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Critical Care Course Objectives Air Medical Transport Fundamentals Explain the role of the Commission on Accreditation of Medical Transport Services (CAMTS) and the concepts of visual flight rules, instrument flight rules, and a sterile cockpit. Discuss the concept of flight following. Summarize Federal Aviation Administration guidelines that are pertinent to air medical transport. Understand the importance of taking safety precautions, including an understanding of crash and survival skills. List techniques for safety and survival in the aircraft environment. Flight Physiology Discuss the seven primary gas laws affecting flight physiology. Define the four types of hypoxia. Recognize the signs and symptoms of altitude-induced hypoxia and the appropriate treatment. Summarize the advantages and disadvantages of pressurized and nonpressurized aircraft. Recognize the physical and physiologic effects of rapid cabin decompression. Define the effective performance time and the time of useful consciousness. List the primary stressors of flight and their physiologic impacts. Define the factors affecting tolerance of the stressors of flight. 1 Critical Care Course Objectives Identify different dysbarisms and trapped gas disorders. Describe assorted exacerbations of medical conditions due to altitude. Patient Assessment Define differential diagnosis and how it is used in the critical care transport setting. Describe and perform the assessments required for critical care transports, including the following: • General appearance • Cardiovascular assessment • Respiratory assessment • Neurologic assessment • Gastrointestinal assessment • Genitourinary assessment • Musculoskeletal assessment • Psychosocial and emotional assessment Understand how to interpret patient complaints, signs, and symptoms to determine patient condition and anticipate changes in condition. Respiratory Emergencies, Airway Management, and Ventilation Summarize the anatomy and physiology of the respiratory system. Define the five requirements for normal ventilation and oxygenation. Explain the physiology of pulmonary function values, including: • • • • • Inspiratory respiratory reserve Inspiratory capacity Expiratory reserve volume Residual volume Functional residual capacity 2 Critical Care Course Objectives 4. Identify parameters indicating patient candidacy for mechanical ventilation. 5. Describe positive and negative pressure ventilation. 6. Differentiate pressure, volume ventilators, and flow- and time-cycled ventilators. 7. Identify components of mechanical ventilation equipment and their functions. 8. Differentiate invasive and noninvasive ventilation. 9. Describe the effects of mechanical ventilation on the pulmonary and cardiovascular systems, including barotrauma, cardiac preload, afterload, and output. 10. Identify the components of a ventilator circuit. 11. Define normal settings for the following transport ventilator parameters: • Tidal volume • Mode • Mechanical sigh • End respiratory pressure • Respiratory rate • Ratio of the length of expiration to inspiration (I:E) ratio • Fraction of inspired oxygen (FiO2) • Peak flow • Positive inspiratory pressure (PIP) • Minute ventilation • Pressure limit • Pressure support • Positive end expiratory pressure (PEEP) 3 Critical Care Course Objectives Describe the clinical uses, precautions, and limitations and adverse effects of the following standard modes of ventilation: • • • • • • Assist control (AC) Synchronized intermittent mandatory ventilation (SIMV) Pressure support ventilation (PSV) Continuous positive airway pressure (CPAP) Bilevel positive airway pressure (BiPAP) Positive end expiratory pressure (PEEP) Explain the use of PEEP. Troubleshoot low pressure (disconnect), high pressure, power failure, and other common alarms. Demonstrate assessment and calculations of adult tidal volumes and pressures. Discuss basic airway management strategies. Describe implementation of a failed airway algorithm. Explain indications and contraindications for tracheostomy. Describe management of tracheostomies during transport, including potential complications. Explain indications and contraindications for needle cricothyrotomy. Describe management of a needle cricothyrotomy during transport and potential complications and interventions. Explain indications and contraindications for surgical 4 Critical Care Course Objectives cricothyrotomy. 26. Describe advantages and disadvantages of surgical cricothyrotomy. 27. Explain the equipment and supplies needed and the procedure for performing a surgical cricothyrotomy. 28. Describe management of a surgical cricothyrotomy during transport and potential complications and interventions. 29. Differentiate between obstructive and restrictive diseases. 30. Assess a respiratory cycle. 31. Identify and interpret normal and abnormal breath sounds. 32. Identify abnormal respiratory patterns. 33. Review the breath sound assessment technique used in critical care transport patients. 34. Define tidal volume, vital capacity, and peak flow. 35. Describe how pulse oximetry, capnometry, and capnography can be used to monitor respiratory function. 