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Critical Care

Cardiopulmonary resuscitation

1. Describe the conditions that most commonly cause cardiopulmonary failure in obstetric and gynecologic patients.
2. Perform a rapid, focused physical examination to identify the patient who requires cardiopulmonary resuscitation and to determine the cause of the patient’s decompensation.
3. Perform basic cardiac life support:

a. Assess airway, breathing, and circulation.
b. Secure the airway.
c. Provide ventilation by mouth-to-mouth and bag-mask techniques.
d. Perform chest compressions.

4. In consultation with a specialist in critical care medicine, perform advanced cardiac life support:

a. Intubate the patient.
b. Administer drugs, such as:

(1) Lidocaine
(2) Atropine
(3) Epinephrine
(4) Sodium bicarbonate

5. Describe the complications of basic and advanced cardiac life support

Allergic drug reactions

1. Describe the drugs most likely to produce allergic reactions in obstetric and gynecologic patients.
2. Describe the typical symptoms experienced by a patient with a drug reaction.
3. Describe the varying degrees of severity of a drug reaction.
4. Perform a focused physical examination to confirm the diagnosis of a drug reaction and assess the severity of the reaction.
5. Describe the differential diagnosis of a drug reaction, such as:

a. Septic shock
b. Hypovolemic shock
c. Cardiogenic shock
d. Pulmonary embolism

6. Treat a drug reaction in consultation with a specialist in critical care medicine

Toxic shock syndrome

1. Describe the pathogenesis of toxic shock syndrome (TSS).
2. Describe the typical signs and symptoms of a patient with TSS, such as:

a. Myalgia
b. Rash
c. Fever
d. Hypotension
e. Tachycardia

3. Perform a focused physical examination to confirm the diagnosis of TSS, determine the etiology, and assess the severity of the patient’s illness.
4. Interpret the results of diagnostic tests, such as:

a. Microbiologic cultures
b. Complete blood count and white cell differential
c. Liver function tests
d. Renal function tests
e. Coagulation profile
f. Chest X-ray

5. Treat patients with TSS in consultation with a specialist in critical care medicine.
7. Counsel affected patients about the risk of recurrence and the value of preventive measures.

Septic shock

1. Describe the usual causes of septic shock in obstetric and gynecologic patients.
2. Describe the typical symptoms experienced by a patient with septic shock.
3. Perform a focused physical examination to confirm the diagnosis of septic shock, determine the etiology of the disorder, and assess the severity of the patient’s illness.
4. Interpret the results of diagnostic tests, such as:

a. Microbiologic cultures
b. Complete blood count and white cell differential
c. Liver function tests
d. Renal function tests
e. Coagulation profile
f. Chest X-ray
g. MRI and CT scan of the abdomen and pelvis
h. Ultrasonography of the pelvis
i. Arterial blood gases
j. Central hemodynamic monitoring

5. Treat a patient with septic shock in consultation with a specialist in critical care medicine.

Adult respiratory distress syndrome

1. Describe the principal causes of adult respiratory distress syndrome (ARDS).
2. Describe the usual signs and symptoms of a patient with ARDS.
3. Perform a focused physical examination to confirm the diagnosis of ARDS, determine the etiology of the disorder, and assess the severity of the condition.
4. Interpret the results of diagnostic tests, such as:

a. Chest X-ray
b. Pulse oximetry
c. Arterial blood gases
d. Pulmonary function tests
e. Central hemodynamic monitoring

5. Treat a patient with ARDS in consultation with a specialist in critical care medicine.

Hemodynamic monitoring

1. Describe the conditions most likely to cause cardiovascular dysfunction in obstetric and gynecologic patients.
2. Perform a focused physical examination to detect hemodynamic derangements, such as:

a. Hypotension or hypertension
b. Bradycardia or tachycardia
c. Apnea or tachypnea
d. Signs of poor tissue perfusion (eg, oliguria, delayed capillary refill)
e. ARDS
f. Myocardial failure
g. Altered mental status

3. Describe the indications for central hemodynamic monitoring (right heart catheterization).
4. Interpret the results of central hemodynamic monitoring.
5. Describe and, in consultation with a critical care specialist, treat the complications of central hemodynamic monitoring




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