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Fnb- Neuro Anesthesia and Critical Care Guidelines for Competency Based Training Programme in FNB- NEURO ANESTHESIA AND CRITICAL CARE NATIONAL BOARD OF EXAMINATIONS Medical Enclave, Ansari Nagar, New Delhi-110029, INDIA Email: [email protected] Phone: 011 45593000 1 CONTENTS I. OBJECTIVES OF THE PROGRAMME a) Programme goal b) Programme objective II. ELIGIBILITY CRITERIA FOR ADMISSION III. TEACHING AND TRAINING ACTIVITIES IV. SYLLABUS V. COMPETENCIES VI. LOG BOOK VII. NBE LEAVE GUIDELINES VIII. EXAMINATION – a) FORMATIVE ASSESSMENT b) FELLOWSHIP EXIT THEORY & PRACTICAL IX. RECOMMENDED TEXT BOOKS AND JOURNALS 2 PROGRAMME GOAL The course has been designed to train candidates by the anesthesiologists in the principles and practice of Neuroanaesthesia and Neurocritical care. The training program should enable the candidates to function independently as faculty / consultant in the anaesthetic / intensive care management of the patients with neurological disorders coming for neurosurgical / radiological intervention. PROGRAMME OBJECTIVES At the end of the course, the candidate should be able to: Understand physiological and pathological basis of central nervous system disorders. Understand the theoretical basis of organ dysfunction and critical illness Develop the knowledge and skills to diagnose critical illnesses and their complications Critically evaluate published literature Learn to practice evidence-based medicine in managing neurological patients Develop skills of communication with family members of critically ill patients Apply the highest ethical standards in the practice of medicine 3 ELIGIBILITY CRITERIA FOR ADMISSIONS TO THE PROGRAMME (A) FNB Neuro Anesthesia and Critical Care Course: 1. Any medical graduate with DNB/MD Anesthesiology qualification, who has qualified the Entrance Examination conducted by NBE and fulfill the eligibility criteria for admission to DNB courses at various NBE accredited Medical Colleges/ institutions/Hospitals in India is eligible to participate in the Centralized counseling for allocation of DNB Neuro Anesthesia and Critical Care seats purely on merit cum choice basis. 2. Admission to 2 years FNB Neuro Anesthesia and Critical Care course is only through Entrance Examination conducted by NBE and Centralized Merit Based Counseling conducted by National Board of Examination as per prescribed guidelines. Duration of Course: 2 Years Every candidate admitted to the training programme shall pursue a regular course of study (on whole time basis) in the concerned recognized institution under the guidance of recognized post graduate teacher for assigned period of the course. 4 TEACHING AND TRAINING ACTIVITIES The fundamental components of the teaching programme should include: 1. Case presentations & discussion- once a week 2. Seminar – Once a week 3. Journal club- Once a week 4. Grand round presentation (by rotation departments and subspecialties)- once a week 5. Faculty lecture teaching- once a month 6. Clinical Audit-Once a Month 7. One poster and one oral presentation at least once during their training period in a recognized conference. The training program would focus on knowledge, skills and attitudes (behavior). It is divided into theoretical, clinical and practical training in all aspects of the delivery of care. It also includes methodology of research and teaching. Theoretical: The theoretical knowledge would be imparted to the candidates through discussions, journal clubs, symposia and seminars. The students are exposed to recent advances through discussions in journal clubs. Symposia: Trainees would be required to present a minimum of 20 topics based on the curriculum over a period of two years to the combined class of teachers and students. A free discussion would be encouraged in these symposia. The topics of the symposia would be given to the trainees with the dates for their presentation. Clinical: The trainee would be attached to a faculty member to be able to pick up methods of history taking, examination, prescription writing and management. Bedside: The trainee would work up cases, learn management of cases by discussion with faculty of the department. 5 Journal Clubs: This would be a weekly academic exercise. A list of suggested Journals is given towards the end of this document. The candidate would summarize and discuss the scientific article critically. A faculty member will suggest the article and moderate the discussion, with participation by other faculty members and resident doctors. The contributions made by the article in furtherance of the scientific knowledge and limitations, if any, will be highlighted. Research: The student would carry out a research project and write a thesis/ dissertation in accordance with NBE guidelines. He/ she would also be given exposure to take part in the research projects going on in the departments. 