36. Identify the parameters measured in arterial blood gas monitoring and identify which parameter reflects the effectiveness of ventilation and oxygenation. 37. Describe particular clinical events that alter the functioning of the respiratory system in the critical care patient. 38. Describe how ventilation and perfusion abnormalities affect blood gas values. 5 Critical Care Course Objectives Perform a basic respiratory assessment for adequacy of ventilation and oxygenation using inspection, auscultation, palpation, and noninvasive monitoring. Critical Care Pharmacology Outline the principles of medication administration for CCFPs, including patient and medication selection, predicted and desired responses, absorption and elimination principles, side effects or adverse medication reactions, and transport and monitoring considerations. Discuss the significance of medication pharmacokinetics and pharmacodynamics in the critical care transport setting. Identify airway management medications used during critical care transport, including indications, contraindications, dosages, side effects, and interactions. Identify respiratory management medications used during critical care transport, including indications, contraindications, dosages, side effects, and interactions. Identify cardiovascular system medications used during critical care transport, including indications, contraindications, dosages, side effects, and interactions. Identify medications for neurologic conditions that are used during critical care transport, including indications, contraindications, dosages, side effects, and interactions. Identify medications affecting the gastrointestinal system that are used during critical care transport, including indications, contraindications, dosages, side effects, and interactions. Identify any miscellaneous medications that are used during critical care transport, including indications, contraindications, dosages, side effects, and interactions. 6 Critical Care Course Objectives Understand the sequence for medication infusion and know how to infuse medication with an infusion pump during transport and through changes in altitude. Given a medication order, correctly calculate the correct dosage for administration. Laboratory Analysis and Diagnostic Studies Understand relevant basic chemistry and physiology. Understand the importance of abnormal laboratory results as they relate to patient condition. Discuss the causes of abnormal laboratory results. Recognize blood typing and blood groups. Shock and Multiple Organ Dysfunction Syndrome Discuss oxygen transport and utilization of oxygen by the cell. Discuss cellular respiration. Discuss the pathophysiology of shock and its stages: initial, compensatory, progressive, and refractory. Describe the clinical manifestations associated with the various shock states. Discuss the classification of shock: hypovolemic, cardiogenic, distributive (neurogenic), anaphylactic, and septic. Identify from a patient presentation what type and stage of shock the patient is experiencing. Define the following terms: infection, sepsis, sepsis syndrome, 7 Critical Care Course Objectives systemic inflammatory response syndrome (SIRS), severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS). Describe the etiology and pathophysiology of shock, sepsis, SIRS, and MODS. Describe the risk factors considered important in the development of sepsis. Identify the signs and symptoms that describe the patient in shock, sepsis, SIRS, or MODS. Discuss lab values of the septic or MODS patient. Discuss assessment and management of the shock/MODS patient. Discuss the pathophysiology, treatment, and prevention of adult respiratory distress syndrome (ARDS). List the parameters necessary to monitor during the transport of a critical patient experiencing shock, sepsis, SIRS, or MODS. Select from a list those interventions necessary during transport of the critically ill patient experiencing shock, sepsis, SIRS, or MODS. Discuss pharmacologic agents used in the treatment of the shock/MODS patient. Describe the anatomy, purpose, function, and physiology of the hematologic system, including: • • • • • Bone marrow Liver Stem cells Red blood cells Platelets 8 Critical Care Course Objectives Explain ABO and Rh blood grouping. Compare and contrast the indications and contraindications for and the benefits and drawbacks of the administration of whole blood and various blood products. Explain the process of blood and blood-product administration. Predict the consequences of the administration of blood and blood products incompatible with the recipient's blood type. Recognize the signs and symptoms of a reaction to the infusion of blood and blood products. Given a clinical scenario of a patient experiencing a reaction to an infusion of blood or blood products, develop a plan of intervention. Explain indications, contraindications, precautions, and complications of using the following blood products: • • • • • • Packed red blood cells (PRBCs) Whole blood Platelets Albumin Fresh frozen plasma Cryoprecipitate Describe the method of administering the following blood