BIRDEM Hospital being the pioneer in introducing post graduate course in Critical Care Medicine deserves special place in the history of CCM in Bangladesh. In 2007 Govt. of peoples republic of Bangladesh approved introduction of postgraduate course (in MD) in critical Care Medicine at BIRDEM. That was followed by approved for university of Dhaka in 2008.The first batch of MD CCM students were enrolled. On August10, 2008 ‘’First time in Bangladesh: Introduction of MD CCM at BIRDEM” was celebrated. Director General of Family Welfare and Director, Health Education, Govt of people republic of Bangladesh were invited in that celebration.
MD CCM BIRDEM - first batch students are:
Dr. Amina Sultana
Dr. Md. Asaduzzaman
Dr. Motiul Islam
Dr. Uzzwal Kumar Mallik
MD CCM BIRDEM -2nd batch students are:
Dr. Hasibul Hashan
Dr. Rozina Sultana
Dr. Kazi Nuruddin Ahmed
Dr. Habibulla
MD CCM BIRDEM -3nd batch students are:
Dr. Tarikul Hamid
Dr. Mohammad Rabiul Halim
Dr. Reaz Uddin Chowdhury
Dr. Hasib Mahmud
MD CCM fourth Batch students are
Dr. Jahurul Islam
Dr. Arafat Hossain Rubayet
Dr. Abu Kawsar
DR. Abdul Hannan
MD CCM BIRDEM- Final Part Students
Dr. Kaniz Fatema
FCPS (Medicine), Assitant Prof, dept of critical care Medicine
Dr. Fatema Ahmed
FCPS(Medicine), Junior consultant, Dept of Critical Care Medicine
First MD - Critical Care Medicine specialist in Bangladesh
Dr. A.S.M Areef Ahsan, Associate Profesor & Head of ICU, BIRDEM & Organizing Secratery of BSCCM has complited his MD in Critical Care Medicine first time in Bangladesh.
SYLLABUS FOR MD (CRITICAL CARE MEDICINE): FIRST PART
Paper I (Anatomy and Pharmacology):
Anatomy:
1. Gross and Applied Anatomy
a. Respiratory System:
i. Upper and lower airways, structure of bronchial tree.
ii. Lungs, lobes, segments, structure of lungs
iii. Pleura, mediastinum
iv. Bony thorax
v. Respiratory muscles
vi. Innervation, blood supply and lymphatic drainage of respiratory system
b. Cardiovascular System:
i. Heart, chambers, conducting system, blood supply, innervation
ii. Great vessels, peripheral vessels, Lymphatics
iii. Pericardium
c. Nervous system:
i. Brain
ii. Spinal cord
iii. Spinal meninges
iv. Cranial nerves
v. Peripheral nerves, plexuses, dermatomes
vi. Autonomic nervous system
d. Gastrointestinal system:
i. GI tract, enteric nervous system
ii. Liver and Biliary tract
iii. Pancreas
e. Genito-urinary system:
i. Kidneys and urinary tract
ii. Nephron
f. Musculo-skeletal system:
i. Skull
ii. Vertebral column
iii. Peripheral and axial joints
g. Endocrine system:
i. Pituitary
ii. Thyroid
iii. Adrenal glands
2. Basic Histology
3. Development & Embryology
Pharmacology:
General and systemic pharmacology
Paper II (Physiology and Biochemistry):
1. Cell functions, cell membrane, receptors
2. Organization of human body and control of internal environment
3. Ageing process. Differences among neonates, infants, children, adults and elderly
4. Body fluids, composition, compartments, capillary dynamics, lymphatic system. Special fluids: cerebrospinal fluid, ocular, pleural, pericardial and peritoneal fluid
5. Acid base balance, buffers
6. Haematology: RBC, WBC, platelets, plasma and their function. Haemoglobin types, function. Haemostasis and coagulation. Blood groups.
