Anesthesia — Core of Discipline

C2 Providing anesthetic management for patients with defined critical illness

- This EPA focuses on the anesthetic care of the patient who is critically ill, defined as needing some form of critical life support, with emphasis on mitigating risk and adapting the anesthetic plan to the patient’s underlying condition and stability, and to the required surgery.
- This includes anticipating perioperative complications and ensuring appropriate postoperative care.
- This EPA may be observed with patients coming to the OR from the ICU or ER.
- This EPA does not address the care of the highly unstable patient needing resuscitative care.
- Relation with other EPAs: Management of the highly unstable patient needing resuscitative care is addressed by another EPA. Management of the patient with significant cardiac disease is a separate EPA.

Form

F1: Observation

Milestones

• ME 1.1. Demonstrate commitment and accountability for patients in their care

• ME 1.3. Apply knowledge of advanced life support to optimize and prepare the patient and operating room for surgical intervention in the critically ill patient

• ME 2.2. Elicit a history, perform a physical exam, select appropriate investigations, and interpret their results for the purpose of determining prioritized anesthetic considerations and perioperative management plan

• ME 1.3. 4 ME 1.3 Apply knowledge of physiologic derangements and their impact on anesthesia care in considering the risks and benefits of all approaches

• ME 3.4. Establish and implement a plan for post-anesthesia care

• ME 2.4. Develop an anesthetic management plan, demonstrating sound judgment and insight

• ME 3.4. Perform the anesthetic management and all related technical procedures in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 5.2. Apply the principles of situational awareness to clinical practice

• COL 1.3. Engage in respectful shared decision-making with physician and other colleagues in the health care professions

• COL 3.2. Demonstrate safe handover of care, both verbal and written

• L 1.2. Contribute to a culture that promotes patient safety

• L 4.3. Implement processes to ensure personal practice improvement

• HA 1.1. Respond to an individual patient’s health needs

• P 1.1. Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards

Context Variables

No context variables defined.

Requirements

• Direct observation and review of clinical documentation by supervisor
• Use Form 1 or local alternative. Form collects information on: Type of critical life support [select all that apply]: circulatory; respiratory; renal;other life support
• minimum of 5 observations of achievement