Given a critically ill patient, the student must be able to determine the presence or absence of respiratory failure, provide for its emergency support, and have a plan of action to subsequently investigate and manage the problem. These actions must be based on a sound knowledge of respiratory physiology, pathology, pathophysiology, and pharmacology.

1. 1. Recognize the clinical signs and symptoms of acute respiratory failure
   2. Describe the pathophysiology of hypoxemic respiratory failure, list the 6 causes of hypoxemia, and write the alveolar-arterial gas equation
   3. Describe the appropriate management of hypoxemic respiratory failure
   4. Describe the pathophysiology of hypercapnic respiratory failure, and list the physiologic causes of hypercapnia
   5. Discuss the role of oxygen therapy in the treatment of hypercapnic respiratory failure
   6. List the differential diagnosis for an exacerbation of COPD
   7. Describe the appropriate management of hypercapnic respiratory failure
   8. Have a basic understanding of measurements of lung mechanics and pulmonary function tests
   9. Accurately interpret arterial blood gas analysis.
   10. Have a basic working knowledge of the principles of pulse oximetry, capnography, and co-oximetry
   11. Recognize, diagnose, and perform adequate initial investigation and treatment of specific respiratory illnesses including ARDS, cardiogenic pulmonary edema, status asthmaticus, COPD, smoke inhalation, airway burns, near drowning, severe community-acquired pneumonia, nosocomial pneumonia, and aspiration pneumonia, pneumothorax, hemothorax, empyema, massive effusion, pulmonary hemorrhage and massive hemoptysis
   12. Describe the principles and the application of oxygen therapy
   13. Describe the principles and application of mechanical ventilation including knowledge of the various modes of mechanical ventilation, the indications and possible complications; 
       • Be able to write orders for initiating mechanical ventilation including the mode, tidal volume, rate, PEEP and FiO2
       • Discuss advantages and disadvantages of common modes of ventilation (CMV, A/C, SIMV, PS, PC )
       • List complications of mechanical ventilation
       • Describe the possible causes and management of an acute life-threatening elevation in airway pressures while a patient is on mechanical ventilation
       • Weaning from mechanical ventilation – describe criteria for weaning and weaning techniques
       • Describe 3 common weaning modes
       • List at least 4 weaning parameters and give specific values for each
   14. Describe the principles and application of non-invasive ventilatory support (CPAP and BiPAP)
   15. Describe the pharmacology of commonly used drugs including Beta-agonists, anticholinergics, and steroids.

Given a critically ill patient presenting with chest pain, myocardial infarction, arrhythmia, pulmonary edema, hypertension, or hypotension, the student must be able to recognize the problem, provide emergency life support, and embark upon a diagnostic and management program to correct the instability. This must be based on a sound knowledge of cardiovascular physiology, pathology, pathophysiology, and pharmacology. 