7. Respiratory system:
a. Ventilation: Volumes, capacities, flows
b. Pulmonary circulation
c. Gaseous exchange, O2, CO2 transport, hypoxia, hypercapnoea
d. Ventilation/ perfusion abnormalities
e. Regulation of respiration
8. Cardiovascular system:
a. Cardiac muscle contraction, action potential, electrocardiogram
b. Cardiac cycle, pressure-volume relationship
c. Rythmicity of heart
d. Regulation of cardiac function
e. Neuro-humoeral regulation of blood pressure
f. Peripheral circulation, capillaries, vascular endothelium, arteriolar smooth muscle
g. Special circulation: Pulmonary, cerebral, coronary, portal, renal
9. Nervous system:
a. Function of nerve cells and synaptic transmission
b. The brain: functional division – cortex, brainstem, cerebellum, limbic system
c. Spinal cord: Tracts, effect of cord section
d. CSF flow, Intracranial pressure
e. Motor function: spinal and peripheral
f. Senses: receptors, nociception, special senses. Pain: afferent sensory and efferent modulatory pathways, peripheral and central mechanisms and response to nociception
g. Reflexes
h. Autonomic nervous system
10. Urinary system:
a. Renal blood flow, GFR, plasma clearance
b. Tubular function and urine formation
c. Regulation of fluid and electrolyte balance
d. Regulation of acid base balance
11. Gastrointestinal system:
a. Gastric, intestinal, pancreatic functions and secretions.
b. Gut motility, sphincters, reflex control
c. Digestive functions
d. Liver: Functional anatomy, blood supply, metabolic functions
12. Endocrinology:
a. Mechanisms of hormonal contro: Feedback mechanisms, effect on membrane and intracellular receptors
b. Hypothalamic and pituitary hormones
c. Thyroid hormones
d. Adrenal hormones
e. Parathyroid hormones, calcium homeostasis
13. Metabolism:
a. Nutrients: Carbohydraytes, proteins, fats, vitamins, minerals
b. Metabolic pathways, energy production, enzymes, metabolic rate
c. Hormonal control of metabolism, regulation of plasma glucose, response to stress
d. Physiological alterations: starvation, obesity, exercise, stress response
e. Body temperature and its regulation
14. Musculo-skeletal system:
a. Muscle action potential: generation and transmission
b. Neuromuscular junction and transmission
c. Muscle types, skeletal muscle contraction, smooth muscle contraction, motor unit
Paper III (Pathology and Microbiology including Immunology):
A. Microbiology:
1. Introduction to Microbiology
2. Morphology and structures of bacterial cell and growth requirements
3. Recombinant DNA technology and its application in medical microbiology
4. Gram positive organisms
5. Gram negative organisms
6. Anaerobic infections
7. Mycobacterial infections
8. Spirochetes
9. Normal flora of the body and nosocomial infection
10. Sterilization and Disinfection
11. Collection, handling and transport of samples for microbiological investigations
12. Mycology: Candida, dermatophytes
13. Parasitology:
Classification of parasites, general morphology, pathogenesis and clinical findings and laboratory diagnosis of:
a. E. histolytica
b. Giardia
c. Trichinoses
d. Leishmania
e. Malaria
f. Echynococcus
g. Ascaris
h. Hookworm
i. Trichuriasis
j. Strongyloidiasis
k. Taenia
l. Filaria
17. Virology: General properties and classification of virus, general morphology, pathogenesis, clinical findings and laboratory diagnosis of:
Hepatitis viruses
Dengue and viral hemorrhagic fevers
Encephalitis viruses
Rabies virus
Influenza and other respiratory viruses
Measles and Rubella virus
Rota virus
HIV and HTLV
Virus and human cancer
B. Basic and applied immunology:
1. Introduction to Immunology and Immune system with historical perspective
2. Immunogen: Immunogenicity and antigenic specificity
3. Immunoglobulin: Structure, types, functions, properties and synthesis
4. Monoclonal antibody: definition and use
5. Cellular basis of immune response: B&T lymphocytes, macrophages etc, T-B cooperation and role of macrophage
6. Complement system
7. MHC and HLA
8. Immunity to infection
9. General principles of immunological tests
10. Hypersensitivity and Drug reactions
11. Auto immunity, transplantation and tumor immunity
C. Pathology:
General pathology
Systemic pathology
Medical Genetics
SYLLABUS FOR MD (CRITICAL CARE MEDICINE): SECOND PART
Paper I (Internal Medicine):
A. Principles of Internal Medicine
B. Systemic diseases:
1. Infectious diseases
2. Diseases of Respiratory system
3. Cardiovascular diseases
4. Diseases of Kidneys and Urinary tract
5. Diseases of Nervous system and Muscles
6. Disorders of Haematopoietic system
7. Endocrine diseases
8. Disorders of Gastrointestinal system
9. Rheumatological disorders
10. Skin and Venereal diseases
11. Acute poisoning
12. Nutritional diseases
13. Psychiatric diseases
14. Genetic diseases
15. Immunological diseases
16. General oncology
Paper II (Biostatistics, Genetics and Immunology):
Biostatistics:
1. Basic concepts of Biostatistics: Definition, importance, uses, scope and limitation
2. Definition and concepts of important terms and rates used in medical and vital statistics, standard death rate and concise life table
