Anesthesia — Core of Discipline

C3 Providing perioperative anesthetic management for patients with significant cardiac disease

- The focus of this EPA is the management of patients with significant cardiac disease throughout the perioperative period.
- This includes the preoperative assessment of patients with various cardiac diseases, including assessing severity of the disease and identification of perioperative hemodynamic goals.
- It includes the management of the induction of anesthesia and establishment, analysis and interpretation of various hemodynamic monitors, both invasive and non-invasive.
- It may include use of various inotropic, vasoactive, and antidysrhythmic pharmacologic interventions and the use of temporary pacemakers if needed.
- This EPA also includes appropriate postoperative disposition and follow up.
- This EPA may be observed in any surgery, including cardiac surgery.

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of the clinical and biomedical sciences relevant to anatomy, physiology, pharmacology and embryology of the cardiac system

• ME 2.2. Interpret the summary reports of cardiac investigations and appropriately use the data in the anesthetic management

• ME 2.2. Synthesize patient information to determine indications for invasive and non- invasive monitoring

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

• ME 3.1. Integrate all sources of information to develop an anesthetic induction plan that is safe with specific hemodynamic goals adapted to the pre-existing cardiac disease

• ME 3.4. Establish invasive monitoring in a skillful and safe manner, adapting to unanticipated findings or changing clinical circumstances

• ME 4.1. Establish plans for ongoing and postoperative care
  Apply the principles of situational awareness to clinical practice

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

• COM 5.1. Document all aspects of an anesthesia encounter in an accurate, complete, legible, timely, and accessible manner, in compliance with regulatory and legal requirements

• COL 1.1. Establish and maintain positive relationships with physicians and other colleagues in the health care professions

• COL 1.3. Convey the anesthetic plan to the interprofessional team

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

• L 2.1. Use clinical judgment to minimize wasteful practices

• P 1.2. Demonstrate a commitment to excellence in all aspects of practice

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Type of cardiac disease (select all that apply): coronary disease; mitral stenosis; mitral regurgitation; aortic stenosis; aortic regurgitation; cardiomyopathy; left ventricular dysfunction; right ventricular dysfunction; other (write in)
• Type of surgery: cardiac; other surgery
• Intraoperative hemodynamic monitors used (select all that apply): none; central line; pulmonary artery catheter; TEE; other (write in)
• Hemodynamic support (select all that apply): none; vasopressors; inotropes; anti
• dysrhythmic; other (write in)
• Collect observation from a large breadth of training experiences including patients with various cardiac disease with the expectations not all will be achieved, with a minimum of 6 observations of achievement
• At least one each of: severe mitral valve disease; severe aortic stenosis; significant left ventricular dysfunction.