. Introduced in 1970 by Swan and Ganz [22], its use became widespread after Shoemaker advocated the goal of supra-normal oxygen delivery in intensive care patients as a means of improving their chances of survival [23]. Enthusiasm for such goal-directed therapy was tempered after studies showed that in the acutely critically ill, seeking to raise oxygen delivery beyond normal limits was not helpful [24]. Optimisation of oxygen delivery, however, does seem to be of benefit in patients undergoing high-risk elective surgery [25]. The use of pulmonary artery catheters was further discouraged when a non-randomised cohort study suggested that their use was associated with increased patient mortality and length (and cost) of hospital

6 6 J. Jones stay [26]. An editorial published in the same journal demanded a moratorium on the use of pulmonary artery catheters and a prospective multicentre trial [27]. Further studies have yielded conflicting results [28] and, whilst pulmonary artery catheters continue to be employed in intensive care units, less invasive methods of assessing cardiac output have become more popular. Intravenous feeding is another example of a treatment that has been over-enthusiastically pursued, then denounced and finally reinstated with caution. There is good reason to believe that patients in intensive care units should be fed within 24 hours of admission (see Chapter 9), but enteral feeding is simpler and cheaper than intravenous, and may be associated with fewer infective complications. Parenteral feeding is now something to fall back on if attempts to establish enteral feeding fail. Clinical practice in intensive care has, then, not been without controversy. It is encouraging that, as large randomised trials have been published, intensive care has gradually become based more upon evidence than conjecture. The history of intensive care may be regarded as a story of the successful developments of a new and challenging medical specialty. In a recent critical review [29] Soni complained that its raison d être of providing support for failing organs has led the specialty to focus on syndromes such as ARDS and ARF and give them real disease status, regardless of the disparity of their causes. He argues that more attention should be paid to the causes of organ failure and suggests that it might be beneficial if the abbreviations and acronyms of intensive care ARDS, sepsis, systemic inflammatory response syndrome (SIRS), amongst others were relegated to history. Whatever happens, the future of intensive care will bring change. References [1] Drinker, P. and Shaw, L.A. (1929). An apparatus for the prolonged administration of artificial respiration I. A design for adults and children, J Clin Invest, 7, [2] Lassen, H.C.A. (1953). A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen, with special reference to the treatment of acute respiratory insufficiency, Lancet, 1,

7 History of Intensive Care 7 [3] Astrup, P., Gotzche, H. and Neulukirch, F. (1954). Laboratory investigations during treatment of patients with poliomyelitis and respiratory paralysis, BMJ, 4865, [4] Aylward, R.B. (2006). Eradicating polio; today s challenges and tomorrow s legacy, Ann Trop Med Parasitol, 100, [5] Sykes, M.K., Adams, A.P., Finley, W.E.I. et al. (1970). The effects of variations in end-expiratory inflation pressure on cardiorespiratory function in normo-, hypo- and hypervolemic dogs, Brit J Anaesth, 42, [6] Suter, P.M., Fairley, H.B. and Isenbery, M.D. (1975). Optimum end-expiratory airways pressure in patients with acute pulmonary failure, N Engl J Med, 292, [7] The Acute Respiratory Distress Syndrome Network (2000). Ventilation with lower tidal volumes as compared with traditional volumes for acute lung injury and the acute respiratory distress syndrome, N Engl J Med, 342, [8] Safdav, N., Desfulian, C., Collard, H.R. et al. (2005). Clinical and economic consequences of ventilator associated pneumonia, a systematic review, Crit Care Med, 33, [9] British Medical Association (1967). Intensive care, BMA Planning UNIT Report No1, British Medical Association, London. [10] Knaus, W.A., Draper, E.A., Wagner, D.P. et al. (1985). APACHE II; a severity of disease classifications system, Crit Care Med, 13, [11] Rowan, K.M., Kerr, J.H., Major, E. et al. (1993). Intensive Care Society s APACHE II study in Britain and Ireland II: Outcome comparisons of intensive care units after adjustments for case mix by the American APACHE II method, BMJ, 307, [12] Lee, A., Bishop, G., Hillman, K.M. et al. (1995). The medical emergency team, Anaesth Intens Care, 23, [13] McQuillan, P., Pilkington, S., Allan, A. et al. (1998). Confidential inquiry into quality of care before admission to intensive care, BMJ, 316, [14] The Intensive Care Society (2002). Guidelines for the Introduction of Outreach Services, The Intensive Care Society, London. [15] Fletcher, S.J. and Cuthbertsen, B.H. (2010). Outreach, epistemology and the evolution of critical care, Anaesthesia, 65, [16] Ashbaugh, D.G., Bigelow, D.B., Petty, T.L. et al. (1967). Acute respiratory distress in adults, Lancet, 2, [17] Cochrane Injuries Group Albumin Reviewers (1998). Human albumin administration in critically ill patients; systematic review of randomised clinical trials, BMJ, 317,

