Learning Objectives

1. Introduction

• Goals of the course
  
• Faculty
  
• Student Responsibilities
  
• Grading

2. Unresponsive patient and pulseless algorithms

• The AVPU scale
  
• Ventricular fibrillation and pulseless ventricular activity - Timely intervention
• Pulseless electrical activity - Sherlock Holmes time
  
• Asystole (erroneously called “flatline”) - Goodbye heart
• To shock or not to shock
  
• The reigning triumvirate: Oxygen, CPR, and epinephrine

3. Brady and tachy dysrhythmias

• How fast is too fast? How slow is too slow? - Stable vs. unstable patient
  
• Rate and symptoms – Cause and effect
  
• Where’s the pacemaker? - Supraventricular vs. ventricular rhythms
  
• The role of the vagus nerve: Stimulate it? Inhibit it?
  
• Non-sinus pacemakers
  
• A-V blocks - On again/off again
  
• Idioventricular rhythm
  
• Mixed agonists in bradycardia - Epinephrine, dopamine
  
• Jolts of volts - Cardiac pacing, synchronized countershock (cardioversion)

4. Management of the routine and difficult airway

• What are indications for bag-valve mask ventilation?
  
• What are indications for tracheal intubation?
  
• Demonstrate technique of mask ventilation, insertion of oral and nasopharyngeal airways and direct laryngoscopy.
  
• Demonstrate proper technique for extubation of the trachea.
  
• Define the "difficult airway" and characterize the anatomic and pathophysiologic conditions that make an airway "difficult."
  
• Characterize methods to treat difficulties with mask ventilation.
  
• Describe and show methods to assist with a difficult tracheal intubation, including the use of various styles of laryngoscope blade, laryngeal mask airways, flexible fiberoptic intubation, needle cricothyrotomy and jet ventilation, and the esophageal-tracheal combitube.

5. Cardiac pharmacology

• Discuss the role of oxygen in acute cardiac events
• Drugs to stabilize ventricular rate/slow overall heart rate
  
• Drugs to increase the heart rate
  
• Drugs used for rhythm control:
  • Ventricular arrhythmias
  • Atrial arrhythmias
    
• Drugs used to treat hypertension
  
• Drugs used to treat hypotension
  
• Drugs used to improve cardiac output
  
• Drugs used in cardiac arrest
  
• Other drugs:
  
  • Pain control
    
  • Workload reduction
    
  • Platelet aggregation blocking
    
  • Fibrinolytic agents

6. Hemodynamic instability

• Understand the pathophysiology, diagnosis and treatment of hemodynamic instability including hypertension, hypotension, and acute coronary syndromes.

7. Respiratory monitoring

• Describe the methods used to monitor the respiratory system.
• Discuss the rationale behind the use of pulse oximetry and end-tidal CO2 monitoring and their pitfalls.
• Basic arterial blood gas interpretation.

8. Respiratory failure

• Define respiratory failure.
• Describe physiologic mechanisms of hypercapnic and hypoxemic respiratory failure.
• Describe how understanding the physiologic mechanism assists in the treatment of respiratory failure.

9. Neurologic life support

• Develop an understanding of the manifestations, pathophysiology, and treatment of head trauma, increased intracranial pressure, spinal cord injury, seizures, and coma.
• Understand the effects of physiologic and pharmacologic alterations on cerebral blood flow.

10. Sepsis and shock

• Define shock and categorize the various types of shock.
• Discuss the manifestations and treatment of various types of shock.

11. Intravenous therapy

• Indications for IV access
• Catheters, administration sets, fluids
• Pitfalls
• Hands-on practice
• Intraosseous cannulation in infants/children Venous cutdown techniques

12. Operating room experience

• Develop an understanding of the role of the primary care practitioner in the preoperative readiness of the surgical patient.
• Understand the essential elements of the preoperative anesthetic evaluation.
• Develop an understanding of the use and pharmacology of the benzodiazepines, barbiturates, opioids, and neuromuscular blocking agents.
• Develop an understanding of the methods to monitor the level of sedation, respiratory, and cardiac status in a wide range of pathophysiologic conditions.