intensive care for the developing world the basic approach colin graham & charles gomersall
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Intensive Care for the Developing World
The BASIC approach
Colin Graham & Charles Gomersall
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Challenges
• Education
• Equipment
• Supplies
• Finances….
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What is Intensive Care?
• Increased nursing capability…
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What is Intensive Care?
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What is Intensive Care?
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Level 1
• Monitoring– HR, NIBP, SpO2, RR, urine output
• POCT– Hb– Glucose, electrolytes and renal function test
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Level 1
• Organ support:– fluid challenge, blood transfusion– high flow oxygen therapy,& nebulisation of
drugs– continuous intravenous infusion of drugs
(insulin,heparin, nicardipine, labetolol, dopamine…) with syringe pump
• Not epinephrine and norepinephrine
– NG nutrition
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Level 1
• Patients:– Post-operative (including multiple trauma)
– Medical (DKA, severe asthma, severe pneumonia, severe dehydration…)
– Obstetric emergencies (including eclampsia)
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Level 2
• Level 1 +• Continuous ECG monitoring• POCT
– blood gases and cardiac enzymes • Organ support
– management of arrhythmias (pharmacological, defibrillation)
– NIV• Patients:
– cardiovascular emergencies– acute respiratory failure requiring non-invasive
ventilation
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Level 3
• Level 2 +• Monitoring
– invasive BP
• Investigations– Microbiology and high level of pathology tests (biochemistry,
haematology…)
• Organ support:– epinephrine and norepinephrine infusion via central venous catheter– invasive mechanical ventilation
• Patients:– multiple trauma, poisoning, infectious disease such as tetanus and
severe CNS infections (malaria, meningitis…)
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BASIC collaboration
• Informal
• Intensivists with an interest in providing free, high quality, practical course material
• Hosted by Dept of Anaesthesia & Intensive Care, The Chinese University of Hong Kong
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BASIC collaboration
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“Products”
• Packaged, self-contained courses
• Focused on specific target audience
• Practical
• No license fees
• Minimal cost
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Finances
• Dept of Anaesthesia & Intensive Care, CUHK
• Commercial sponsorship
• Profits from HK-based courses
• “Turn the wheel of learning”
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BASIC course venues 2005-11
Hong Kong,Guangzhou, Shunde, Hainan, Zhengzhou
Brisbane, Sydney
Hawkes Bay, Hamilton, Middlemore, Christchurch
London, Birmingham,
Oxford, Colchester,
Brighton, Wessex
Johannesburg,Cape Town, Sun City
Kuala Lumpur
Bali
Beijing, Shanxi
Hama
Mumbai, Kolkata,Pune, Jaipur, Chennai, Agra, Coimbatore, Aurangabad
Perth
Dubai
Phnom Penh
Seoul
Riyadh
Kuwait
Doha
Muscat
Bahrain
Adelaide
Jerusalem
Dublin
Melbourne
FijiSingapore
BerlinSinaia
Athens
Colombo
Khartoum
Alice Springs
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Course material
• Course manual
• Pre-course “open book” MCQ
• CD-ROM
• Lectures
• Skill stations
• Post-course “closed book” MCQ
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Course material
• Enough for 2.5 days
• Usually run over 2 days
• Select what is relevant to your situation
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Course manual
• Addresses knowledge aspect of course
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Pre-course MCQ
• Aim is to encourage candidates to read course manual
• On-line
• Immediate feedback– Identify knowledge deficiencies
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CD-ROM
• Interactive tutorial on arterial blood gas interpretation– Practical application of knowledge
• Narrated lecture on acute respiratory failure
• CVP line insertion– “Demonstration” component of practical skills
teaching
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Lectures
• Emphasize key points
• Case based lectures– Practical application of theoretical knowledge
• NOT a textbook projected onto a wall
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Skill station
• Practice skills
• Application of knowledge to solve problems
• Revision of key material
• Learn from mistakes– Allow the trainee to make mistakes
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Post course MCQ
• Motivational
• Clinical scenarios
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Course development
• Continuous, iterative process
• Tailored to needs of participants
• High quality course material– Extensive use of graphics
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Laryngeal mask
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Courses
• BASIC
• Very BASIC
• BASIC DHS
• Not so BASIC
• BASIC4NOW
• Mechanical ventilation: beyond BASIC
• Intensive Care Nephrology: beyond BASIC
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What can we offer?
• Course material
• Experience in course development
• Instructors– Train the trainers
• Sustainability
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Courses
• BASIC– Introductory course in Intensive Care (level 3)
• Very BASIC– Acute care training for final year medical students and
interns, includes non-invasive ventilation (level 2)
• BASIC DHS– Acute care training for doctors in developing
healthcare systems, not including ventilation (level 1)
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How can you help us?
• Insight
• Purpose
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Synergy
SuccessfulIntensive
Care
MSF BASIC
StaffEquipment Resources
Course material Instructors
Insight
Feedback