Anesthesia — Core of Discipline

C22 Initiating and leading resuscitation for unstable patients, outside of the operating room or PACU

- This EPA focuses initiating resuscitation for critically ill patients, outside of the perioperative and peripartum periods, following the principles of crisis resource management. 

- This EPA includes the rapid detection and correction of life-threatening situations such as respiratory failure, congestive heart failure, shock, sepsis, neurological events, cardiac ischemia, cardiac arrhythmias, drowning and intoxication. 

- The observation of this EPA may occur in the intensive care setting, the ER or on the ward prior to transfer to the ICU.
- This EPA may be observed in adult or pediatric patients.
- Relation with other EPAs:
- Providing comprehensive ongoing care of critically ill patients in an ICU setting is the focus of EPA COD # 21
- Managing resuscitative efforts in the perioperative period is the focus of EPA COD # 5 Managing resuscitative efforts in the parturient is the focus of EPA COD # 8

Form

F1: Observation

Milestones

• ME 1.6. Adapt care as the patient’s clinical condition evolves

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed

• ME 2.2. Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements

• ME 2.4. Provide concurrent treatment and ongoing assessment of the patient’s clinical condition

• ME 2.4. Reassess clinical status and response to treatment to re-evaluate and adjust resuscitative and diagnostic efforts as appropriate

• ME 3.2. Use shared decision-making in the consent process, taking risk and uncertainty into consideration

• ME 3.4. Competently perform resuscitation protocols

• ME 4.1. Ask for additional assistance and/or other services when indicated

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

• COM 3.1. Convey information related to the patient’s status, care, and needs in a timely, honest, and transparent manner

• COL 1.3. Communicate with the health care team using closed loop communication and clear language

• COL 3.2. Organize the handover of care to the most appropriate physician or health care professional

• L 4.2. Apply the principles of crisis resource management

• ME 2.2. Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued

• L 4.3. Improve personal practice by evaluating a problem, setting priorities, executing a plan, and analyzing the results

• S 1.2. Seek and interpret multiple sources of performance data and feedback, with guidance, to continually improve performance

• S 2.3. Balance clinical supervision and graduated responsibility, ensuring patient safety and optimal learner experience

Context Variables

No context variables defined.

Requirements

• Direct observation or chart review and debrief by supervisor
• Use Form 1 or local alternative. Form collects information on:
• Type of condition [select all that apply]: cardiac event; neurologic event; respiratory failure; sepsis; shock; other condition.
• Location: ICU; ER; ward
• Patient age: adult; pediatric
• Collect observations from a large breadth of training experiences with the expectations not all will be achieved, with a minimum of 7 observations of achievement.
• At least 3 different types of conditions
• At least 1 on ward or in ER.