Intensive Care for the Developing World

The BASIC approach

Colin Graham & Charles Gomersall

Challenges

• Education

• Equipment

• Supplies

• Finances….

What is Intensive Care?

• Increased nursing capability…

What is Intensive Care?

What is Intensive Care?

Level 1

• Monitoring– HR, NIBP, SpO2, RR, urine output

• POCT– Hb– Glucose, electrolytes and renal function test

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

Level 1

• Patients:– Post-operative (including multiple trauma)

– Medical (DKA, severe asthma, severe pneumonia, severe dehydration…)

– Obstetric emergencies (including eclampsia)

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

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…)

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

BASIC collaboration

“Products”

• Packaged, self-contained courses

• Focused on specific target audience

• Practical

• No license fees

• Minimal cost

Finances

• Dept of Anaesthesia & Intensive Care, CUHK

• Commercial sponsorship

• Profits from HK-based courses

• “Turn the wheel of learning”

BASIC course venues 2005-11

Hong Kong,Guangzhou, Shunde, Hainan, Zhengzhou

Brisbane, Sydney

Hawkes Bay, Hamilton, Middlemore, Christchurch

London, Birmingham,

Oxford, Colchester,

Brighton, Wessex

Johannesburg,Cape Town, Sun City

Kuala Lumpur

Bali

Beijing, Shanxi

Hama

Mumbai, Kolkata,Pune, Jaipur, Chennai, Agra, Coimbatore, Aurangabad

Perth

Dubai

Phnom Penh

Seoul

Riyadh

Kuwait

Doha

Muscat

Bahrain

Adelaide

Jerusalem

Dublin

Melbourne

FijiSingapore

BerlinSinaia

Athens

Colombo

Khartoum

Alice Springs

Course material

• Course manual

• Pre-course “open book” MCQ

• CD-ROM

• Lectures

• Skill stations

• Post-course “closed book” MCQ

Course material

• Enough for 2.5 days

• Usually run over 2 days

• Select what is relevant to your situation

Course manual

• Addresses knowledge aspect of course

Pre-course MCQ

• Aim is to encourage candidates to read course manual

• On-line

• Immediate feedback– Identify knowledge deficiencies

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

Lectures

• Emphasize key points

• Case based lectures– Practical application of theoretical knowledge

• NOT a textbook projected onto a wall

Skill station

• Practice skills

• Application of knowledge to solve problems

• Revision of key material

• Learn from mistakes– Allow the trainee to make mistakes

Post course MCQ

• Motivational

• Clinical scenarios

Course development

• Continuous, iterative process

• Tailored to needs of participants

• High quality course material– Extensive use of graphics

Laryngeal mask

Courses

• BASIC

• Very BASIC

• BASIC DHS

• Not so BASIC

• BASIC4NOW

• Mechanical ventilation: beyond BASIC

• Intensive Care Nephrology: beyond BASIC

What can we offer?

• Course material

• Experience in course development

• Instructors– Train the trainers

• Sustainability

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)

How can you help us?

• Insight

• Purpose

Synergy

SuccessfulIntensive

Care

MSF BASIC

StaffEquipment Resources

Course material Instructors

Insight

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