Run by School of Medical and Health Sciences

20.000 Credits or 10.000 ECTS Credits

Semester 1 & 2

Organiser: Mrs Heather Bloodworth

The aim of this module is to provide the HEMS practitioner with the skills required to be proficient in assisting with the management of level 3 patients, which means a need to demonstrate knowledge and skills in invasive ventilation and transfer of the ventilated, inotrope-dependent patient. The module is intended for experienced healthcare professionals who wish to formalise and develop their practice, and will require learners to develop within credible practice settings.

Topics may include:

Procedural sedation and analgesia including; Risk/benefit assessment

Respiratory Support including; Arterial or capillary blood gas interpretation and use to guide ventilation decisions Respiratory management failure and indications for ECMO Relevant anatomy, physiology and pathology underpinning the history and examination of the respiratory system Indications for oxygen therapy Knowledge of oxygen delivery devices Interpretation of P/V loops, FV loops and other ventilator data Lung protective strategies and management of acute lung injury/ARDS

Neurological assessment

Gastrointestinal support including; Indications for and use of terlipressin Awareness of nutritional considerations during transfer

Metabolic support including; Electrolyte interpretation including acid/base balance Understanding of common poisons, mechanisms of harm and antidotes

Sepsis management including; Rationale for approach to sepsis management Pharmacology and use of antibiotics Understanding of common pathogens and sources Understanding of hospital-acquired and multi-resistant pathogens

General Management of multiorgan failure states

Ventilator setup: all ages, all modes Non-invasive ventilation setup and management (Biphasic; CPAP including neonatal)

Open thoracostomy including chest drain insertion and management NG tube insertion and management (all age groups)

Cadrivascular support including; Invasive monitoring/transducer setup Arterial line insertion and management Assistance with central vascular access Setup and management of infusions of vasoactive substances Arrythmia management including pacing

Renal Support including; Renal (dialysis) line management and safety Identification and support of renal failure

Gastrointestinal support including; Insertion of nasogastric tubes for gastric decompression in all ages groups. Maintaining safety of intestinal tubes (NG, OG, percutaneous) for transfer including feeding tubes Maintaining safety of indwelling devices (eg drains) during transfer Insertion and management of Sengstaken tubes

Adverse events in ventilation

Transfer of the ventilated, inotrope-dependent patient.

threshold

Basic understanding of the facts and principles specific to the topics covered in this module. Students will be required to achieve a minimum of C- grade in the assignment to pass the theory component of the module.

excellent

Excellent understanding of the facts and principles specific to the topics covered in this module and evidence of additional evidence gained by the student. Very good understanding of professional accountability issues. This equates to a minimum mark of Grade A- in the Grading Criteria

good

Very good understanding of the facts and principles specific to the topics covered in this module. Good understanding of professional accountability issues. This equates to a minimum mark of Grade B- in the Grading Criteria.

1. Develop comprehensive and systematic knowledge and skills in key aspects of advanced prehospital critical care, retrieval and transportation

2. Analyse the pharmacology of the key drugs / agents used in the critical care management of patients and special patient groups and evaluate their effectiveness.

3. A critical understanding of decision making theory used to make clinical decisions in critical care management.

4. Critically evaluate advanced assessment and management plans for a wide variety of critically ill or injured patients, encountered within a pre-hospital environment.

5. Critically evaluate information from and about critical care patients in order to determine timely interventions and appropriate care pathways.

6. Critically review the aetiology, physiology and pathophysiology of key body systems relevant to the module.

Type	Name	Description	Weight
ORAL	Viva Voce	45 minutes oral examination which will focus on clinical emergencies and the care and treatment of the patient. The student will be required to learn about 5 emergencies, 2 of which will be picked for the assessment.	100.00
LOGBOOK OR PORTFOLIO	Clinical competencies	Successful achievement of clinical competencies that relate to advanced pre hospital critical care retrieval and transportation. All competencies will need to be successfully completed in order to pass the module. (LO: 1-6). All relevant work based competencies should be fully evidenced and the work based assessment form completed and signed by the Doctor or Practitioner conducting the assessment prior to submission at the end of the module.	0.00

		Hours
Lecture	28 hours Distance learning lectures, this will include panoptos, recorded power points and SWAY's.	28
Practical classes and workshops	8 hours Workshops 6 hrs in practice with Consultant – Case of the day / SOP of the day 6 hrs engaging in Clinical Governance discussions with Consultant – RSI or Transfer audits	20
Private study	21 hours - working towards assessments 50 hours - directed reading 32 hours developing personal knowledge	103
Fieldwork	7x7 hours MINIMUM time in Critical Care unit gaining practical skills	49