products, including required equipment, size of intravenous (IV) access, fluid required, volume in one unit, and rate of infusion, as well as steps for safe administration and monitoring requirements during and after transfusion with: • • • • PRBCs Whole blood Platelets Albumin 9 Critical Care Course Objectives • Fresh frozen plasma • Cryoprecipitate Explain indications, contraindications, precautions, and complications that arise from transfusion of the following blood products: • • • • • • PRBCs Whole blood Platelets Albumin Fresh frozen plasma Cryoprecipitate Describe the mechanism, signs and symptoms, timing, and treatment for the following blood transfusion reactions: • • • • Hemolytic Anaphylactic Febrile Circulatory overload Trauma Understand the CCFP's impact on preventing trauma deaths by performing proper prehospital care and transporting to the appropriate trauma center. Understand the various trauma scoring systems, including the Glasgow Coma Scale, the trauma score, the revised trauma score, the abbreviated injury scale, the injury severity score, and the trauma injury severity score, and how they are used. Understand Newton's first, second, and third laws of motion and how they relate to patterns of injury. Discuss the types of trauma. 10 Critical Care Course Objectives Describe the steps of the assessment process that are specific to critical care trauma patients. Understand how to assess a trauma critical care patient. Know how to recognize, assess, and manage the most common critical care injuries, including pneumothorax (open, tension, and simple), hemothorax, flail chest, pericardial tamponade, aortic dissection, myocardial contusion, diaphragmatic rupture, tracheobronchial disruption, pulmonary contusion, esophageal perforation, and traumatic asphyxia. Know how to recognize, assess, and manage critical care ear, eye, neck, throat, and thyroid injuries. Know the signs and symptoms as well as how to manage abdominal and pelvic injuries, including both hollow and solid organ injuries. Know how to recognize, monitor, and manage compartment syndrome, crush injuries, and rhabdomyolysis. Understand pharmacology as it relates to trauma and know the specific treatments and medications. Understand the specific trauma considerations for special populations. Neurologic Emergencies Describe the major anatomic structures of the central and peripheral nervous systems and their physiology as pertinent to the CCTP. List the components of a focused neurologic assessment and differentiate between normal and abnormal findings. Describe how to perform a neurologic assessment, including the following specific assessments: mini-mental exam; assessment of 11 Critical Care Course Objectives speech abnormalities, cranial nerves, eyes, motor function, and sensory function, reflex testing, and evaluation of meningeal irritation. Discuss the pathophysiology of traumatic brain injury, including primary and secondary brain injury. Explain the significance of cerebral perfusion pressure and mean arterial pressure. Discuss the pathophysiology of specific neurologic injuries, including scalp injuries, skull fractures, facial fractures, epidural hematoma, subdural hematoma, and diffuse axonal injury. Discuss lab values relevant to neurologic emergencies and their interpretation. Define intracranial pressure (ICP) and explain its pathophysiology. Define and explain cerebral perfusion pressure (CPP) and cerebral blood blow (CBF) and describe their relationship to ICP and mean arterial pressure (MAP). Discuss clinical manifestations of increased ICP, including brain herniation. Discuss the concept of ICP monitoring, including indications, contraindications, methods, devices, waveforms, complications, procedures, adverse reactions and interventions, and post- procedure care. Describe normal ICP and CPP values and causes of increased and decreased values. Discuss the relationship between intracranial volume and intracranial pressure. 12 Critical Care Course Objectives List special considerations when transporting a patient with ICP monitoring. Describe how to drain cerebrospinal fluid (CSF) using a monitoring catheter. Discuss management of ICP during transport. Describe spinal injuries, including primary spinal cord injury and secondary spinal cord injury, and their assessment, management, and complications. Discuss types of stroke, their assessment, transport management, and thrombolytic and fibrinolytic therapy. Describe the pathophysiology of subarachnoid hemorrhage, its assessment, and its management, including neurologic diagnostics. Discuss seizures and epilepsy, including transport management. Discuss transport considerations for patients with neurologic injuries. Discuss considerations for managing neurologic emergencies in flight. Interpret data collected from neurologic assessment and monitoring devices and integrate findings to formulate an impression of the patient's clinical status. Construct a treatment plan for a critically ill patient with a neurologic disorder. 