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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.
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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:
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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:
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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
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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.
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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.
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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,
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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:
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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:
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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:
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PRBCs
Whole blood
Platelets
Albumin
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• Fresh frozen plasma
• Cryoprecipitate Explain indications, contraindications, precautions, and complications
that arise from transfusion of the following blood products:
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PRBCs
Whole blood
Platelets
Albumin
Fresh frozen plasma
Cryoprecipitate Describe the mechanism, signs and symptoms, timing, and treatment
for the following blood transfusion reactions:
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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.
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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
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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.
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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.
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Critical Care Course Objectives
Explain the common treatments and potential complications during
transport of patients with the following conditions:
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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.
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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.
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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.
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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:
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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
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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:
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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
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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:
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Early inflation
Early deflation
Late inflation
Late deflation 20
Critical Care Course Objectives
Discuss transport considerations and potential complications of IABP
therapy:
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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
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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.
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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.
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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
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Critical Care Course Objectives
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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.
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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.
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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.
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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.
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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.
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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.
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