Intensive Care for the Developing World

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Intensive Care for the Developing World

• The BASIC approach
• Colin Graham Charles Gomersall

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Challenges

• Education
• Equipment
• Supplies
• Finances.

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What is Intensive Care?

• Increased nursing capability

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What is Intensive Care?
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What is Intensive Care?
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Level 1

• Monitoring
• HR, NIBP, SpO2, RR, urine output
• POCT
• Hb
• Glucose, electrolytes and renal function test

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Level 1

• Organ support
• fluid challenge, blood transfusion
• high flow oxygen therapy, nebulisation of drugs
• continuous intravenous infusion of drugs
  (insulin,heparin, nicardipine, labetolol,
  dopamine) with syringe pump
• Not epinephrine and norepinephrine
• NG nutrition

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Level 1

• Patients
• Post-operative (including multiple trauma)
• Medical (DKA, severe asthma, severe pneumonia,
  severe dehydration)
• Obstetric emergencies (including eclampsia)

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Level 2

• Level 1
• Continuous ECG monitoring
• POCT
• blood gases and cardiac enzymes
• Organ support
• management of arrhythmias (pharmacological,
  defibrillation)
• NIV
• Patients
• cardiovascular emergencies
• acute respiratory failure requiring non-invasive
  ventilation

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Level 3

• Level 2
• Monitoring
• invasive BP
• Investigations
• Microbiology and high level of pathology tests
  (biochemistry, haematology)
• Organ support
• epinephrine and norepinephrine infusion via
  central venous catheter
• invasive mechanical ventilation
• Patients
• multiple trauma, poisoning, infectious disease
  such as tetanus and severe CNS infections
  (malaria, meningitis)

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BASIC collaboration

• Informal
• Intensivists with an interest in providing free,
  high quality, practical course material
• Hosted by Dept of Anaesthesia Intensive Care,
  The Chinese University of Hong Kong

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BASIC collaboration
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Products

• Packaged, self-contained courses
• Focused on specific target audience
• Practical
• No license fees
• Minimal cost

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Finances

• Dept of Anaesthesia Intensive Care, CUHK
• Commercial sponsorship
• Profits from HK-based courses
• Turn the wheel of learning

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BASIC course venues 2005-11
Mumbai, Kolkata,Pune, Jaipur, Chennai, Agra,
Coimbatore, Aurangabad
Berlin
Dublin
Sinaia
Athens
Hama
London, Birmingham,Oxford, Colchester, Brighton,
Wessex
Jerusalem
Seoul
Kuwait
Bahrain
Beijing, Shanxi
Hong Kong,Guangzhou, Shunde, Hainan, Zhengzhou
Riyadh
Dubai
Khartoum
Doha
Phnom Penh
Muscat
Singapore
Colombo
Fiji
Kuala Lumpur
Johannesburg,Cape Town, Sun City
Bali
Brisbane, Sydney
Perth
Alice Springs
Melbourne
Adelaide
Hawkes Bay, Hamilton, Middlemore, Christchurch
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Course material

• Course manual
• Pre-course open book MCQ
• CD-ROM
• Lectures
• Skill stations
• Post-course closed book MCQ

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Course material

• Enough for 2.5 days
• Usually run over 2 days
• Select what is relevant to your situation

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Course manual

• Addresses knowledge aspect of course

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Pre-course MCQ

• Aim is to encourage candidates to read course
  manual
• On-line
• Immediate feedback
• Identify knowledge deficiencies

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CD-ROM

• Interactive tutorial on arterial blood gas
  interpretation
• Practical application of knowledge
• Narrated lecture on acute respiratory failure
• CVP line insertion
• Demonstration component of practical skills
  teaching

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Lectures

• Emphasize key points
• Case based lectures
• Practical application of theoretical knowledge
• NOT a textbook projected onto a wall

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Skill station

• Practice skills
• Application of knowledge to solve problems
• Revision of key material
• Learn from mistakes
• Allow the trainee to make mistakes

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Post course MCQ

• Motivational
• Clinical scenarios

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Course development

• Continuous, iterative process
• Tailored to needs of participants
• High quality course material
• Extensive use of graphics

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Laryngeal mask
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Courses

• BASIC
• Very BASIC
• BASIC DHS
• Not so BASIC
• BASIC4NOW
• Mechanical ventilation beyond BASIC
• Intensive Care Nephrology beyond BASIC

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What can we offer?

• Course material
• Experience in course development
• Instructors
• Train the trainers
• Sustainability

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Courses

• BASIC
• Introductory course in Intensive Care (level 3)
• Very BASIC
• Acute care training for final year medical
  students and interns, includes non-invasive
  ventilation (level 2)
• BASIC DHS
• Acute care training for doctors in developing
  healthcare systems, not including ventilation
  (level 1)

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How can you help us?

• Insight
• Purpose

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Synergy
MSF
BASIC
Insight
Course material
Instructors
Staff
Equipment
Resources
Feedback
SuccessfulIntensiveCare