8 8 J. Jones [18] Stockwell, M., Soni, N. and Riley, B. (1992). Colloid solutions in the critically ill. A randomized comparison of albumin and polygeline 1. Outcome and duration of stay in the intensive care unit, Anaesthesia, 47, 3 6. [19] The SAFE Study Investigators (2004). A comparison of albumin and saline for fluid resuscitation in the intensive care unit, N Engl J Med, 350, [20] Mesmer, K., Lewis, D.H., Sunder-Plassman, L. et al. (1972). Acute normovolemic hemodilution, Europ Surg Res, 4, [21] Hébert, P.C., Wells, G., Blajchman, M.A. et al. (1999). A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care, N Engl J Med, 340, [22] Swan, H.J., Ganz, W., Forrester, J. et al. (1970). Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter, N Engl J Med, 283, [23] Shoemaker, W.C., Appel, P.L., Kram, H.B. et al. (1988). Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients, Chest, 94, [24] Hayes, M.A., Tinemins, A.C., Yau, E.H. et al. (1994). Elevation of systemic oxygen delivery in the treatment of critically ill patients, N Engl J Med, 330, [25] Boyd, O., Grounds, R.M. and Bennett, E.D. (1993). A randomized clinical trial of the effect of deliberate peri operative increase of oxygen delivery on mortality in high risk surgical patients, JAMA, 270, [26] Connors Jr, A.F., Speroff, D., Dawson, N.V. et al. (1996). The effectiveness of right heart catheterization in the initial care of critically ill patients, JAMA, 276, [27] Dalen, J.F. and Bobe, R.C. (1996). Is it time to pull the pulmonary artery catheter? JAMA, 276, [28] Harvey, S., Young, D., Brampton, W. et al. (2006). Pulmonary artery catheters for adult patients in intensive care, Cochrane Database Syst Rev, C [29] Soni, N. (2010). ARDS, acronyms and the Pinocchio effect, Anaesthesia, 65,

Physiological values and procedures in the 24 h before ICU admission from the ward

Physiological values and procedures in the 24 h before ICU admission from the ward Anaesthesia, 1999, 54, pages 529 534 Physiological values and procedures in the 24 h before ICU from the ward D. R. Goldhill, 1 S. A. White 2 and A. Sumner 3 1 Senior Lecturer and Consultant Anaesthetist,

More information

@ncepod #tracheostomy

@ncepod #tracheostomy @ncepod #tracheostomy 1 Introduction Tracheostomy: Remedy upper airway obstruction Avoid complications of prolonged intubation Protection & maintenance of airway The number of temporary tracheostomies

More information

Admissions with neutropenic sepsis in adult, general critical care units in England, Wales and Northern Ireland

Admissions with neutropenic sepsis in adult, general critical care units in England, Wales and Northern Ireland Admissions with neutropenic sepsis in adult, general critical care units in England, Wales and Northern Ireland Question What were the: age; gender; APACHE II score; ICNARC physiology score; critical care

More information

Policy for Admission to Adult Critical Care Services

Policy for Admission to Adult Critical Care Services Policy Number: CCaNNI 008 Title: Policy for Admission to Adult Critical Care Services Operational Date: Review Date: December 2009 December 2012 Type of Document: EQIA Screening Date: Corporate x Clinical

More information

ROTOPRONE THERAPY SYSTEM. with people in mind.

ROTOPRONE THERAPY SYSTEM. with people in mind. ROTOPRONE THERAPY SYSTEM with people in mind www.arjohuntleigh.com THE CLINICAL CHALLENGE: MINIMIZING MORTALITY AND POTENTIAL COMPLICATIONS IN ARDS PATIENTS WHILE MAKING IT EASIER TO DELIVER PRONE THERAPY

More information

Sue Brown Clinical Audit and Effectiveness Manager. Safety and Quality Committee

Sue Brown Clinical Audit and Effectiveness Manager. Safety and Quality Committee Report to Trust Board of Directors Date of Meeting: 24 June 2014 Enclosure Number: 11 Title of Report: Clinical Audit Plan for 2014/15 Author: Executive Lead: Responsible Sub- Committee (if appropriate):

More information

A high percentage of patients were referred to critical care by staff in training; 21% of referrals were made by SHOs.

A high percentage of patients were referred to critical care by staff in training; 21% of referrals were made by SHOs. 6. Referral process Key findings A high percentage of patients were referred to critical care by staff in training; 21% of referrals were made by SHOs. Consultant physicians had no knowledge or input into

More information

Study Title: Optimal resuscitation in pediatric trauma an EAST multicenter study

Study Title: Optimal resuscitation in pediatric trauma an EAST multicenter study Study Title: Optimal resuscitation in pediatric trauma an EAST multicenter study PI/senior researcher: Richard Falcone Jr. MD, MPH Co-primary investigator: Stephanie Polites MD, MPH; Juan Gurria MD My

More information

History of Critical Care in the World. Ahmet Çınar YASTI, M.D. Hitit University Medical School, Çorum Chair, Numune E&R Hospital, Ankara

History of Critical Care in the World. Ahmet Çınar YASTI, M.D. Hitit University Medical School, Çorum Chair, Numune E&R Hospital, Ankara History of Critical Care in the World Ahmet Çınar YASTI, M.D. Hitit University Medical School, Çorum Chair, Numune E&R Hospital, Ankara Close observation of critically ill persons dates back to ancient

More information

OPERATIONAL POLICY DOCUMENT FOR THE DIALYSIS UNIT WARD 20 UNIVERSITY HOSPITAL AINTREE

OPERATIONAL POLICY DOCUMENT FOR THE DIALYSIS UNIT WARD 20 UNIVERSITY HOSPITAL AINTREE OPERATIONAL POLICY DOCUMENT FOR THE DIALYSIS UNIT WARD 20 UNIVERSITY HOSPITAL AINTREE CHRISTINE JONES RENAL SPECIALIST NURSE JANUARY 2005 UNIVERSITY HOSPITAL AINTREE OPERATIONAL POLICY DIALYSIS UNIT WARD