13 Critical Care Course Objectives Explain the common treatments and potential complications during transport of patients with the following conditions: • • • • • • • • • • Subarachnoid hemorrhage Epidural hematoma Subdural hematoma • Hydrocephalus Cerebral neoplasm (brain tumor) Intracranial aneurysms Arteriovenous malformations Acute stroke Spinal cord injury (SCI) Status epilepticus Guillain-Barre syndrome Burns List the major causes of burn injury. Describe the anatomy of a burn. Explain the factors that determine the classification of burn injury, including body surface area and burn depth. List the classifications of burn injuries, including superficial burns, partial thickness burns, deep partial thickness burns, full-thickness burns, subdermal burns, as well as minor burns, moderate burns, and major burns. Identify the methods for calculating the total body surface area burned, including the rule of nines and the Lund and Browder chart. Describe how to evaluate a burn patient and what constitutes a pertinent history. Discuss assessment considerations for a burn patient's airway, breathing, and circulation. 14 Critical Care Course Objectives List situations in which the CCFP should suspect an inhalation injury. Discuss the roles of edema and compartment syndrome in relation to a burn injury. Describe the process of stopping a burn, including irrigation, cooling, decontamination, and special considerations. Discuss management of a burn patient's airway, breathing, and circulation. Discuss special considerations for patients who may have carbon monoxide poisoning or cyanide poisoning in conjunction with a burn injury. Explain various fluid resuscitation formulas, including the Parkland formula and the Galveston formula, and describe parameters for adjusting the infusion rate. Discuss pain management of burn patients. Discuss special situations relating to burn injuries such as hypothermia, the need for gastric decompression, renal failure, and rhabdomyolysis. Discuss management of specific burns, including ocular burns, facial burns, ear burns, circumferential burns, hand and foot burns, genitalia burns, pediatric burns, electrical burns, and chemical burns. Cardiovascular Disorders Explain how to correctly place leads from a 12-lead electrocardiographic (ECG) monitor. Explain how to correctly place additional precordial leads for diagnosing right ventricular and posterior infarctions. 15 Critical Care Course Objectives Explain how to determine the heart's electrical axis. Describe how to identify a hemiblock on an ECG. Describe how to identify a bundle branch block on an ECG. Describe the significance of ST- and T-wave changes and how they are identified on an ECG. Describe complications that can occur with a cardiac patient during critical care transport. Describe different criteria for determining the presence of left ventricular hypertrophy (LVH), right ventricular hypertrophy (RVH), and the presence of strain. Using various criteria, identify cases of LVH and RVH on a 12-lead ECG. Describe the clinical significance of LVH. Identify criteria suggestive of right and left atrial enlargement, and describe the clinical implications of such enlargement. Describe the ECG changes that indicate the presence of WolffParkinson-White syndrome. Identify ECG changes that could indicate conditions such as pericarditis, acute pulmonary embolism, and early repolarization variant. Describe the potential implications of a prolonged QT interval. Describe how to identify ventricular tachycardia on an ECG, including when it occurs in conjunction with wide complex tachycardia. 16 Critical Care Course Objectives Explain the management of a patient with ventricular tachycardia, including when it occurs in conjunction with wide complex tachycardia. Describe ECG changes associated with drug and electrolyte disturbances, hyperkalemia, hypokalemia, hypercalcemia, and hypocalcemia and the clinical implications of these conditions. Describe the spectrum of therapeutic options for patients with cardiac arrhythmias. Briefly discuss the general categories of cardiovascular drugs and their actions and indications. Describe the pathophysiology, etiologies, symptoms, and treatments for patients with the following cardiovascular conditions: • • • • • • • • • • • • • • • • • Coronary artery disease Angina pectoris. Myocardial infarction Heart failure Cardiac arrhythmia Myocarditis Pericardial disease Infective endocarditis Cardiomyopathy End-stage heart disease Mitral insufficiency Mitral stenosis Aortic insufficiency Aortic stenosis Hypertensive crisis Aortic arterial disease Peripheral vascular disease 17 Critical Care Course Objectives Hemodynamic Monitoring Discuss the principles of and indications for invasive hemodynamic monitoring. Interpret the following hemodynamic values and discuss their meaning: • Central venous pressure (CVP) • Systolic blood pressure (SBP) • Diastolic blood pressure (DBP) • Mean arterial pressure (MAP) • Pulse pressure • Pulmonary artery pressures (systolic, diastolic, and mean) • Pulmonary capillary wedge pressure (PCWP) • Cardiac output (CO) • Cardiac index • Pulmonary vascular resistance (PVR) • Systemic vascular resistance (SVR) • Stroke volume (SV) • Mixed venous saturation (SvO2) List normal hemodynamic values for the