6 Syllabus: Basic Sciences Anatomy of the central & peripheral nervous system Physiology of Central Nervous System a) Cerebral blood flow/metabolism b) Cerebrospinal fluid dynamics c) Intracranial pressure d) Electrophysiology of CNS Pathophysiology of Cerebral ischemia/Traumatic brain injury Pharmacology of Anaesthetic/adjuvant drugs and emergency drugs Neuromicrobiology as applicable to operating rooms and critical care units, neuroinfections Basics of statistical Methods/Research methodology Fundamental of Biomedical Engineering : Basics of instrumentation, Biological signal processing Clinical Sciences Anaesthetic Management of : a) Brain tumours b) Neurovascular surgery c) Hydrocephalus d) Spinal surgery e) Surgery for epilepsy f) Awake craniotomy g) Neuroendoscopy h) Head injury i) Pituitary surgery j) DBS and other functional neurosurgery Cerebral protection Stroke Intraoperative and Postoperative Monitoring 7 Neuroimaging techniques Neurointerventional procedures Airway related issues in neuroanaesthesia Monitoring: Cardiac: Respiratory: Neurological: EEG, Evoked potentials,TCD, NIRS, SjVO2, Pbto2, cranial nerve monitoring Renal: Coagulation: Intensive care: Respiratory management Principles of ventilatory management Pulmonary edema – Adult respiratory distress syndrome Severe asthma and COPD Respiratory infections community and hospital acquired Chest trauma Principles of cardiac and haemodynamic management Haemodynamic instability and shock Cardiac arrest Acute myocardial infarction Unstable angina Severe heart failure Common arrhythmias and conduction disturbances - Cardiomyopathies Cardiac tamponade Pulmonary embolism Neurology Coma Status epilepticus Head trauma Subarachinoid haemorrhage intracranial hypertension Cerebrovascular accidents and cerebral vasospasm Meningo-encephalitis Acute neuromuscular disease (including myasthenia & Guillain Barre syndrome) Post anoxic brain damage Acute confusional states 8 Spinal cord injury Neurosurgery and post-operative care Brain death Stroke Renal Olguria/ anuria Acute renal failure Renal replacement therapy (RRT) Continuous RRT Metabolic and Nutritional Fluid balance Electrolyte balance and its disorders Acid-base disorders Endocrine disorders (including diabetes mellitus, acute adrenal insufficiency, pituitary disorders, hyper and hypothyroidism) Nutrition in critical illness Enteral and Parenteral nutrition Monitoring of nutrition Hematological Disseminated intravascular coagulation and other coagulation disorders Thrombocytopenia Hypercoagulable states and anticoagulation Haemolytic syndromes Acute blood loss and anaemia Neutropenia Blood component therapy Immunological disorders Infections Severe infection due to aerobic and anaerobic bacteria Acute severe viral infection Fungal and parasites infections with sepsis and organ failure Nosocomial infection Infection in the immunocopromised host Tropical disease Antimicrobial therapy 9 Gastrointestinal and hepatic disorders Prevention and treatment of acute upper G.I. bleeding Management of acute lower GI bleeding Perforated viscus and Peritonitis Acute hepatic failure and Ascitis Clinical skills to be acquired: a) Preanaesthetic evaluation for elective and emergency neurosurgery b) Anaesthetic and Perioperative management of various neurosurgical conditions c) Intensive Care PROCEDURES, TECHNIQUES, AND MINIMALLY INVASIVE MONITORING Airway Management and Endotracheal Intubation Central Venous Catheterization Arterial Line Placement and Care Temporary Cardiac Pacing Cardioversion and Defbrillation Pericardiocentesis Chest Tube Insertion and Care Bronchoscopy PercutaneousTracheostomy Cerebrospinal Fluid Aspiration Interventional Ultrasound Cardiopulmonary Resuscitation Management of Pain in the Critically Ill Patient Routine Monitoring of Critically Ill Patients Minimally Invasive Hemodynamic Monitoring Neurologic Multimodal Monitoring Echocardiography in the Intensive Care Unit Mechanical ventilation in neurological patients Haemodynamic management in a neuro-ICU patient including ACLS, Fluid & electrolyte management in neuro-ICU patient ICP monitoring 10 TCD monitoring Basics interpretation of EEG, Evoked potential Management of blood gases and acid – base status Infection control in a neuro – ICU Bedside echocardiography Diagnostic:- Ultrasound evaluation of critically ill patients Cardiac: Tamponade, ejection fraction estimation, intravascular volume status assessment, assessment of contractility Abdomen: Detection of fluid/hemoperitoneum, liver/spleen tear Vascular: Deep vein thrombosis, placement of IV canula, CVP lines, arterial canuala NON TECHNICAL
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