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CRITICAL CONCEPTSLSU SCHOOL OF MEDICINESENIOR ROTATIONhttp www medschool lsuhsc edu ... WELCOME TO CRITICAL.ROTATION OBJECTIVES Provide all senior students with exposure toacute and critical care concepts in a varietyof learning modalities Review and reinforce diagnostic and.management skills in common and orcritical disease entities and proceduresencountered in a range of specialties Prepare senior students for their new rolesas resident physicians with direct patient.care and health care team responsibilities UNDERLYING PRINCIPLE Every physician regardless ofspecialty should know how tomanage acutely ill undifferentiated.patients with a variety of emergentconditions CLINICAL SCENARIOS JUNE 5 2014 When suddenly . Is there a doctor on the plane A 63 year old woman traveling alone in firstbegan shouting incoherently andwandering around about ten minutes ago Suddenly she slumps forward and.becomes unresponsive The flight attendant hands you a medicalbag You are able to feel a weak radialpulse at approximately 110 beats minuteand note a respiratory rate of 8.breaths minute CLINICAL SCENARIOS JULY 1 2014When suddenly yourpager goes off . A 60 year old man admitted to the floorgot up to go to the restroom Suddenly he fell back into bed andbecame unresponsive The floor nurse goes out to find a code.cart You are able to feel a weak radialpulse at approximately 120beats minute and note a respiratoryrate of 10 breaths minute CLINICAL SCENARIOS .October 10 2014You are on your EM rotationon a busy night shift when EMS brings in a 57 year old man whowas an unrestrained driver in a.rollover MVC with multiple cars Hewas not responsive at the scene Vital signs in the ambulance were HR115 BP 100 60 and RR 10 All ofthe EM residents are busy working.up the other cars passengers WHAT NOW What would your immediate actions be In the air If when this happens to you on your first day of.internship If you are the first medical professional caring foran acutely ill injured patient FOR EACH CASE LIST 5 OF THE FOLLOWING Initial actions. Possible diagnoses Management treatment steps MANAGEMENT OF THE ACUTELYILL PATIENT Based on the principles of.identifying and treating theimmediate life threateningconditions first All other considerations come KEEP IT SIMPLE. PRIMARY SURVEYVITAL SIGNS CRITICAL IMPORTANCE PRIMARY SURVEYA airway evaluation Are there any signs of obstruction . Masses Trauma TONGUE INTERVENTIONS RELIEVE THE OBSTRUCTION before. Finger sweep Chin tilt head lift or jaw thrust Repositioning Suctioning hemorrhage control FUTURE AIRWAY PROTECTION . PRIMARY SURVEY B breathing oxygenation ventilation Is the patient able to sufficientlyoxygenate and or ventilate . Look for Agitation restlessness Tachypnea use of accessory muscles Bradypnea apnea Breath sounds on BOTH sides. Tracheal deviation PRIMARY SURVEY Life threatening conditionsrequiring immediate intervention Tension PTX. Flail chest Respiratory failure distress Primary pulmonary issue Consequence of underlying disorder INTERVENTION . Assisted oxygenation ventilation Supplemental O2 how much how Proper bag valve mask Non invasive positive pressureventilation. Intubation RSI PRIMARY SURVEY C circulatory status Assess for PULSES bilaterally andheart tones. Any obvious bleeding Other s s MS changes Cool pale extremities Capillary refill. BP HR shock index PRIMARY SURVEY Life threatening conditionsrequiring immediate intervention Shock states . Hypovolemic Cardiogenic Distributive Obstructive Active hemorrhage. INTERVENTION Venous access large bore CVC Administration of blood or fluidproducts in rapid boluses Target to specific types of shock . Cardiogenic inotropes BP support procedures Sepsis distributive EGDT source Obstructive PE tamponade Anaphylactic epi antihistamines. PRIMARY SURVEY D disability assessment Mental status level of consciousness Gross neurologic exam GCS if trauma. INTERVENTION Prompt imaging as warranted trauma hemorrhage or fracture medical CVA mass Prompt Neuro specialist.involvement if appropriate Reversal supportive care if Consider likelihood of airwayprotection GCS less than 8 intubate . PRIMARY SURVEY E FULL exposure Every inch of the patient is surveyedand documented for obvious life Occult traumatic injury. Infectious sources Rashes skin changes Medications patches INTERVENTIONS Imaging tests treatment based on. Removal of any offending agent After stabilization Brief targeted HPI PMH etc AMPLE REASSESSMENT OF VITAL SIGNS.and success of any intervention Detailed testing Longer term treatment andmanagement Secondary survey FULL PHYSICAL . in the care of theundifferentiated patient Identify life threatening processes Immediate stabilization Consideration of most serious and.most likely diagnoses Initiation of definitive treatment and Utilization of all available resourceswhen appropriate DON T BE AFRAID .This is fun ROTATION HOUSEKEEPING Course structure and expectations 1 didactics week 2 EM weeks. 1 ICU week You are expected to be an activeparticipant in all parts of thecourse and a full member of consider yourselves acting interns . YOUR GOALS What should you get out of this Expanded skills and knowledge base from Application of those skills knowledge tomore complicated critically ill patients. Increased exposure to experience withcommon and emergent procedures interventions More sophisticated understanding ofdisease complexity health systems.management Most of you are here REPORTER WHEN We want to move you here INTERPRETER HOW.MANAGER WHAT NEXT DIDACTICS WEEK Please read assigned material onwebsite prior to each session comeprepared to discuss . Each of the 9 specialties has designedtheir own interactive module on whatthey perceive to be most important inmanaging their most critical orcommon emergencies. Each module requires afaculty preceptor signature ICU ROTATION You are an active part of the ICU team andexpected to have direct patient care and.documentation duties You should participate in family and teamdiscussions of care plans Details will differ between ICUs Information on where when to report to ICUs .see CC website under Didactics Schedule ICU Information TICU students please contact fellows for time place to meet prior to starting the week EM ROTATION. Again you are expected to havedirect patient careresponsibilities as part of the EM Please read the assigned EMreadings during your 2 week block. While on the EM portion of therotation you are expected toattend EM student lectures and CASE PROCEDURE LOGS During your EM block please log all.patient encounters and proceduresthat you observe assist with and or perform into NewInnovations This is a way to begin to build your.medical portfolio RESPONSIBILITIES BE ON TIME for all sessions rounds and shifts Adhere to the school honesty policy.at all times Be properly supervised in alleducational and clinical settingsand duties EVALUATION METHODS. Final grade is based on End of rotation on line exam derived from EM and specialty specific reading all online on Social media content Didactic session lectures and labs. Professionalism assessment during clinical H HP P F system Either component can be remediated if ATTENDANCE POLICY Students may miss 2 days of the.rotation FOR INTERVIEWS ONLY During EM block may miss 1 ED shiftand one free day During ICU block if 2 ICU days aremissed they must be remediated the.weekend before or after in order to have afull week of ICU DIDACTICS DAYS MAY NOT BE MISSED Please contact Dr Avegno forattendance questions. Please turn in evaluation form toJennifer Jeansonne coursecoordinator upon completion of therotation room 615 NOW ENJOY THE COURSE .EMS brings in a 57 year old man who was an unrestrained driver in a rollover MVC with multiple cars. He was not responsive at the scene. Vital signs in the ambulance were HR 115, BP 100/60, and RR 10. All of the EM residents are busy working up the other carsâ€™ passengers.