More information

Early Recognition of In-Hospital Patient Deterioration Outside of The Intensive Care Unit: The Case For Continuous Monitoring

Early Recognition of In-Hospital Patient Deterioration Outside of The Intensive Care Unit: The Case For Continuous Monitoring Early Recognition of In-Hospital Patient Deterioration Outside of The Intensive Care Unit: The Case For Continuous Monitoring Israeli Society of Internal Medicine Meeting July 5, 2013 Eyal Zimlichman MD,

More information

Number of sepsis admissions to critical care and associated mortality, 1 April March 2013

Number of sepsis admissions to critical care and associated mortality, 1 April March 2013 Number of sepsis admissions to critical care and associated mortality, 1 April 2010 31 March 2013 Question How many sepsis admissions to an adult, general critical care unit in England, Wales and Northern

More information

New research: Change peripheral intravenous catheters only as clinically

New research: Change peripheral intravenous catheters only as clinically Content page New research: Change peripheral intravenous catheters only as clinically indicated, not routinely. The results of a nurse led and nationally funded multicentre, randomised equivalence trial

More information

Perioperative management of the higher risk surgical patient with an acute surgical abdomen undergoing emergency surgery

Perioperative management of the higher risk surgical patient with an acute surgical abdomen undergoing emergency surgery CLINICAL GUIDELINE Perioperative management of the higher risk surgical patient with an acute surgical abdomen undergoing emergency surgery CG10214-2 For use in (clinical areas): For use by (staff groups):

More information

Manitoba Transfusion Best Practice Resource Manual Appendix 17 Guidelines for Perioperative Autologous Blood Collection and Administration

Manitoba Transfusion Best Practice Resource Manual Appendix 17 Guidelines for Perioperative Autologous Blood Collection and Administration Guidelines for Perioperative Autologous Blood Collection and Administration Purpose These guidelines intend to inform health care providers about the principles of Perioperative Autologous Blood Collection

More information

The impact of nighttime intensivists on medical intensive care unit infection-related indicators

The impact of nighttime intensivists on medical intensive care unit infection-related indicators Washington University School of Medicine Digital Commons@Becker Open Access Publications 2016 The impact of nighttime intensivists on medical intensive care unit infection-related indicators Abhaya Trivedi

More information

Prone Ventilation of the Critically Ill Patient

Prone Ventilation of the Critically Ill Patient Prone Ventilation of the Critically Ill Patient Statement of Best Practice Patients who require prone ventilation will be clinically assessed by the appropriate medical team, taking into account indications/contraindications,

More information

Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System

Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System Environ Health Prev Med (2008) 13:30 35 DOI 10.1007/s12199-007-0004-y REVIEW Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System Machi

More information

Title: Length of use guidelines for oxygen tubing and face mask equipment

Title: Length of use guidelines for oxygen tubing and face mask equipment Title: Length of use guidelines for oxygen tubing and face mask equipment Date: September 12, 2007 Context and policy issues: There is concern that oxygen tubing and face mask equipment in the ventilator

More information

Course: Acute Trauma Care Course Number SUR 1905 (1615)

Course: Acute Trauma Care Course Number SUR 1905 (1615) Course: Acute Trauma Care Course Number SUR 1905 (1615) Department: Faculty Coordinator: Surgery Dr. Joseph P. Minei Hospital: Periods Offered: Length: Parkland Health & Hospital System All year 4 weeks

More information

CNA SEPSIS EDUCATION 2017

CNA SEPSIS EDUCATION 2017 CNA SEPSIS EDUCATION 2017 WHAT CAUSES SEPSIS? Sepsis occurs when the body has a severe immune response to an infection Anyone who has an infection is at risk for developing sepsis Sepsis occurs when the

More information

Phases of staged response to an increased demand for Paediatric Intensive Care in the event of pandemic or other disaster.

Phases of staged response to an increased demand for Paediatric Intensive Care in the event of pandemic or other disaster. Phases of staged response to an increased demand for Paediatric Intensive Care in the event of pandemic or other disaster. Working document The Critical Care Contingency Plan in the event of an emergency

More information

1. CRITICAL CARE. Preamble. Adult and Pediatric Critical Care

1. CRITICAL CARE. Preamble. Adult and Pediatric Critical Care 1. CRITICAL CARE Complete understanding of the following paragraphs is essential to appropriate billing of the critical care fees. Members of the team billing the Critical Care Payment Schedule can not

More information

CA-1 CRITICAL CARE ROTATION University of Minnesota Medical Center Fairview (UMMC) Rotation Site Director: Dr. Martin Birch Rotation Duration: 4 weeks

CA-1 CRITICAL CARE ROTATION University of Minnesota Medical Center Fairview (UMMC) Rotation Site Director: Dr. Martin Birch Rotation Duration: 4 weeks CA-1 CRITICAL CARE ROTATION Medical Center Fairview (UMMC) Rotation Site Director: Dr. Martin Birch Rotation Duration: 4 weeks Introduction: Critical Care is an integral aspect of anesthesiology training.