various types of invasive hemodynamic measurements. Describe the significance of each pressure reading used in patient management. Describe how a central venous line works and list the sites where it may be placed. Describe the types of catheters used for central venous lines. Discuss indications, contraindications, and complications for central venous lines. Describe how an arterial line works and list the sites where it may be 18 Critical Care Course Objectives placed. Describe the types of catheters used for arterial lines. Discuss the indications, contraindications, and complications for arterial lines. Discuss the concepts of preload, afterload, and the Frank-Starling curve. Demonstrate the proper placement of and zeroing procedure for a pressure transducer. Describe proper transport procedures for invasive hemodynamic monitoring. Describe troubleshooting procedures for common problems with invasive hemodynamic monitoring during transport. Discuss flight considerations related to invasive hemodynamic monitoring. Intra-aortic Balloon Pumps and Cardiac Assist Devices List the five phases of the cardiac cycle and describe the associated events that affect: • • • • • Blood volume in the heart chambers Coronary perfusion as it relates to the cardiac cycle Myocardial oxygen demand The arterial pressure waveform The physiologic effects of heart failure 19 Critical Care Course Objectives Describe the setup and operation of an intra-aortic balloon pump (IABP). Describe the mechanics of the IABP, including the following: • Basic design and functions of the IABP • Catheter structure and function • Balloon structure and function List indications for IABP therapy. List contraindications to IABP therapy. Describe methods and locations of insertion. Discuss complications from IABP insertion. Discuss timing of balloon inflation and deflation. Explain modes of IABP timing. Define these primary physiologic effects achieved by inflation and deflation of the intra-aortic balloon: • Diastolic augmentation • Systolic afterload reduction • Improved coronary flow Identify improper balloon inflation timing and discuss the hemodynamic effects and corrective action during each of the following stages: • • • • Early inflation Early deflation Late inflation Late deflation 20 Critical Care Course Objectives Discuss transport considerations and potential complications of IABP therapy: • • • • • • • Altitude changes Cardiac arrest during transport Depletion of helium Console failure Balloon rupture Limb ischemia Insertion site bleeding Discuss cardiac-assist devices, including: • Extracorporeal membrane oxygenation (ECMO) • Implanted left ventricular-assist device (LVAD), • right ventricular-assist device (RVAD), and • biventricular-assist device (BiVAD) Gastrointestinal and Genitourinary Emergencies Differentiate between upper and lower gastrointestinal bleeding. Understand the pathologies related to common disorders of the gastrointestinal system, including peptic ulcers, gastritis, esophageal varices, Mallory-Weiss syndrome, diverticulitis, inflammatory bowel disease, and ulcerative colitis. Properly assess the signs and symptoms as well as describe the management of the various gastrointestinal conditions. Describe laboratory results as they relate to specific gastrointestinal system disorders. Understand the pathologies related to diseases of the gastrointestinal 21 Critical Care Course Objectives system, including acute abdomen of unknown origin, intestinal obstructions, inflammatory bowel disease, ileus, liver disease, acute gastrointestinal bleeding, and pancreatitis. Understand the pathologies related to common disorders of the genitourinary system, including both acute and chronic renal failure, urinary tract infections, testicular torsion, penile fracture, and priapism. Discuss different renal therapies, including hemodialysis; renal replacement therapies, such as continuous hemofiltration; and peritoneal dialysis. Describe assessment and care of the following dialysis devices: arteriovenous shunt, peritoneal catheter, external hemodialysis catheter, and tunneled hemodialysis catheter. Describe the rationale and method for insertion of nasogastric (NG) and orogastric (OG) tubes and care of tubes during transport as well as potential complications and interventions. Understand acid-base physiology. Examine how the body's chemical buffer system mitigates acid-base imbalances. Describe how to interpret blood gas samples. Understand the pathologies related to an imbalance of acid-base, their clinical features, and their treatment. Pathologies include metabolic alkalosis, metabolic acidosis, and renal metabolic acidosis. Endocrine Emergencies Describe the anatomic structures of the endocrine system and their physiology. 