1. Recognize and begin initial management of all forms of shock;
   • Give a differential diagnosis of shock
   • Describe the physiological determinants of cardiac output and blood pressure
   • Write the equations for oxygen delivery, oxygen uptake, and the shunt equation
   • Describe the determinants of venous return
   • Describe or draw the Frank-Starling curve
   • Devise a therapeutic approach to the patient in cardiogenic shock; considering preload, afterload, rhythm, and inotropic interventions
   • Describe the causes and management of hypovolemic shock, obstructive shock, cardiogenic shock and distributive shock
2. Describe the pharmacology of the following vasoactive drugs 
   • Dobutamine
   • Dopamine
   • Epinephrine
   • Norepinephrine
   • Amrinone or milrinone
   • Isoproterenol
3. List the function, indications, and the role of the intra-aortic balloon pump in the setting of acute myocardial infarction and cardiogenic shock
4. Discuss right ventricular dysfunction, its causes, hemodynamic patterns, and treatment
5. Be capable to recognize, and perform the initial investigation and treatment of
   • Pulmonary embolism (thromboembolic, air, fat, amniotic) and DVT
   • Treatment of cardiac tamponade and other pericardial disease
   • Myocardial infarction and its complications
   • Acute and chronic valvular disorders
   • Pulmonary edema – cardiogenic and noncardiogenic
   • Pulmonary hypertension and cor pulmonale
   • Aortic emergencies – dissections and ruptured aneurysms
   • Acute vascular ischemia
   • Hypertensive emergencies and urgencies
   • Acute cardiomyopathies
6. Hemodynamic monitoring
7. State the indications for central lines and Swan-Ganz catheters
8. State the complications of central line and Swan-Ganz catheter placement and maintenance
9. Recognize the various waveforms during placement of a Swan-Ganz catheter
10. Describe the thermodilution technique of cardiac output determination and possible sources of error
11. Be able to plot the PCWP on a PA balloon occlusion tracing
12. State the indications and complications of arterial lines
13. Recognize, investigate, and treat cardiac conduction disturbances and dysrhythmias
    • Supraventricular tachycardias
    • Atrial fibrillation and flutter
    • Ventricular dysrhythmias – PVC’s, VT, VF
    • Bradycardias
14. State the indications, contraindications, and pharmacology of beta-blockers, calcium-channel blockers, digoxin, adenosine, procainamide, quinidine, lidocaine, propafanone, sotolol, amiodorone, atropine, adrenaline, isoproterenol
15. List the classification of antidysrhythmic drugs and give at least one example for each
16. List the relevant energy levels required for electrical cardioversion of atrial flutter, atrial fibrillation, SVT, VT
17. List 5 predisposing factors and 3 treatments for torsade de pointes
18. Management of hypertension 
    • Distinguish between hypertensive emergencies and urgencies;
    • Know the pharmacology, indications, contraindications, and complications for nitroglycerin, nitroprusside, labetalol, nifedipine, hydralazine
19. Peri-operative management of patients undergoing cardiovascular surgery
20. Describe all ACLS algorithms

Given a patient with CNS crisis and/or an altered level of consciousness, or with progressive life-threatening neuromuscular disorders, the student must be able to recognize the nature of the situation, institute immediate life-sustaining measures, carry out appropriate neurological examination, derive a differential diagnosis, and continue with appropriate diagnostic and supportive measures until the problem is eventually resolved.

1. Recognize and initiate the acute management of; 
   • coma
   • acute hydrocephalus
   • brain death evaluation
   • persistent vegetative state
   • intracranial vascular accidents (subarachnoid hemorrhage, intraventricular hemorrhage, intraparenchymal hemorrhage)
   • Sub-Dural Hematomas
   • Epi-Dural Hematomas
   • Status Epilepticus
   • Intracranial Infection
   • Intracranial Hypertension
   • Spinal Cord Injury
2. Recognize, investigate, and describe the pathophysiology and treatment of raised intracranial pressure.
3. Discuss the Monroe-Kellie doctrine and the physiology of cerebral vascular auto-regulation.
4. State the advantages, disadvantages, and indications for hyperventilation, Mannitol, hypertonic saline, hypothermia, and induced hypertension in the management of raised ICP.

Given the critically ill patient with a gastrointestinal disorder, the student must be able to critically evaluate the nature of the illness, institute immediate life-sustaining support, and embark upon a program of precise diagnosis, continuing support and, where possible, resolution of the pathophysiological entity.

1. Recognize, investigate, and treat the following; 
   • Upper GI Bleeds including variceal bleeding
   • Lower GI Bleeds
   • Pancreatitis
   • Acute hepatic failure or jaundice
   • Portal hypertension
   • Acalculous cholecystitis
   • Perforated viscus
   • Intraabdominal abscess
   • Ischemic bowel
   • Peri-operative complications including fistulas, wound infection, and evisceration
2. Describe the principles of stress ulcer prophylaxis
3. Describe the appropriate investigation of possible sepsis from the abdomen including the utility of abdominal radiography, ultrasound, CT Scans, diagnostic peritoneal taps, and diagnostic laparotomies

Given a patient with oliguria, evidence of advancing renal failure, or established renal failure, the student must be able to recognize the problem, institute measures to preserve remaining renal function, and provide for precise diagnosis, adequate supportive measures, and primary therapy if available.

