CCT in Anaesthetics - Intermediate Level Training
Cardiothoracic anaesthesia and cardiothoracic critical care
Learning outcomes:
- To gain knowledge and understanding of the underlying principles of anaesthesia for cardiac surgery, both ‘on’ and ‘off’ pump, and thoracic surgery
- Understands the skills required to provide safe and effective anaesthetic care to patients undergoing elective cardiac and thoracic surgery
- To understand the pathophysiology and presentation of advanced cardiac disease to better understand the peri-operative management of such patients who undergo coincidental surgery
Core clinical learning outcome:
- Deliver safe and effective perioperative anaesthetic care to patients undergoing elective coronary artery surgery and minor thoracic investigative procedures under direct supervision
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 CARDIAC |
---|
Competence |
Description |
Assessment Methods |
GMP |
---|---|---|---|
CT_IK_01 |
Describes the principles of the perioperative anaesthetic management of patients for cardiac surgery |
A,C,E |
1,2,3,4 |
CT_IK_02 |
Understands and explains the principles of cardiopulmonary bypass including the use of cardioplegia |
A,C,D,E |
1 |
CT_IK_03 |
Learns from the perioperative management of patients with cardiac disease knowledge applicable to those requiring non cardiac surgery |
A,C,E |
1,2,3,4 |
CT_IK_04 |
Understands the pathophysiological changes and organ dysfunction associated with cardiac disease, and their implications in the perioperative period |
A,C,E |
1,2 |
CT_IK_05 |
Correctly assesses the risk of operation in a patient who has cardiac or respiratory disease, using common scoring systems |
A,C,E |
1 |
CT_IK_06 |
Explains the results of the special investigations used during the assessment of patients with cardiac disease including, X-rays, coronary angiography, ECHO, and Scanning techniques including CT, MRI and PET |
A,C,E |
1,3,4 |
CT_IK_07 |
Understands and explains the principles of antibiotic prophylaxis in patients with cardiac disease |
A,C,E |
1,2 |
CT_IK_08 |
Recalls/describes the anaesthetic and surgical problems associated with “off pump” cardiac surgery |
A,C,E |
1,2 |
CT_IK_09 |
Describes the problems associated with post-cardiac surgery including bleeding and the clinical signs and symptoms of cardiac tamponade, and its management |
A,C,E |
1,2 |
CT_IK_10 |
Evaluates the indications for invasive and non-invasive cardiovascular monitoring, and is able to interpret the common findings |
A,C,D,E |
1 |
CT_IK_11 |
Describes the methods used to cool and re-warm patients during cardiac surgery, and the complications |
A,C,E |
1,2 |
CT_IK_12 |
Explains the need for, and methods of, altering blood coagulability during cardiac surgery |
A,C,E |
1 |
CT_IK_13 |
Recalls/describes the indications for cardiac pacing and lists the different modes available |
A,C,E |
1 |
CT_IK_14 |
Describes the principles of action, and the use of, Intra-aortic balloon counter-pulsation and other assist devices |
A,C,E |
1 |
CT_IK_15 |
Recalls/explains the abnormalities found in the adult patient with congenital heart disease [including corrected or partially corrected], and the implications for anaesthesia in these patients |
A,C,E |
1 |
CT_IK_16 |
Recalls/explains the indications for the use of inotropes and vasodilators during cardiac surgery |
A,C,E |
1 |
THORACIC |
---|
Competence | Description | Assessment Methods | GMP |
---|---|---|---|
CT_IK_17 |
Explains the significance of preoperative functional investigations of respiratory and cardio-respiratory performance |
A,C,E |
1 |
CT_IK_18 |
Describes specific risks associated with induction and maintenance of anaesthesia in patients requiring thoracic surgery and precautions to be taken to minimise these risks |
A,C,E |
1,2 |
CT_IK_19 |