22 Critical Care Course Objectives Discuss the pathophysiology, assessment, and critical care transport management of conditions related to diabetes, including hypoglycemia, hyperglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic nonketotic syndrome. Discuss the pathophysiology, assessment, and critical care transport management of pituitary disorders, including central diabetes insipidus, pituitary lesions, acromegaly, and gigantism. Discuss the pathophysiology, assessment, and critical care transport management of adrenal abnormalities, including adrenal insufficiency, Addison's disease, Cushing's disease, pheochromocytoma, aldosteronism, and amyloidosis. Discuss the pathophysiology, assessment, and critical care transport management of thyroid abnormalities, including hyperthyroidism, hypothyroidism, myxedema coma, thyrotoxicosis, Hashimoto's disease, and thyroid cancers. Discuss the pathophysiology, assessment, and critical care transport management of lipid disorders, including metabolic syndrome. Environmental Emergencies Discuss risk factors for environmental emergencies. Discuss signs, symptoms, and transport management of heat cramps. Discuss signs, symptoms, and transport management of heat syncope. Discuss signs, symptoms, and transport management of heat exhaustion. Discuss signs, symptoms, and transport management of heat stroke. 23 Critical Care Course Objectives Discuss signs, symptoms, and transport management of frostbite. Discuss signs, symptoms, and transport management of hypothermia. Discuss signs, symptoms, and transport management of drowning and submersion. Discuss signs, symptoms, and transport management of diving injuries. Explain the purpose of hyperbaric therapy and when it might be used. List flight considerations relating to environmental emergencies. Infectious and Communicable Diseases Describe the physiology of the immune response. Understand the types of anaphylaxis and state the signs, symptoms, and treatment of anaphylaxis. Compare the effects of bacterial endotoxins and exotoxins. Describe viral pathogenesis. Differentiate infectious versus communicable diseases. Discuss epidemiology, including reservoirs of infection and transmission of infectious disease. Discuss the etiologic agents, mode of transmission, signs and symptoms, and treatment of the following: • Meningitis (bacterial and viral) • Respiratory syncytial virus • Necrotizing fasciitis 24 Critical Care Course Objectives • • • • • • • • Epiglottitis Tuberculosis Pneumonia Influenza Various herpes viruses Viral hepatitis Human immunodeficiency virus Severe acute respiratory syndrome Understand acquired immunodeficiency syndrome–defining conditions. Toxicologic Emergencies Describe priority interventions and considerations common to all patients following a poisoning or overdose. Discuss the assessment findings associated with the various toxidromes and medication reaction syndromes encountered in the critical care environment. Describe the management of a patient experiencing a toxicologic emergency. Discuss situations in which decontamination is required or indicated following a toxic exposure or overdose. Identify which chemicals or medications require enhanced elimination (removal of absorbed toxins) from the body. Discuss the risks and benefits of and the techniques for administration of various antidotes. Identify the clinical presentation, mechanism of toxicity, and treatment of poisoning or overdose situations commonly encountered or requiring specialized management by critical care transport professionals. 25 Critical Care Course Objectives Obstetric and Gynecologic Emergencies Recognize the physiologic changes during pregnancy. Describe the changes that occur in the cardiovascular, respiratory, gastrointestinal, renal, and endocrine systems. Describe the management of the pregnant patient who is in cardiac arrest. Discuss potential maternal cardiovascular complications exacerbated or induced by pregnancy. Discuss fetal oxygenation and heart rate, including conditions associated with fetal distress during labor. Discuss how to assess a fetus during a critical care transport. Describe several methods of fetal monitoring during critical care transport of a pregnant patient, including electronic fetal monitoring. Explain how to use a Doppler device. Define the complications of pregnancy, including spontaneous abortion and causes of bleeding. Recognize and treat abruptio placenta, placenta previa, and uterine rupture. Discuss medical conditions that can exist during pregnancy, including pregnancy-induced hypertension, preeclampsia, eclampsia, and HELLP syndrome, and how to manage them during critical care transport. Discuss medications used in treating pregnancy-induced hypertension, including labetalol and hydralizine. 26 Critical Care Course Objectives Understand the concerns regarding preterm labor and premature delivery. Discuss the use of tocolytic agents to interrupt labor. Recognize fetal malpresentations of delivery, including frank breech, complete breech, incomplete breech, footling breech, and umbilical cord prolapse. Discuss how to manage fetal malpresentations during a critical care transport, including frank breech, complete breech, incomplete breech, footling breech, and umbilical cord prolapse. Describe shoulder dystocia and how to manage this complication during a critical care transport. Discuss multiple-birth deliveries and how to manage these during a critical care transport. Briefly discuss postpartum care of the mother and infant during a critical care transport. Describe potential postpartum complications and their management during critical care transport, including amniotic fluid embolism and postpartum hemorrhage. Recognize and discuss how to manage gynecologic issues and emergencies during critical care transport, including ectopic pregnancy, pelvic inflammatory disease, toxic shock syndrome, ovarian cysts, pathologic cysts, ovarian torsion, and gynecologic trauma including vulvular hematoma and sexual assault. 