More information

The curriculum is based on achievement of the clinical competencies outlined below:

The curriculum is based on achievement of the clinical competencies outlined below: ANESTHESIOLOGY CRITICAL CARE MEDICINE FELLOWSHIP Program Goals and Objectives The curriculum is based on achievement of the clinical competencies outlined below: Patient Care Fellows will provide clinical

More information

PULMONARY FUNCTION STUDIES

PULMONARY FUNCTION STUDIES Pulmonary Function StudiesApril 1, 2015 PREAMBLE PULMONARY FUNCTION STUDIES SPECIFIC ELEMENTS Pulmonary Function diagnostic procedures are divided into a professional component listed in the columns headed

More information

Welcome to the Anaesthesia and Perioperative Care Prioritisation Survey

Welcome to the Anaesthesia and Perioperative Care Prioritisation Survey Welcome to the Anaesthesia and Perioperative Care Prioritisation Survey We want you to nominate the most important topics for future research in anaesthesia and perioperative care. We are therefore asking

More information

Dr. Rubina Aman Module 1 MCCM 10/09/09 PIMS

Dr. Rubina Aman Module 1 MCCM 10/09/09 PIMS HISTORICAL PERSPECTIVE OF INTENSIVE CARE Dr. Rubina Aman Module 1 MCCM 10/09/09 PIMS Florence Nightingale era 1854 Cremean war Mortality rate 40% Nightingale & 38 volunteers Joined field of Scurati. Practiced

More information

The deteriorating patient recognition and management Dave Story

The deteriorating patient recognition and management Dave Story The deteriorating patient recognition and management Dave Story MBBS, MD, BMedSci, FANZCA Professor and Foundation Chair of Anaesthesia Head of Anaesthesia, Perioperative and Pain Medicine Unit (APPMU)

More information

Barriers to Early Rehabilitation in Critically Ill Patients. Shannon Goddard, MD Sunnybrook Health Sciences Centre

Barriers to Early Rehabilitation in Critically Ill Patients. Shannon Goddard, MD Sunnybrook Health Sciences Centre Barriers to Early Rehabilitation in Critically Ill Patients Shannon Goddard, MD Sunnybrook Health Sciences Centre Disclosures/Funding No financial disclosures or conflicts of interest Work is funding by

More information

Recognising a Deteriorating Patient. Study guide

Recognising a Deteriorating Patient. Study guide Recognising a Deteriorating Patient Study guide Recognising a deteriorating patient Recognising and responding to clinical deterioration Background Clinical deterioration can occur at any time in a patient

More information

Modified Early Warning Score Policy.

Modified Early Warning Score Policy. Trust Policy and Procedure Modified Early Warning Score Policy. Document ref. no: PP(15)271 For use in (clinical areas): For use by (staff groups): For use for (patients): Document owner: Status: All clinical

More information

TheValues History: A Worksheet for Advance Directives Courtesy of Somerset Hospital s Ethics Committee

TheValues History: A Worksheet for Advance Directives Courtesy of Somerset Hospital s Ethics Committee TheValues History: A Worksheet for Advance Directives Courtesy of Somerset Hospital s Ethics Committee Advance Directives Living Wills Power of Attorney The Values History: A Worksheet for Advanced Directives

More information

About the Report. Cardiac Surgery in Pennsylvania

About the Report. Cardiac Surgery in Pennsylvania Cardiac Surgery in Pennsylvania This report presents outcomes for the 29,578 adult patients who underwent coronary artery bypass graft (CABG) surgery and/or heart valve surgery between January 1, 2014

More information

Department of Critical Care Restricted Registration Proposal for Call Coverage by Residents in TOH Intensive Care Units

Department of Critical Care Restricted Registration Proposal for Call Coverage by Residents in TOH Intensive Care Units Department of Critical Care Restricted Registration Proposal for Call Coverage by Residents in TOH Intensive Care Units Background: In 2004, the CPSO adopted a model for a pilot project to institute limited

More information

The Royal College of Surgeons of England

The Royal College of Surgeons of England The Royal College of Surgeons of England Provision of Trauma Care Policy Briefing This policy briefing outlines the view of the Royal College of Surgeons of England in relation to the planning and provision

More information

Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study

Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study Susan C Berney, Megan Harrold, Steven A Webb, Ian Seppelt, Shane Patman, Peter J Thomas and Linda Denehy Immobility,

More information

ICU. Rotation Goals & Objectives for Urology Residents

ICU. Rotation Goals & Objectives for Urology Residents THE UNIVERSITY OF BRITISH COLUMBIA Department of Urologic Sciences Faculty of Medicine Gordon & Leslie Diamond Health Care Centre Level 6, 2775 Laurel Street Vancouver, BC, Canada V5Z 1M9 Tel: (604) 875-4301

More information

Duration of life-threatening antecedents prior to intensive care admission

Duration of life-threatening antecedents prior to intensive care admission Intensive Care Med (2002) 28:1629 1634 DOI 10.1007/s00134-002-1496-y ORIGINAL Ken M. Hillman Peter J. Bristow Tien Chey Kathy Daffurn Theresa Jacques Sandra L. Norman Gillian F. Bishop Grant Simmons Duration

More information

Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3)

Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Goals GOALS AND OBJECTIVES To analyze and interpret