Describes commonly performed thoracic surgical procedures and the relevant anaesthetic problems |
A,C,E |
1 |
CT_IK_20 |
Describes commonly used methods of local and general anaesthesia for bronchoscopy including techniques of ventilation |
A,C,E |
1 |
CT_IK_21 |
Describes the airway management of a patient undergoing one-lung ventilation and anaesthesia including placement of double lumen endobronchial tubes and bronchial blockers [Ref; EN_IK_11] |
A,C,E |
1 |
CT_IK_22 |
Recalls/explains the changes that occur during one lung ventilation and the strategies to manage these changes |
A,C,E |
1 |
CT_IK_23 |
Recalls the causes, symptoms and signs of a pneumothorax and explains the principles of its management |
A,C,E |
1 |
CT_IK_24 |
Describes the common problems associated with the postoperative care of patient who have had thoracic surgery and the methods that can be used to minimise these |
A,C,E |
1,2 |
Skills |
---|
CARDIAC |
---|
Competence |
Description |
Assessment methods |
GMP |
---|---|---|---|
CT_IS_01 |
Demonstrates the ability to assess and give a risk assessment for patients presenting for cardiac surgery including those with valvular and ischemic heart disease |
A,D |
1,2,3,4 |
CT_IS_02 |
Demonstrates the ability to assess patients with intra thoracic aortic pathology such as aneurysm, dissection and coarctation, and give an informed judgement on the risks and benefits of anaesthesia and surgery for the procedure |
A,C,D,M |
1,2,3,4 |
CT_IS_03 |
Demonstrates safe delivery of perioperative anaesthesia for a patient undergoing elective coronary bypass including the management of:
|
A,C,D,M |
1,2,3,4 |
CT_IS_04 |
Forms postoperative care plans appropriate to the surgery and the patient’s condition including postoperative analgesia and respiratory support |
A,D |
1 |
CT_IS_05 |
Demonstrates correct use of invasive and non-invasive monitoring in patients with cardiac or respiratory disease including non-invasive cardiac output monitoring devices utilising a variety of technologies, such as LIDCO, PICCO and ODM |
A,D |
1 |
CT_IS_06 |
Demonstrates an understanding of effective and evidence based use of inotropes and vasodilators |
A,C,D,E |
1,2 |
CT_IS_07 |
Demonstrates the ability to provide anaesthesia for procedures in cardiac intensive care including resternotomy, reintubation, tracheostomy and cardioversion |
A,C,D |
1,2,3,4 |
CT_IS_08 |
Perform anaesthesia for patients having cardiological electrophysiological procedures, including pacemaker insertion |
A,C,D |
1,2,3,4 |
THORACIC |
---|
Competence | Description | Assessment Methods | GMP |
---|---|---|---|
CT_IS_09 |
Demonstrates ability to assess and recommend treatments to optimise a patient about to undergo thoracic surgery |
A,C,D |
1,2,3,4 |
CT_IS_10 |
Demonstrates safe delivery of perioperative anaesthetic care to patients for minor thoracic procedures, in particular bronchoscopy, including the safe use of the Sanders injector |
A,C,D,M |
1,2,3,4 |
CT_IS_11 |
Demonstrates correct selection of appropriate airway management for the intended procedure and the ability to correctly insert single or double lumen endobronchial tubes and bronchial blockers [Ref; AM_IS_05] |
A,D |
1,2 |
CT_IS_12 |
Demonstrates correct use of clinical and endoscopic methods to confirm correct tube placement |
A,D |
1,2 |
CT_IS_13 |
Demonstrates safe delivery of perioperative anaesthetic care for major thoracic procedures, including correct airway and ventilatory management, positioning and patient protection |
A,C,D |
1,2,3,4 |
CT_IS_14 |
Demonstrates the ability to manage a patient undergoing one lung ventilation |
A,D |
1,2 |
CT_IS_15 |
Demonstrates the ability to formulate correct post-operative care plans, taking into account the patient’s condition and the surgical procedure, including an assessment of the need for management in Intensive care or high dependency |
A,C,D,M |
1,2,3,4 |