CCT in Anaesthetics - Intermediate Level Training

Published: 05/09/2019

Management of respiratory and cardiac arrest in adults and children

It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Intermediate Level training and that these should be achievable in most general hospitals. 

Any trainee who has successfully completed a Resuscitation Council [UK] ALS course [for adults] and EPLS/APLS courses [for children] in the previous year, or who is an Instructor/Instructor candidate for these courses, may be assumed to have achieved the adult/paediatric outcomes

Learning Outcomes:

  • Build upon the knowledge and skills obtained during the management of respiratory and cardiac arrest during the ST1 year of training.
  • Develop the skills necessary to safely and effectively manage patients in the peri-arrest period

Core clinical learning outcome:

  • Is an effective member of the multi-disciplinary member of the resuscitation team and takes responsibility for the initial airway management

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

Knowledge

Competence

Description

Assessment

Methods

GMP

RC_IK_01

Recalls/describes the interpretation of arrhythmias seen in the peri-arrest period, including but not limited to:

  • Narrow complex tachycardias
  • Broad complex tachycardias
  • Atrial fibrillation
  • Paroxysmal SVT
  • Bradycardia
  • 1st 2nd and 3rd degree heart block

C,E,S

1

RC_IK_02

Recalls/describes the pharmacology of drugs used to treat common arrhythmias, dosage and frequency, including but not limited to:

  • Adenosine
  • Digoxin
  • Magnesium
  • Beta-blockers
  • Amiodarone
  • Atropine

C,E,S

1

RC_IK_03

Recalls the indications for performing cardioversion and the energies used

C,E,S

1

RC_IK_04

Recalls/outlines the indication for, and principles of, pacing including percussion, external and transvenous

C,E,S

1

RC_IK_05

Recalls the indications for use of thrombolysis

C,E,S

1

RC_IK_06

Recalls/discusses the indications and principles of therapeutic hypothermia after cardiac arrest 

C,E,S

1

RC_IK_07

Outlines indications and principles of:

  • Open chest cardiac compressions 
  • Resuscitative thoracotomy [Cross ref cardiothoracic]

C,E,S

1

RC_IK_08

Describes the principles of managing cardiac arrest in the prone position

C,E,S

1

RC_IK_09

Recalls/explains the difference in aetiology of cardiac arrest between adults and children

C,E,S

1

RC_IK_10

Describes how to recognize the sick/deteriorating ill child and what treatment should be initiated to reverse such deterioration and prevent, where possible, respiratory or cardiac arrest

C,E,S

1

RC_IK_11

Recalls the specific conditions likely to deteriorate to respiratory or cardiac arrest in children [e.g. meningococcal sepsis] and describes their initial management

C,E,S

1

RC_IK_12

Recalls/details the indications for, and use of, cuffed and uncuffed tubes in the critically ill child requiring tracheal intubation 

C,E,S

1,2

RC_IK_13

Describes how to:

  • Recognise supra-glottic airway obstruction and understands the indications/contra-indications of supra-glottic airway devices to bypass such obstruction
  • Manage complications of tracheostomy in children [e.g. obstruction and displacement]

C,E,S

1,2

RC_IK_14

Outline the principles of safe inter-hospital transfer of the resuscitated patient

C,E,S

1,2,3,4

Skills

Competence

Description

Assessment methods

GMP

RC_IS_01

Demonstrates the use of external cardiac pacing 

D,S

1

RC_IS_02

Demonstrates the treatment of arrhythmias using drugs and cardioversion 

D,S

1,2

RC_IS_03

With specific reference to the paediatric airway, demonstrates the ability to:

  • Control the airway rapidly using different airway devices
  • Perform positive pressure ventilation using bag/mask systems [i.e. T-piece and self-inflating bags]

D,S

1,2

RC_IS_04

Demonstrates the ability to establish vascular access in children with ‘difficult veins’, including the use of intraosseous devices

D,S

1,2

RC_IS_05

Demonstrates leadership during resuscitation, including supporting less experienced members of the team 

D,S

1,2,3,4

RC_IS_06

Demonstrates ability to teach and assess basic level competencies 

D,S

1,3,4

RC_IS_07

Demonstrates ability to provide feedback to staff and relatives in post-resuscitation attempts debriefs 

D,S

1,3,4