More information

AICU/CICU guidelines for Prone Ventilation in Severe Hypoxic ARDS

AICU/CICU guidelines for Prone Ventilation in Severe Hypoxic ARDS AICU/CICU guidelines for Prone Ventilation in Severe Hypoxic ARDS Issue:- Version2 Issue Date:- March2014 Review Date:- March 2017 Issued To:- All staff AICU Consultant Jonathan Chantler, Senior Sister

More information

anaesthetic services Chapter 15 Services for neuroanaesthesia and neurocritical care 2014 GUIDELINES FOR THE PROVISION OF ACSA REFERENCES

anaesthetic services Chapter 15 Services for neuroanaesthesia and neurocritical care 2014 GUIDELINES FOR THE PROVISION OF ACSA REFERENCES Chapter 15 GUIDELINES FOR THE PROVISION OF anaesthetic services ACSA REFERENCES 15.1.1 15.1.2 15.1.3 15.1.4 15.1.5 15.1.8 15.1.9 15.1.11 15.2.1 15.2.9 15.2.13 15.2.17 15.2.18 15.2.19 15.3.2 15.4.2 15.5.1

More information

If you have questions or concerns about the information provided in this pamphlet, please feel free to discuss it with a KGH staff member, such as

If you have questions or concerns about the information provided in this pamphlet, please feel free to discuss it with a KGH staff member, such as If you have questions or concerns about the information provided in this pamphlet, please feel free to discuss it with a KGH staff member, such as your doctor. Other staff members such as a nurse, bio-ethicist

More information

PURPOSE CONTENT OUTLINE. NR324 ADULT HEALTH I Learning Plan. Application of Chamberlain Care Through Experiential Learning

PURPOSE CONTENT OUTLINE. NR324 ADULT HEALTH I Learning Plan. Application of Chamberlain Care Through Experiential Learning PURPOSE NR324 ADULT HEALTH I Learning Plan This learning plan expands upon the key concepts identified for the course and guide faculty teaching the pre-licensure BSN curriculum in all locations. Readings

More information

HAWAII HEALTH SYSTEMS CORPORATION

HAWAII HEALTH SYSTEMS CORPORATION All Positions HE-13 6.822 Function and Location This position works in the respiratory therapy unit of a hospital and is responsible for supervising several respiratory therapy technicians in providing

More information

The impact of an ICU liaison nurse service on patient outcomes

The impact of an ICU liaison nurse service on patient outcomes The impact of an ICU liaison nurse service on patient outcomes Suzanne J Eliott, David Ernest, Andrea G Doric, Karen N Page, Linda J Worrall-Carter, Lukman Thalib and Wendy Chaboyer Increasing interest

More information

CLINICAL PREDICTORS OF DURATION OF MECHANICAL VENTILATION IN THE ICU. Jessica Spence, BMR(OT), BSc(Med), MD PGY2 Anesthesia

CLINICAL PREDICTORS OF DURATION OF MECHANICAL VENTILATION IN THE ICU. Jessica Spence, BMR(OT), BSc(Med), MD PGY2 Anesthesia CLINICAL PREDICTORS OF DURATION OF MECHANICAL VENTILATION IN THE ICU Jessica Spence, BMR(OT), BSc(Med), MD PGY2 Anesthesia OBJECTIVES To discuss some of the factors that may predict duration of invasive

More information

Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For. Patients And Their Families

Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For. Patients And Their Families Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For Patients And Their Families The goal of this pamphlet is to help you participate in the decision about whether or not to have cardio-pulmonary resuscitation

More information

Thomas E Belda RRT, Ognjen Gajic MD, Jeffrey T Rabatin MD, and Barry A Harrison MD RESPIRATORY CARE SEPTEMBER 2004 VOL 49 NO

Thomas E Belda RRT, Ognjen Gajic MD, Jeffrey T Rabatin MD, and Barry A Harrison MD RESPIRATORY CARE SEPTEMBER 2004 VOL 49 NO Practice Variability in Management of Acute Respiratory Distress Syndrome: Bringing Evidence and Clinician Education to the Bedside Using a Web-Based Teaching Tool Thomas E Belda RRT, Ognjen Gajic MD,

More information

COBAFOLIO: DOCUMENTING THE EVIDENCE OF COMPETENCE

COBAFOLIO: DOCUMENTING THE EVIDENCE OF COMPETENCE COBAFOLIO: DOCUMENTING THE EVIDENCE OF COMPETENCE (2006) The CoBaTrICE Collaboration: 1 st September 2006. European Society of Intensive Care Medicine (ESICM) Avenue Joseph Wybran 40, B-1070,Brussels.

More information

2018 Optional Special Interest Groups

2018 Optional Special Interest Groups 2018 Optional Special Interest Groups Why Participate in Optional Roundtable Meetings? Focus on key improvement opportunities Identify exemplars across Australia and New Zealand Work with peers to improve

More information

Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland

Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland Program director: Thorunn Sch. Eliasdottir, CRNA, PhD Specialized Nursing Postgraduate Diploma Faculty

More information

A PATIENT S GUIDE TO UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES. By Maureen Kroning EdD, RN

A PATIENT S GUIDE TO UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES. By Maureen Kroning EdD, RN A PATIENT S GUIDE TO UNDERSTANDING ADVANCE HEALTH CARE DIRECTIVES By Maureen Kroning EdD, RN Dedication This handbook is dedicated to patients, families, communities and the nurses that touch their lives