3. Methods of data collection
4. Concepts of sampling
5. Basic concepts of probability
6. Frequency and probability distribution and their application in medicine
7. Methods of displaying and projecting data
8. Correlation and Regression
9. Measures of variability
10. Basic concepts of experimental design relevant to medical science, clinical trials
11. Tests of significance
12. Methods and principles of recording and maintenance of information
13. Requirement of health information system
14. Basic statistical computer softwares: SPSS, EPI info etc.
SYLLABUS FOR MD (CRITICAL CARE MEDICINE): FINAL PART
1. Resuscitation
A) Cardiopulmonary resuscitation
B) Central nervous system resuscitation
2. Cardiovascular physiology, pathology, pathophysiology and therapy
A) Shock
1) Hypovolemic
2) Cardiogenic
3) Distributive low vs. high resistance
4) Obstructive
B) Myocardial infarction and complications
C) Cardiac arrhythmias and conduction disturbances pacemakers
D) Pulmonary embolism
E) Pulmonary edema cardiogenic and noncardiogenic
F) Acute pericardial diseases including cardiac tamponade
G) Acute vulvular disorders
H) Acute aortic and /or peripheral vascular disease disorders including A-V fistulae
I) Cardiomyopathies and myocarditis
J) Management of early post-cardiac surgical patients
K) Vasopressor and/or vasodilator therapy and cardio assist devices
L) Current concepts of Starling’s law of the heart and capillary circulation including circulations and interpretation of hemodynamic measurements
M) Hemodynamic effects caused by ventilatory assistance devices
N) Hypertension and hypertensive crises
O) Angioplasty and thrombolytic therapy of acute coronary artery disease
3. Respiratory physiology, pathology, pathology and therapy
A) Acute respiratory failure
1) Hypoxic acute respiratory syndrome
2) Hypercapnic
3) Neurological; mechanical
B) Status asthmaticus
C) Smoke inhalation; airway burns
D) Aspiration; chemical pneumonitis; drowning
E) Flail chest; barotraumas
F) Bronchopulmonary infections
G) Upper airway obstruction
H) Pulmonary function tests
1. Pulmonary mechanics
2. Respiratory adequacy e.g. blood gases
I) Oxygen therapy
J) Hyperbaric oxygen
K) Mechanical ventilation including indications and hazards
1. Pressure and volume ventilators
2. Positive end expiratory pressure, intermittent mandatory ventilation, continuous positive airway pressure, etc.
L) Airway maintenance
1. Endotracheal intubation
2. Tracheostomy
3. Long term intubation vs. tracheostomy
M) Bronchiolitis
N) Hemoptysis
4. Renal physiology, pathology, pathophysiology and therapy
A) Renal failure
1) Prerenal
2) Renal
3) Postrenal
B) Derangements secondary to alterations in volume, osmolality and electrolytes (sodium, potassium, magnesium, calcium, chloride, phosphate)
C) Acid-base disorders
D) Principles of hemodialysis and peritoneal dialysis
E) Urinary tract bleeding
5. CNS physiology, pathology, pathophysiology and therapy
A) Coma
1) Metabolic
2) Traumatic
3) Infectious
4) Mass lesions
5) Vascular-anoxic-ischaemic-hemorrhagic
6) Overdose and poisonings
B) Seizure disorders
C) Psychiatric emergencies
6. Metabolic and endocrinologic aspects of critical illness
A) Colloid osmotic pressure
B) Nutrition
1) Enteral
2) Parenteral
C) Endocrine
1) Thyroid storm
2) Myxedema coma
3) Adrenal crisis
4) Disorders of antidiuretic hormone metabolism
5) Diabetes mellitus
a) Ketotic and nonketotic hyperosmolar coma
b) Hypoglycaemia
6) Pheochromocytoma
7. Infectious disease physiology, pathology, pathophysiology and therapy
A) Antimicrobial agents including adverse reactions
B) Infection control for special care units
C) Severe infections
D) Sepsis and septic shock
E) Infections in immunocompromised hosts
F) Hospital acquired and opportunistic infections in critically ill
8. Hematologic disorders related to acute illness
A) Acute coagulation defects
B) Anticoagulation fibrinolytic therapy
C) Principles and complications of blood component therapy
D) Acute hemolytic disorders
E) