Introduction to Critical Care in Emergency Medicine

The course runs for two months (February-April 2025), with bi-monthly Zoom sessions (one hour in duration each) and quizzes (two bi-monthly). There will be an in-person session (four hours) held at AAEM25 as an add-on course.

All Zoom sessions are at 8:00 p.m. ET / 7:00 p.m. CT (one hour in length, except the final session which is two hours in length).

Sun. February 2: Course begins with an introduction video (no Zoom session this week)
Sun. February 16: Zoom session for Lectures 1 and 2 (one hour)
Sun. March 2: Zoom session for Lectures 3 and 4 (one hour)
Sun. March 16: Zoom session for Lectures 5 and 6 (one hour)
Sun. March 30: Zoom session for Lectures 7, 8, and 9 (two hours)
Sun. April 6: In-person practical session (four hours) at AAEM25 in Miami, Florida. Attendance is required.

1. 100% attendance for all Zoom lectures AND in-person practical sessions at AAEM25 (unless extraneous circumstances are encountered). If you are NOT planning on attending the AAEM25 conference in Miami, FL this must be brought to the attention of the course faculty BEFORE March 2^nd. If this is not brought to the attention of the faculty by the date listed above, the stipend offered for the course by the CCMS will become null, and you will be charged the entirety of the course cost.
2. The minimum pass rate for quizzes is 80%, with a 100% completion rate (due the Sunday prior to the Zoom session).
3. Zoom cameras must be ON during the sessions.
4. Active engagement in discussions.
5. Completion of pre- and post-course exams. The post-course test must be completed prior to the in-person session at AAEM25.

Failure to meet any of the above requirements will result in an incomplete of the curriculum.

This course delves into the fundamentals of critical care to prepare medical students and interns for the rigors of the specialty as it pertains to emergency medicine. Subjects covered will include arterial blood gas/CBC/BMP interpretation, oxygen therapy and mechanical ventilation, drug therapy (pertaining to analgesics, sedatives and paralytics), intra-aortic balloon pump therapy and extracorporeal membrane oxygenation, pediatric and neonatal critical care, hemodynamic and intracranial pressure monitoring, cardiac pacing and implantable cardiac devices and lastly, fluid therapy and massive transfusion and POCUS ultrasonography. A certification of completion will be offered if all requirements are met.

Books

There are no mandatory texts for this course. However, Critical Care Transport, the Pediatric and Neonatal Critical Care Transport Course and the University of Florida’ Critical Care Paramedic Program were utilized heavily based on previous theoretical knowledge gained, and therefore assisted in induction of this course.

Objectives

1. Analgesics, Sedatives and Paralytics
   • List the three types of NSAIDS and their mechanism of action
   • List the non-narcotic analgesics and their mechanism of action
   • Rationalize Tylenols reversal medication, Mucomyst
   • List the various narcotic analgesics, along with their mechanism of action and reversal medication
   • Explain the purpose behind inhaled anesthetics, and the various drugs in this category
   • List the various benzodiazepines, and their mechanism of action and reversal medication
   • List the various barbiturates and non-barbiturates along with their own mechanism of action
   • List the primary depolarizing paralytic, its mechanism of action and reversal medication
   • Explain malignant hyperthermia, and the procedure to deal with its onset
   • List the various non-depolarizing paralytics, their mechanism of action, and reversal medication
   • List the various vasopressors, their mechanism of action and indications

2. Arterial Blood Gas (ABG’s), Basic Chemistry Panel, and CBC Interpretation
   • Explain the rationale for completing an ABG
   • Explain the procedure for completing an ABG
   • Determine the normal values found when reading an ABG
   • Interpret pathological values found in an ABG
   • Explain the rationale for completing a basic chemistry panel
   • Explain the procedure for completing a basic chemistry panel
   • Determine the normal values found in a basic chemistry panel
   • Interpret pathological values found in a basic chemistry panel
   • Explain the rationale for a complete blood count
   • Explain the procedure involved in obtaining a complete blood count
   • Interpret the normal values involved in a complete blood count
   • Interpret pathological values found in a complete blood count
   • Explain the general rules involved with pH, CO₂ and K⁺
   • Explain the osmolar effects of glucose on sodium levels, lactate and anion gap   calculations

3. Oxygen Therapy and Ventilation
   • Discuss the anatomy behind airway interventions
   • Discuss invasive vs. non-invasive means of ventilation
   • Cover the 7P’s of orotracheal intubation and rapid sequence intubation in
   • Discuss the differences between cricothyroidotomy and tracheostomy
   • Explain the purpose of using a ventilator
   • Locate the various parameters on both a transport and in-hospital ventilator
   • Explain each parameter on a ventilator
   • Differentiate between the various modes of artificial ventilation
   • Differentiate the various pathologies due to a high or low-pressure alarm
   • Explain a plan of action for acute respiratory decompensation while on a ventilator
   • Understand the various special circumstances during artificial ventilation

4. Intra-aortic Balloon Pumps (IABP) and Extracorporeal Membrane Oxygenation (ECMO) and Central Line Insertion
   • Describe the goals of Intra-aortic balloon pump therapy
   • Describe the procedure of intra-aortic balloon pump placement
   • Describe the uses and contraindications of intra-aortic balloon pump therapy
   • Demonstrate the ability to understand an IABP waveform
   • Describe the different timing errors involved with IABP therapy
   • Describe the two forms of ECMO therapy
   • Describe the indications and contraindications for ECMO therapy
   • Describe the indications and contraindications for central line insertion
   • Determine the various locations and landmarks for central line insertion
   • Define the Seldinger technique of central line insertion