More information

PATIENT - CARDIO-PULMONARY RESUSCITATION POLICY

PATIENT - CARDIO-PULMONARY RESUSCITATION POLICY 1.0 Preamble PATIENT - CARDIO-PULMONARY RESUSCITATION POLICY 1.1 Cardiopulmonary resuscitation (CPR) is a medical intervention aimed at restarting circulation and breathing in a patient who has suddenly

More information

Questions. Background to the ICNARC Case Mix Programme

Questions. Background to the ICNARC Case Mix Programme Number of admissions, unit length of stay and days of mechanical ventilation for admissions with blunt chest trauma to critical care in England, Wales and Northern Ireland Questions What were the number,

More information

Management of surge and escalation in critical care services: standard operating procedure for adult respiratory extra corporeal membrane oxygenation

Management of surge and escalation in critical care services: standard operating procedure for adult respiratory extra corporeal membrane oxygenation Management of surge and escalation in critical care services: standard operating procedure for adult respiratory extra corporeal membrane oxygenation 1 NHS England INFORMATION READER BOX Directorate Medical

More information

SUPERVISION POLICY. Roles, Responsibilities and Patient Care Activities of Subspecialty Residents (Fellows)

SUPERVISION POLICY. Roles, Responsibilities and Patient Care Activities of Subspecialty Residents (Fellows) Roles, Responsibilities and Patient Care Activities of Subspecialty Residents (Fellows) Definitions Pediatric Critical Care Medicine Fellowship Program Seattle Children s Hospital and Harborview Medical

More information

does staff intervene; used? If not, describe.

does staff intervene; used? If not, describe. Use this pathway for a resident who requires or receives respiratory care services (i.e., oxygen therapy, breathing exercises, sleep apnea, nebulizers/metered-dose inhalers, tracheostomy, or ventilator)

More information

Guidelines on Postanaesthetic Recovery Care

Guidelines on Postanaesthetic Recovery Care Page 1 of 10 Guidelines on Postanaesthetic Recovery Care Version Effective Date 1 OCT 1992 2 FEB 2002 3 APR 2012 4 JUN 2017 Document No. HKCA P3 v4 Prepared by College Guidelines Committee Endorsed by

More information

Penn State Milton S. Hershey Medical Center. Division of Trauma, Acute Care & Critical Care Surgery

Penn State Milton S. Hershey Medical Center. Division of Trauma, Acute Care & Critical Care Surgery Curriculum Penn State Milton S. Hershey Medical Center Division of Trauma, Acute Care & Critical Care Surgery Residency-SICU The Section Chief for the Emergency General Surgery section within the Division

More information

Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta

Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta Abstract Introduction: Day care units are playing an increasingly important role in healthcare provision,

More information

Unit length of stay and APACHE II scores for ventilated admissions to critical care in England, Wales and Northern Ireland

Unit length of stay and APACHE II scores for ventilated admissions to critical care in England, Wales and Northern Ireland Unit length of stay and APACHE II scores for ventilated admissions to critical care in England, Wales and Northern Ireland Questions What was the unit length of stay and APACHE II scores for ventilated

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

More information

Death and readmission after intensive care the ICU might allow these patients to be kept in ICU for a further period, to triage the patient to an appr

Death and readmission after intensive care the ICU might allow these patients to be kept in ICU for a further period, to triage the patient to an appr British Journal of Anaesthesia 100 (5): 656 62 (2008) doi:10.1093/bja/aen069 Advance Access publication April 2, 2008 CRITICAL CARE Predicting death and readmission after intensive care discharge A. J.

More information

Trevor Duke Intensive Care Unit, Royal Children s Hospital Centre for International Child Health, University of Melbourne

Trevor Duke Intensive Care Unit, Royal Children s Hospital Centre for International Child Health, University of Melbourne vs Trevor Duke Intensive Care Unit, Royal Children s Hospital Centre for International Child Health, University of Melbourne Realities A global summary of quality and safety One vision Quality in acute

More information

Acutely ill patients in hospital

Acutely ill patients in hospital Issue date: July 2007 Acutely ill patients in hospital Recognition of and response to acute illness in adults in hospital Developed by the Centre for Clinical Practice at NICE Contents Key priorities for

More information

GUIDELINE FOR STEP-DOWN TRANSFER OF PATIENTS FROM CRITICAL CARE AREAS

GUIDELINE FOR STEP-DOWN TRANSFER OF PATIENTS FROM CRITICAL CARE AREAS GUIDELINE FOR STEP-DOWN TRANSFER OF PATIENTS FROM CRITICAL CARE AREAS This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the

More information

The How to Guide for Reducing Surgical Complications

The How to Guide for Reducing Surgical Complications The How to Guide for Reducing Surgical Complications Post operative wound (surgical site) infections Maintaining perioperative normothermia Main contacts for Reducing Surgical Complications Campaign Director:

More information

Part 1: Basic Data. Module Code UZYSY Level 2 Version 1

Part 1: Basic Data. Module Code UZYSY Level 2 Version 1 ACADEMIC SERVICES MODULE SPECIFICATION Part 1: Basic Data Module Title Critical Care and Cardio Respiratory Rehabilitation Module Code UZYSY8-30-2 Level 2 Version 1 UWE Credit Rating 30 ECTS Credit Rating

