The present CU aims primarily to allow contact with the reality of the critically ill patient, and the problem of multiple organ dysfunction / failure syndromes. Intensive Care Medicine is defined by the clinical severity of the patient rather than by the underlying disease.
Intensive Care Medicine is part of the hospital's Patient Critical / Urgent Medicine which often begins in out-of-hospital setting with the initiation of Basic Life Support to victims of respiratory and cardiac arrest, as well as trauma.
Critical Care Medicine is characterized by:
- the promptness and timeliness of response (when the patient needs it);
- the proportionality of interventions (what the patient needs);
- by inclusiveness and teamwork;
- the ability to identify and rank priorities for action;
- the human dimension, particularly in relation to patients limited in their ability to make decisions, the urgency of interventions, and the sharing of decision between patient / family and professionals.
Intensive Care Medicine and the creation of the ICU were initiated in the 50s after the severe outbreak of poliomyelitis in Copenhagen. Since then, the ICUs are the places with skilled medical and nursing teams, highly specialized in the management of patients with severe / multiple organ failure, as well as equipment monitoring and organ support required for this intervention.
The evolution of the concept of hospital towards its transformation into acute patients hospital, an aging population, the complexity of the surgery patients increasingly severe, transplantation, immunosuppression, and others have increase the needs for intensive care beds. For this reason, the ICUs are a nuclear department in the hospital for acute patients, treating patients in the emergency department / resuscitation, the operating and intermediate care units to wards.
This optional CU aims to give students contact with the reality of intensive care and the practice of intensive care medicine.
Prof. Doutor Pedro Póvoa
Weekly - Available soon
Total - Available soon
The slides of the seminar as well as other material that is deemed essential will be available to students.
- The ICU Book, 3rd edition, Paul Marino, Lippincott Williams and Wilkins
- Critical Care Medicine: The Essentials, 4th edition, John J. Marini e Arthur P. Wheeler, Lippincott Williams and Wilkins
- Surgical Intensive Care Medicine, 2nd edition, John M. O'Donnell, Flávio E. Nácul, Springer
- References of open access on-line (changing every year)
The educational strategies to be used in CU Critical Ill patient are:
Seminars and discussion of clinical cases
Practical classes - clinical activity in affiliated ICU supervised by their collaborators.
Assessment has three components, for a maximum of 20 points:
1. performance (0-7 points)
2. log-book (0-7 points)
3. evaluation (0-6 points)
1. Performance - criteria
Students who miss more than 1/3 of the number of days, will automatically fail the course. This evaluation will be done by the Tutor and aim to classify.
1. attendance and punctuality
2. respect for the patient, family, other professional
3. ability to perform assigned tasks
4. motivation and interest in professional development
5. integration in teamwork
The log-book is intended to be a record of what each student observes, performs with supervision and perform independently. Students should record their progress and identify problems or difficulties (F - fundamental C - complementary).
1. Manipulation of arterial line and central venous catheter - F
2. Arterial and venous puncture - F
3. Handling monitors - C
4. Manipulation of syringes and infusion pumps - C
5. Aseptic techniques - F
6. See / help placement of central venous catheter and arterial line - F
7. See / help bladder catheterization - F
8. See / help / perform tracheal intubation - F
9. Dealing with ventilators and respiratory care equipment - F
10. Contact with dialysis monitors - C
11. Aspirate secretions - C
12. Collaborate on patient positioning - C
13. Monitoring of patients on intra-hospital transport - C
14. Register other activities not covered
Is a written test with resolution of 2 out of 3 clinical cases. The topics required are the identification(s) of the most important organ(s) dysfunction(s), diagnoses (causes) more likely, and exams priority, the initial therapeutic approach, justification of ICU admission, and estimation on prognosis.
The CU takes place over two weeks (34th and 35th week) being organized in seminars, clinical case discussions and clinical practice in the affiliated ICU.
Seminars will be discussed in the following topics:
Reception of students. History of Intensive Care. The modern ICU.
General principles of hemodynamic (DO2 and VO2)
Fluids and Vasopressors
Acute respiratory failure
Postoperative respiratory failure and trauma
Infection, sepsis, severe sepsis and septic shock and multiple organ failure
Acute renal failure
Presentation and interactive discussion of clinical cases, with problem solving learning methodology, with the following objectives:
1. initial approach in critically ill patients (resuscitation and hierarchy of attitudes)
2. hemodynamic monitoring and vasopressor support
3. selection of diagnostic exams
4. rules of empirical antibiotic
5. organ support (mechanical ventilation and dialysis techniques)
6. Nutritional support
Intensive Care Unit
During the stay in the ICU each student is attached to a tutor, doctor from the UCI, chosen for the involvement in critical ill medicine and teaching ability. The activity aims to strengthen the contact with clinical activity with critically ill patients as well as their initial approach, make contact with various specific techniques of Intensive Care Medicine and whenever possible to practice them.
The student participates in different activities including UCI namely daily visits; must know how to perform a history and observation of the critical ill patient.
Students will also be introduced to some current skills of ICU (medical, nursing and general care):
1. monitors, wall outlets of gases and vacuum
2. the airway and aspiration of secretions
3. placement and manipulation of central venous catheters and arterial lines
4. collection of biological products (venous puncture, arterial blood gases, bacteriological products, ...)
5. contact with ventilators, monitors, dialysis monitors, infusion pumps
6. aseptic precautions and prevention of infection transmission
7. the patient unit (space, layout, equipment, ...)
8. isolation policies and prevention of nosocomial infection
9. systems of registration and prescription
10. point of care - intelligence technologies
11. interface with other services (operating theatre, imaging, interventional medicine, other specialties ...)
12. intrahospital transport of critically ill patients
Programs where the course is taught: