General

  • Be proficient in all aspects of BLS and ACLS
  • Know DVT prophylaxis measures (SCDs, SQ heparin, etc.)
  • Know stress ulcer prophylaxis measures (PPIs)
  • Be comfortable with fluids, pressors, sedation, pain regimens, and other drips

Respiratory Failure

  • Know the two overarching types of respiratory failure (hypercapnic, hypoxemic)
  • Be able to recognize each type using physical exam clues, an ABG, and vital signs
  • Identify the common causes of respiratory failure and the pathogenesis/management of each:
    • ARDS
    • Pneumonia
    • COPD/asthma exacerbation
    • Massive pulmonary embolism
    • Decreased respiratory drive
  • Know when supplemental oxygen is indicated and be able to recognize a shunt
  • Know when to use NIPPV/High Flow O2
  • Know when to intubate
  • Recognize the general ventilator settings (PEEP, FiO2, Tidal Volume, respiratory rate) and
  • when to adjust them
  • Know the criteria used to wean a patient from a ventilator

Shock

  • Identify the types of shock (cardiogenic, septic, anaphylactic, neurogenic, hypovolemic, distributive) using vitals, physical exam, LA wedge pressure, central venous pressure
  • Be able to manage each type of shock and know when to use fluids, pressors, antibiotics, inotropes, invasive (Swan-Ganz) and biochemical monitoring (lactate)
  • Recognize when a patient is bleeding and be able to identify the source of the bleed (fecal occult blood stool, FAST scan, etc.)
  • Know routine transfusion and massive transfusion protocols
  • Know when to use cryoprecipitate, fresh frozen plasma, platelets, pRBC’s
  • Know how to reverse commonly used anticoagulants and how to monitor response

Heart Failure

  • Recognize the signs, symptoms of heart failure
  • Be able to identify the physical exam findings of HF: JVD, hepatomegaly, ascites, lung base crackles, LE pitting edema
  • Know the medications to use for symptomatic therapy (diuretics) and for long-term therapy (ACE-I/ARBs, beta blockers, spironolactone) in patients with HF
  • Know how to use patient’s weight to evaluate progress
  • Be able to correct electrolyte abnormalities seen in HF patients
  • Identify when a patient is acutely decompensating
  • Identify, manage and follow up massive and submassive PE

Acute Coronary Syndrome

  • Know the difference between stable angina, unstable angina, NSTEMI, STEMI
  • Recognize when a patient is suffering from an ACS and know which labs/imaging studies to order (i.e. ECG, troponin/CK-MB, etc.)
  • Know the initial pharmacological management of each presentation
  • Recognize an NSTEMI, STEMI using an ECG
  • Identify the major causes of mortality and what complications to monitor for in a post-MI patient (recurrent MI, ventricular rupture, papillary muscle rupture, etc.)
  • Have familiarity at recognizing commonly seen ECG rhythms and arrhythmias

Acute Renal Failure

  • Know the different etiologies of pre-renal acute renal failure and how to manage them
  • Know the different etiologies of intra-renal causes of acute renal failure and how to manage them
  • Know the different etiologies of post-renal causes of acute renal failure and how to manage them
  • Be able to diagnose acute renal failure and the specific cause using laboratory findings (BUN/Cr, electrolyte abnormalities, urine output, urinalysis, vital signs, etc.)

Chronic Kidney Disease

  • Identify the most common causes of chronic kidney disease (HTN, DM, etc.)
  • Know the sequelae of CKD (anemia, HTN, electrolyte abnormalities, hyperparathyroidism, etc.)
  • Be able to manage fluids/electrolytes in a patient with CKD
  • Identify the indications for emergent dialysis
  • Identify the indications for long-term dialysis

Acid-Base Disturbances

  • Be able to recognize using an ABG and laboratory findings, metabolic acidosis/alkalosis, respiratory acidosis/alkalosis
  • Recognize the appropriate compensatory changes for each disturbance
  • Known common causes of each disturbance and the initial management
  • Be able to calculate an anion gap in patients with metabolic acidosis
  • Know when to use serum osmolarity gap

Electrolytes

  • Identify electrolyte abnormalities and common causes:
    • Hyperkalemia
    • Hypokalemia
    • Hypercalcemia
    • Hypocalcemia
    • Hyperphosphatemia
    • Hypophosphatemia
    • Hypernatremia
    • Hyponatremia
  • Recognize the ‘red-flag’ sequelae for each electrolyte disturbance and know how to manage these complications (i.e. Peaked T‐waves in hyperkalemia, QT prolongation in hypocalcemia, etc.)
  • Know the common clinical pearls in the correction of each electrolyte disturbance (i.e. avoid rapid correction of Na in patient with hyponatremia)

Fluid Management

  • Know the difference between crystalloids and colloids
  • Know the commonly used fluids (0.9% NaCl, 0.45% NaCl, 3.0% NaCl, LR, D5W)
  • Identify the electrolyte composition and osmolarity of each
  • Know the common indications and contraindications for each
  • Know the commonly used infusion rates and hydration status indicators
  • Know how to assess a patient’s fluid status using physical exam, Chem 7, UA, ultrasound
  • Know how to manage fluids in a euvolemic patient
  • Identify the most common causes of hypervolemia
  • Know the fluid management and hydration goals in a hypervolemic patient
  • Identify the most common causes of hypovolemia
  • Know the fluid management and hydration goals in a hypovolemic patient

Infectious Disease

  • Know the commonly encountered infections in the ICU setting (HA -¬‐PNA, UTIs, sepsis, C. Diff etc.)
  • Know the criteria for sepsis and its variants (SOFA)
  • Know the antibiotic regimens used to treat these infections
  • Identify the preventative measures used to avoid PNA, line-involved infections, UTIs, etc.

Diabetic Management

  • Be able to use the sliding scale insulin to control a patient’s glucose
  • Know how to manage fluids in a patient with diabetic nephropathy/CKD
  • Know how to manage electrolyte abnormalities in a patient with diabetic nephropathy/CKD
  • Recognize when a patient is in DKA or hyperosmolar hyperglycemic state (HHS)
  • Know the initial management and monitoring of patients in each (normal saline, insulin + glucose, bicarbonate, potassium replenishment, etc.)

ICU Procedural Goals

  • Know the indications and post-procedure complications for the following IR procedures commonly performed on ICU patients:
    • Tunneled Catheter Insertion / Removal
    • Port Removal
    • Percutaneous Cholecystostomy Tube Placement
    • Percutaneous transhepatic cholangiogram (PTC) and biliary drainage catheter placement(PTBD)
    • Abscess Drainage
    • Image-guided Thoracentesis, Paracentesis or Lumbar Puncture (in difficult patients)
    • IVC filter placement and retrieval
    • G/J-tube placement / exchange
    • Percutaneous nephrostomy tube placement / exchange
    • Visceral angiography and embolization for post-op hemorrhage or trauma
    • Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement / revision
    • Participate in, know each step of, and/or perform the following procedures:
      • Intubation / Extubation
      • Arterial Line Placement (Radial and Femoral)
      • Central Venous Catheter Placement (Jugular, Subclavian and Femoral)
      • Arterial and Venous Blood Gas Sampling
      • Lumbar Puncture
      • Thoracentesis
      • Paracentesis
      • NG/OG/Dobhoff Tube Placement