More information

Advance Medical Directives

Advance Medical Directives Advance Medical Directives What Are Advance Medical Directives? These documents could be a living will or a durable power of attorney for health care (also called a health-care proxy). They allow you to

More information

About the Critical Care Center

About the Critical Care Center Patient and Family Education Section 2 About the Critical Care Center The 5-Southeast and 5-East units 5-Southeast and 5-East When You Arrive for a Visit Patient Services Specialist Waiting Rooms Patient

More information

Effectiveness of respiratory rates in determining clinical deterioration: a systematic review protocol

Effectiveness of respiratory rates in determining clinical deterioration: a systematic review protocol Effectiveness of respiratory rates in determining clinical deterioration: a systematic review protocol Rikke Rishøj Mølgaard 1 Palle Larsen 2 Sasja Jul Håkonsen 2 1 Department of Nursing, University College

More information

Australian and New Zealand College of Anaesthetists (ANZCA)

Australian and New Zealand College of Anaesthetists (ANZCA) PS08 2016 Australian and New Zealand College of Anaesthetists (ANZCA) Statement on the Assistant for the Anaesthetist 1. PURPOSE The purpose of this document is to recognise the importance of and to promote

More information

Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath

Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Up to 25,000 surgical deaths per year 5-10% of surgical cases are high risk 79% of deaths occur in the high risk group Overall

More information

MEDICATION ADMINISTRATION: BELOW THE DRIP CHAMBER

MEDICATION ADMINISTRATION: BELOW THE DRIP CHAMBER KINGSTON GENERAL HOSPITAL MEDICATION ADMINISTRATION: BELOW THE DRIP CHAMBER LEARNING GUIDE FOR REGISTERED NURSES AND REGISTERED PRACTICAL NURSES Prepared by: Nursing Education Date: 2001 November Revised:

More information

Maryland MOLST. Guide for Patients. Maryland MOLST Training Task Force

Maryland MOLST. Guide for Patients. Maryland MOLST Training Task Force Maryland MOLST Guide for Patients Maryland MOLST Training Task Force May 2012 Health Care Decision Making: Goals and Treatment Options Explanatory Guide for Patients Contents Introduction Section I Section

More information

Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society

Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society Can J Anesth/J Can Anesth (2018) Appendix 5 Position Paper on Anesthesia Assistants: An Official Position Paper of the Canadian Anesthesiologists Society Background Medical and surgical care has become

More information

Peri-operative Pain Management - a multi-disciplinary team-based approach

Peri-operative Pain Management - a multi-disciplinary team-based approach Peri-operative Pain Management - a multi-disciplinary team-based approach Dr Steven Wong Chief of Service Department of Anaesthesiology & OT Services Queen Elizabeth Hospital Outline Development of postoperative

More information

Pediatric Intensive Care Unit (PICU) Elective PL-1 Residents

Pediatric Intensive Care Unit (PICU) Elective PL-1 Residents PL-1 Residents Interns are required to have sufficient knowledge of their patients in order to present them to the team on rounds, and to construct a differential diagnosis and treatment plan. They are

More information

The School Of Nursing And Midwifery. CLINICAL SKILLS PASSPORT

The School Of Nursing And Midwifery. CLINICAL SKILLS PASSPORT The School Of Nursing And Midwifery. BMedSci Nursing (Adult) CLINICAL SKILLS PASSPORT Student Details NAME: COHORT: I understand that this booklet may be reviewed by my mentor, the programme leader, my

More information

Cost of a cardiac surgical and a general thoracic surgical patient to the National Health Service in a

Cost of a cardiac surgical and a general thoracic surgical patient to the National Health Service in a Thorax, 1979, 34, 249-253 Cost of a cardiac surgical and a general thoracic surgical patient to the National Health Service in a London teaching hospital K D MORGAN, F C DISBURY, AND M V BRAIMBRIDGE From

More information

CHPCA appreciates and thanks our funding partner GlaxoSmithKline for their unrestricted funding support for Advance Care Planning in Canada.

CHPCA appreciates and thanks our funding partner GlaxoSmithKline for their unrestricted funding support for Advance Care Planning in Canada. CHPCA appreciates and thanks our funding partner GlaxoSmithKline for their unrestricted funding support for Advance Care Planning in Canada. For more information about advance care planning, please visit

More information

The POLST Conversation POLST Script

The POLST Conversation POLST Script The POLST Conversation POLST Script The POLST Script provides detailed information in order to develop comfort and competence when facilitating a POLST conversation. The POLST conversation utilizes realistic

More information

Choosing Wisely Canada 5 things NOT to do in the ICU

Choosing Wisely Canada 5 things NOT to do in the ICU Choosing Wisely Canada 5 things NOT to do in the ICU Andre Amaral, MD on behalf of the CWC Critical Care Task Force Assistant Professor Interdepartmental Division of Critical Care Medicine University of

More information

5/9/2015. Disclosures. Improving ICU outcomes and cost-effectiveness. Targets for improvement. A brief overview: ICU care in the United States

5/9/2015. Disclosures. Improving ICU outcomes and cost-effectiveness. Targets for improvement. A brief overview: ICU care in the United States Disclosures Improving ICU outcomes and cost-effectiveness CHQI grant, UC Health Travel support, Moore Foundation J. Matthew Aldrich, MD Associate Clinical Professor Interim Director, Critical Care Medicine