27 Critical Care Course Objectives Neonatal Emergencies Define the terms newborn, neonate, and term newborn. Recognize anatomy and physiology unique to a neonate, including differences in thermoregulation, respiratory structure and function, oxygen transport, cardiovascular function, renal function, fluid and electrolyte balance, central nervous system, and the skeletal system. Understand how problems with transitional circulation can result in neonatal emergencies. Describe developmental aspects of pain in the neonate. Discuss anatomic and physiologic differences in the premature infant and how these relate to management. Discuss medical complications for which late preterm infants are at risk. Identify important antepartum and intrapartum factors that can affect labor, delivery, and the neonate, and understand the pathophysiology that is associated with these factors. Identify when a CCFP would use the APGAR score in caring for a newborn. Discuss neonatal assessment, stabilization, and management. Discuss how to prepare for and provide neonatal resuscitation, and identify situations in which it should be performed. Explain the initial steps in resuscitation of a neonate. Describe methods that can be used to improve airway and breathing in a neonate with inadequate respiration. 28 Critical Care Course Objectives Determine when vascular access is indicated for a neonate and appropriate fluid selection. Describe appropriate assessment technique for examining a neonate. Describe free-flow oxygen delivery and appropriate assisted ventilation for a neonate. Describe appropriate endotracheal intubation technique for a neonate. Describe appropriate chest compression and ventilation technique for a neonate. Discuss indications for medications, dosage, and routes of administration for a neonate. Distinguish between primary and secondary apnea, and list causes, assessment, and management. Describe how to perform needle thoracentesis for pneumothorax decompression for a neonate. Discuss the pathophysiology, assessment findings, management, and treatment plan of the following respiratory emergencies in a neonate: meconium aspiration, apnea, pneumonia, pneumothorax, respiratory distress, and respiratory failure. Recognize congenital anomalies that may lead to compromise of the neonate. Discuss the pathophysiology, assessment findings, and management of the following cardiovascular emergencies in a neonate: cyanosis, tachyarrhythmias, and bradyarrhythmias, bradycardia, cardiac arrest, persistent pulmonary hypertension, acidosis, shock, and anemia. 29 Critical Care Course Objectives Describe how to perform umbilical vein catheterization in a neonate. Discuss the pathophysiology, assessment findings, and management of the following gastrointestinal emergencies in a neonate: gastroschisis, omphalocele, gastrointestinal obstruction and vomiting, acute intestinal perforation, hematemesis and bleeding from the rectum, volvulus, intussusception, and diarrhea. Discuss management of infectious diseases and sepsis in the neonate. Discuss management of hyperthermia and hypothermia in the neonate. Discuss management of toxic exposure in the neonate, including the appropriate treatment for the neonate with narcotic depression. Discuss the pathophysiology, assessment findings, and management of the following neurologic conditions in the neonate: seizures, hypoxic ischemic encephalopathy, and lethargy. Discuss the pathophysiology, assessment findings, and management of the following metabolic conditions in the neonate: hypoglycemia, hypocalcemia, and inborn errors of metabolism. Pediatric Emergencies Review the anatomic and physiologic differences between adult and pediatric patients. Outline the differences in the general approach to critical care transport patient assessment between adult and pediatric patients. Discuss the indications, dosage, and route of administration for medication administration in pediatric patients in the critical care transport environment. 30 Critical Care Course Objectives Describe what special pediatric equipment may be needed in a critical care transport. Discuss common medical emergencies in the pediatric population, including respiratory conditions, cardiac conditions, renal disorders, sepsis, and meningococcal infections, and their assessment and management in the critical care transport environment. Examine common pediatric trauma emergencies, including head injuries, spinal cord injuries, related breathing and circulation abnormalities, fractures, and burns, and their assessment and management in the critical care transport environment. Discuss how to transport a pediatric critical care patient with special health care needs. 31