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重症加護科

1.訓練目標 欲從事內科重症加護工作之本院各級醫師之訓練:第二,三年住院醫師、加護病房研究員。
2.訓練內容
  1. 加護病房核心課程,目前已有一份講義,內容如下,第二年以上之住院醫師及加護病房研究員均應熟悉。
  2. 重症相關課題,週一, 周三及週五晨會後討論,每次一小時,內容如下:
    休克
    (1) Practice parameters for hemodynamic support of sepsis.
    (2) Surviving sepsis campaign guidelines for management of severe sepsis and septic shock.
    呼吸系統
    (1) Introduction to mechanical ventilation
    (2) Specific modes of mechanical ventilation.
    (3) Ventilatory failure and oxygenation failure.
    (4) PA catheterization guidelines.
    心臟系統
    (1) Acute coronary syndrome.
    (2) Congestive heart failure.
    (3) Management of arrhythmia.
    (4) Echocardiography.
    神經系統
    (1) Assessment of consciousness in ICU.
    (2) Management of stroke.
    (3) ICP monitoring.
    感染科
    (1) Principle of antibiotics usage.
    (2) Fever in ICU.
    (3) Prevention of nosocomial infection.
    腎臟系統
    (1) Acute renal failure.
    (2) Dialysis therapy.
    消化系統
    (1) Management of gastrointestinal bleeding.
    (2) Assessment and management of jaundice in ICU.
    (3) Diagnosis and management of acute pancreatitis in ICU.
    麻醉科
    (1) Airway management.
    (2) Sedative and analgesics in ICU.
    心胸外科系統
    (1) Postoperative care of patients following.
    (2) cardiothoracic surgery.
    婦產科
    (1) Obstetric or gynecologic emergency
  3. 加護病房實務
    第二年以上之住院醫師及加護病房研究員在主任及專科醫師指導下參加內、外科加護病房工作,深入瞭解重症病患之診斷及治療,各種醫療儀器之原理及操作,並進行專題研究及參與各種研討會。
Fellowship Training in Critical care medicine
Goal The major aim of the fellowship training program for critical care medicine is to create a specialist with capability of appropriately handling the patients admitted to the intensive care units.
Training program
  1. Catching up the current status of critical care medicine
    • Textbook:
      There are several textbooks available. The one by Dr. Fink et al is recommended.
    • Journal meeting:
      This will be held twice a week in the intensive care unit morning meeting. One will be held in Monday morning, one will be held in Friday morning. Articles will be selected from the current issues in American journal of respiratory and critical care medicine (AJRCCM), Critical care medicine (CCM), Intensive care medicine (ICM), Anesthesiology etc. The topics in Friday will be targeted at the respiratory system. The themes in Monday will be the other aspects.

  2. Rotations in ICUs: Duration is one year.
Medical ICU

There will be eight months in this unit (including cardiac and abdominal sonography activity)

Some techniques in ICU should be acquainted with. These included:

  1. Hemodynamic monitoring with systemic and pulmonary arterial catheters.
  2. Handling of patients under mechanical ventilation.
  3. Assessment of cardiac performance by echocardiography.
  4. Assessment of the hepatobiliary system with abdominal sonography.
In order to achieve the mentioned goals, the fellows in ICU will be assigned as a key person (just next to the attending physician) in the ICU team. They will be served as an important consultant to the primary care resident in hemodynamic monitoring. They will also be served as an adviser in the ventilator management of critically ill patients. Their knowledge and proficiency in hemodynamic monitoring and ventilator physiology will be improved further with daily discussion with the attending physician. In order to have the skills to screen the cardiac or intra-abdominal problems in ICU patients, The ICU fellows will spend 2 months in learning cardiac and abdominal sonography under specialist direction. They will screen 100 cases in each month.

Surgical ICU

There will be two months in this unit

Aims in surgical intensive care units are to understand the difference between surgical and medical opinions in critical care. The fellows should join the surgical rounds and meetings. They will spend one month in cardiac surgical ICU and another month in neuro-surgical ICU. They will not get involved in the primary care of these patients but will be an opinion provider to the surgical teams. Besides primary care, the surgical team could have an appropriate request to our fellows.