5. Pediatric and Neonatal Critical Care
   • Describe the pediatric triangle and the three factors it entails
   • Describe adult vs. pediatric anatomical differences
   • Describe various respiratory and cardiovascular interventions used in pediatrics
   • Describe the general rule for pediatric care
   • Describe common injury patterns in pediatrics
   • Demonstrate understanding of mechanical ventilation specific to pediatrics
   • Describe the APGAR score
   • Compare and contrast cyanotic vs. acyanotic lesions in neonates
   • Describe the various diseases in neonates
   • Follow the resuscitation guideline for neonates
   • Describe mechanical ventilation techniques for neonates

6. Hemodynamic and Intracranial Pressure Monitoring
   • Describe the purpose and concepts behind arterial hemodynamic monitoring
   • Describe the procedure behind arterial hemodynamic monitoring
   • Illustrate the normal arterial line waveform
   • Review the intracranial hemorrhages
   • Differentiate between ischemic vs. hemorrhagic strokes
   • Describe the purpose and procedure behind intracranial pressure monitoring
   • Describe the ICP waveform and any pathologies that may occur with it

7. Cardiac Pacing and Implantable Cardiac Devices
   • Describe the indications for pacing
   • Differentiate between voltage, rate, pacing spike, and capture
   • Differentiate between the two modes of pacing
   • Describe reasons to consider and the procedure behind non-invasive cardiac pacing
   • Describe reasons to consider and the procedure behind invasive cardiac pacing
   • Describe the pulse generator
   • Describe reasons to consider and the procedure behind temporary epicardial pacing
   • Define NASPE and NBG codes
   • Determine normal and abnormal atrial and ventricular pacing strips

8. Fluid Therapy and Massive Transfusion
   • Describe the bodies intrinsic mechanisms for hemostasis during trauma
   • Describe indications for fluid therapy and massive transfusion in the emergent and critical care setting
   • Identify the differences between normal saline (0.9% and 0.45%) and ringers’ lactate
   • Describe indications and the complications from administering Packed Red Blood Cells (PRBC’s)
   • Describe indications for administering Fresh Frozen Plasma (FFP)
   • Describe indications for administering Platelets
   • Describe indications for administering Cryoprecipitate
   • Describe the indications for administering Albumin
   • Describe the indications for administering Tranexamic acid
   • Briefly describe the transition of an acute infection progressing to sepsis and ultimately disseminated intravascular coagulation if untreated
   • Describe the various transfusion reactions that can occur and the signs and symptoms that underlie them

9. POCUS Course
   • Understand the physics of ultrasonography
   • Understand basic ultrasound knobology
   • Identify, describe and understand reasons to complete echocardiography in POCUS ultrasonography
   • Identify, describe and understand reasons to complete a pulmonary evaluation via ultrasonography
   • Identify, describe and understand reasons to complete an abdominal evaluation via ultrasonography
   • Identify, describe and understand reasons to complete a pelvic evaluation via ultrasonography
   • Identify, describe and understand reasons to complete a vascular evaluation via ultrasonography
   • Identify, describe and understand reasons to complete a soft-tissue evaluation via ultrasonography
   • Identify, describe and understand reasons to complete intravenous access via ultrasonography
   • Identify, describe and understand reasons to complete a RUSH exam via ultrasonography
   • Identify, describe and understand reasons to complete an e-FAST/FAST via ultrasonography
   • Understand the advanced topics of ultrasonography, including TEE, MSK, DVT and ocular evaluations

“This course gave me the confidence to approach critically ill patients from intubation to ventilation. I was very happy to take some time during my 4th year of medical school to help prepare me for the rest of my career in emergency medicine.”
Lauren K. Rosenfeld, MD

“When I first signed up to take the course, I was intimidated and thought maybe my knowledge base and skills weren’t as advanced as some of the others in the class. I quickly realized that this course is designed to teach and bridge the gaps in knowledge and understanding regarding critical care and EM regardless of your initial skill level. I feel more confident in my upcoming 4^th year electives by participating with hands on cases due to the skill set we practiced at AAEM’s Scientific Assembly.”
Emily A. Esposito

“This course was a great introduction to the important topics within critical care medicine. The material we learn included topics we discuss at the hospital, and thanks to this course, I was able to better understand what everything was! I recommend this course to everyone, especially since the best part is the final session when we all meet up and put our new skills to the test!”
Jordan Eichelser, MD

“For a very manageable time commitment, the Critical Care Course provides a comprehensive review of core critical care topics and an essential introduction to a broad spectrum of more advanced topics. Developed by students for students, the course is approachable and targeted. For any students looking to develop their knowledge prior to an ICU or other critical care rotation, I could not recommend this course more highly.”
Rob Canning, MD JD

“I’m so grateful to have had the opportunity to take the Introduction to Critical Care in Emergency Medicine course! This course prepped me so well for my sub-I in the Cardiac Care Unit and made me feel more confident in the ICU environment.”
Mel Ebeling, MS

“The critical care course offered a well-structured introduction to the subject. It was clear and successfully expanded my knowledge through pre-recorded lectures, while the online sessions reinforced my understanding and enabled me to apply what I learned to clinical scenarios. The in-person component at the Scientific Assembly was invaluable, effectively bringing everything I learned to life. I highly recommend this course to anyone looking for an introduction or to expand their knowledge of critical care.”
Alison L. Spice, MD

“The Introduction to Critical Care in Emergency Medicine course provided me with a strong foundation to begin my residency training and also strengthened my confidence in being able to manage and care for critically ill and complex patients. I am extremely grateful for the opportunity to take this course!”
Cathleen ‘Katie’ Cernkovic