1. Distinguish between pre-renal, renal, and post-renal failure by history, physical exam, laboratory tests, and investigations, including interpretation of urinary electrolytes
2. Describe the principles of drug dosage adjustment in renal failure
3. Principles of dialysis
   • List the advantages and disadvantages of hemodialysis, CAVH-D, CVVH-D, peritoneal dialysis
   • List the indications for emergent dialysis
4. Diagnosis and management of rhabdomyolysis
5. Describe the management of the following fluid and electrolyte disorders; 
   • Hyponatremia
   • hypernatremia
   • hyperkalemia
   • hypokalemia
6. Acid-base disorders and their management 
   • Write the equation for calculation of the anion gap and give a differential diagnosis for both anion gap and nonanion gap acidosis

Given a critically ill patient with metabolic-endocrine, fluid or electrolyte abnormalities, the student must be able to recognize the nature and severity of the problem, establish a differential diagnosis and, embark on a course of definitive diagnosis, continued monitoring and support.

1. Recognize and initiate the acute management of; 
   • hypoadrenal crisis
   • diabetes insipidus
   • diabetic ketoacidosis
   • hyperosmolar hyperglycemic non-ketotic coma
   • thyroid storm and myxedema coma

Given a patient with catastrophic septic illness, the student must be able to recognize the probably infective nature of the condition, institute immediate life-sustaining measures, establish a differential diagnosis of probable site of origin and etiological pathogens, and embark upon a course of definitive diagnosis, continued life-support and appropriate antimicrobial and/or surgical therapy.

1. Recognize and initiate the management of 
   • sepsis
   • hospital-acquired and opportunistic infections
2. Describe the principles of 
   • antibiotic selection and dosage schedules for the critically ill patient
   • infection risks to health care workers
3. Differentiate between sepsis and the systemic inflammatory response syndrome(SIRS)
4. Discuss the role of cytokines in SIRS and sepsis

Become familiar with the unique aspects of surgical patients and surgical sepsis.

Given a critically ill patient with a thrombotic or thrombolytic disorder, bleeding, neutropenia, or anemia, the candidate must be able to recognize the problem, provide for any indicated life-sustaining support, and proceed with an orderly course of investigation, management, continued support and treatment.

1. Recognize and initiate the acute management of 
   • defects in hemostasis with significant bleeding
   • hemolytic disorders
   • hematological dysplasias and their complications
   • sickle cell crisis
   • thrombotic disorders
   • thrombocytopenia
2. Describe the principles of
   • anticoagulation and fibrinolytic therapy
   • blood component therapy including indications and potential complications of therapy with PRBC’s, FFP, Platelets, and cryoprecipitate

Given a patient suffering from the effects of an acute or chronic intoxicant, the student must be able to identify this probability, stabilize the life-threatening complication and undertake a sequential plan to support organ function, to prevent further absorption, alter distribution, if possible, and enhance elimination by natural and mechanical means.

1. Describe the following “toxidromes” 
   • Narcotic
   • Sedative -hypnotic
   • Anticholinergic
   • Cholinergic
   • Sympathomimetic/ Withdrawal
   • Salicylates
2. Demonstrate rational laboratory investigation of the poisoned patient including the concepts of the anion gap and the osmolar gap
3. Describe the indications, contraindications, complications, and benefits of gastrointestinal decontamination procedures including gastric lavage, activated charcoal, cathartics, and whole bowel irrigation
4. Describe the indications for hemodialysis in the management of poisonings;
5. Describe the indications, contraindications, complications and benefits for common antidotes including N-acetylcysteine, naloxone, flumazenil, sodium bicarbonate, atropine, glucagon, calcium chloride, digibind, physostigmine, methylene blue, ethanol;
6. Recognize and initiate management of drug-induced hyperthermia including neuroleptic malignant syndrome, malignant hyperthermia, and serotonin syndrome;
7. Describe the indications for ICU admission with respect to the patient with a drug overdose.