More information

Do Not Attempt Resuscitation Policy

Do Not Attempt Resuscitation Policy Do Not Attempt Resuscitation Policy PROV 27 March 2009 1 Document Management Title of document Do Not Attempt Resuscitation Policy Type of document Policy PROV 27 Description To ensure that do not resuscitate

More information

ROTATION: TRAUMA AND CRITICAL CARE (L AND A SURGERY)

ROTATION: TRAUMA AND CRITICAL CARE (L AND A SURGERY) July 2011 ROTATION: TRAUMA AND CRITICAL CARE (L AND A SURGERY) ROTATION DIRECTOR: Areti Tillou, M.D. CHIEF OF TRAUMA SURGERY: Henry G. Cryer, M.D. SITE: RRUMC GOALS AND OBJECTIVES: To provide trainees

More information

SURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF CARDIOTHORACIC SURGERY

SURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF CARDIOTHORACIC SURGERY SURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF CARDIOTHORACIC SURGERY Residency Years Included: PGY1_X_ PGY2_X_ PGY3 PGY4 PGY5 Fellow I. The Clinical Mission of the Division of Cardiothoracic Surgery

More information

ADVANCE DIRECTIVE FOR HEALTH CARE

ADVANCE DIRECTIVE FOR HEALTH CARE ADVANCE DIRECTIVE FOR HEALTH CARE This document includes a list of definitions and the two types of Advance Directives (together called a Combined Directive). Some people choose to fill out only one portion.

More information

CVICU. Attending feedback in the course of patient care. Assessment of clinical decisions Observation on Rounds. Annual In-service evaluation

CVICU. Attending feedback in the course of patient care. Assessment of clinical decisions Observation on Rounds. Annual In-service evaluation ACGME Competency-based Goals and Objectives ROTATION Cardiovascular Critical Care Unit, PGY 4, 5, 6 CVICU Goal 1. Develop a comprehensive and physiology-based understanding of evolving illness in children

More information

SICU Curriculum for CA2 West Virginia University Department of Anesthesiology

SICU Curriculum for CA2 West Virginia University Department of Anesthesiology SICU Curriculum for CA2 West Virginia University Department of Anesthesiology Description of Rotation or Educational Experience One month rotation in SICU as CA1 and another month in SICU as a CA2. During

More information

Teaching Methods. Responsibilities

Teaching Methods. Responsibilities Avera McKennan Critical Care Medicine Rotation Goals and Objectives Pulmonary/Critical Care Medicine Fellowship Program University of Nebraska Medical Center Written: May 2011 I) Rotation Goals A) To manage

More information

ECMO a parent and family guide

ECMO a parent and family guide ECMO a parent and family guide This leaflet aims to provide you with some basic information about ECMO, and will hopefully answer some questions that you may have in helping to decide on ECMO for your

More information

Nurse Led Follow Up: Is It The Best Way Forward for Post- Operative Endometriosis Patients?

Nurse Led Follow Up: Is It The Best Way Forward for Post- Operative Endometriosis Patients? Research Article Nurse Led Follow Up: Is It The Best Way Forward for Post- Operative Endometriosis Patients? R Mallick *, Z Magama, C Neophytou, R Oliver, F Odejinmi Barts Health NHS Trust, Whipps Cross

More information

General information. Hospital type : Acute Care Hospitals. Provides emergency services : Yes. electronically between visits : Yes

General information. Hospital type : Acute Care Hospitals. Provides emergency services : Yes. electronically between visits : Yes General information 80 JESSE HILL, JR DRIVE SE ATLANTA, GA 30303 (404) 616 45 Overall rating : 1 out of 5 stars Learn more about the overall ratings General information Hospital type : Acute Care Hospitals

More information

ADVANCE CARE PLANNING DOCUMENTS

ADVANCE CARE PLANNING DOCUMENTS ADVANCE CARE PLANNING DOCUMENTS Legal Documents to Assure Your Future Health Care Choices Distributed as a Public Service by THE NEVADA CENTER FOR ETHICS & HEALTH POLICY University of Nevada, Reno Revised

More information

Anesthesia Elective Curriculum Outline

Anesthesia Elective Curriculum Outline Department of Internal Medicine Texas Tech University Health Sciences Center Odessa, Texas Anesthesia Elective Curriculum Outline Revision Date: July 10, 2006 Approved by Curriculum Meeting September 19,

More information

ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH. Advance Care Planning. Discussion guide. Discussion Guide. Advance care planning

ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH. Advance Care Planning. Discussion guide. Discussion Guide. Advance care planning ALLINA HOME & COMMUNITY SERVICES ALLINA HEALTH Advance Care Planning Discussion guide Discussion Guide Advance care planning Advance care planning Any of us could think of a time when we might be too sick

More information

Subject: Skilled Nursing Facilities (Page 1 of 6)

Subject: Skilled Nursing Facilities (Page 1 of 6) Subject: Skilled Nursing Facilities (Page 1 of 6) Objective: I. To ensure that Tuality Health Alliance (THA) and delegated Providence Health Plan Medicare members are appropriately placed in skilled nursing

More information

Laparoscopic Radical Nephrectomy

Laparoscopic Radical Nephrectomy Urology Department Laparoscopic Radical Nephrectomy Information Aims of this leaflet To give information on the intended benefits and potential risks of kidney surgery To guide you in the decisions you

More information