• Literacy - Proficiency in reading and writing through a variety of media
• Numeracy - Proficiency in using numbers at appropriate levels of accuracy
• Computer Literacy - Proficiency in using a varied range of computer software
• Self-Management - Able to work unsupervised in an efficient, punctual and structured manner. To examine the outcomes of tasks and events, and judge levels of quality and importance
• Exploring - Able to investigate, research and consider alternatives
• Information retrieval - Able to access different and multiple sources of information
• Inter-personal - Able to question, actively listen, examine given answers and interact sensitevely with others
• Critical analysis & Problem Solving - Able to deconstruct and analyse problems or complex situations. To find solutions to problems through analyses and exploration of all possibilities using appropriate methods, rescources and creativity.
• Safety-Consciousness - Having an awareness of your immediate environment, and confidence in adhering to health and safety regulations
• Presentation - Able to clearly present information and explanations to an audience. Through the written or oral mode of communication accurately and concisely.
• Teamwork - Able to constructively cooperate with others on a common task, and/or be part of a day-to-day working team
• Mentoring - Able to support, help, guide, inspire and/or coach others
• Caring - Showing concern for others; caring for children, people with disabilities and/or the elderly
• Management - Able to utilise, coordinate and control resources (human, physical and/or financial)
• Argument - Able to put forward, debate and justify an opinion or a course of action, with an individual or in a wider group setting
• Self-awareness & Reflectivity - Having an awareness of your own strengths, weaknesses, aims and objectives. Able to regularly review, evaluate and reflect upon the performance of yourself and others
• Leadership - Able to lead and manage, develop action plans and objectives, offer guidance and direction to others, and cope with the related pressures such authority can result in

Resource implications for students

None, apart from funding to complete the module and access to IT and word processing equipment.

Reading list

Benditt, Joshua O (2006) The neuromuscular respiratory system: physiology, pathophysiology, and a respiratory care approach to patients. National Library of Medicine. Respiratory care Vol. 51, Iss. 8: 829-37.

Buerke, M; Lemm, H; Dietz, S; Werdan, K. (2011) Pathophysiology, diagnosis, and treatment of infarction-related cardiogenic shock. National Library of Medicine, Herz Vol. 36, Iss. 2: 73-83.

Bond, Mary; Crathorne, Louise; Peters, Jaime; Coelho, Helen; Haasova, Marcela. (2016) First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis. BMC anesthesiology Vol. 16, Iss. 1: 81.

Dijkstra, B. M.; Berben, S. A. A.; van Dongen, R. T. M.; Schoonhoven, L. (2014) Review on pharmacological pain management in trauma patients in (pre‐hospital) emergency medicine in the Netherlands. European Journal of Pain Vol. 18, Iss. 1: 3-19.

Gando, Satoshi; Hayakawa, Mineji. (2016) Pathophysiology of Trauma-Induced Coagulopathy and Management of Critical Bleeding Requiring Massive Transfusion. National Library of Medicine. Seminars in thrombosis and hemostasis Vol. 42, Iss. 2: 155-165.

Hollenberg, Steven M (2011) Vasoactive drugs in circulatory shock. National Library of Medicine. American journal of respiratory and critical care medicine Vol. 183, Iss. 7: 847-855.

Jones, Jeannine G; Smith, Sandra L. (2009) Shock in the critically ill neonate. National Library of Medicine. The Journal of perinatal & neonatal nursing Vol. 23, Iss. 4: 346-54; quiz 355-6.

Nduka, O Okorie; Parrillo, Joseph (2011) The pathophysiology of septic shock. National Library of Medicine. Critical care nursing clinics of North America Vol. 23, Iss. 1: 41-66.

Russell, James A; Rush, Barret; Boyd, John. (2018) Pathophysiology of Septic Shock. National Library of Medicine. Critical care clinics Vol. 34, Iss. 1: 43-61.

Reyentovich, Alex; Barghash, Maya H; Hochman, Judith S. (2016) Management of refractory cardiogenic shock. National Library of Medicine. Nature reviews. Cardiology Vol. 13, Iss. 8: 481-492.

Yuki, Koichi; Murakami, Naoka (2015) Sepsis pathophysiology and anesthetic consideration. National Library of Medicine. Cardiovascular & hematological disorders drug targets Vol. 15, Iss. 1): 57-69.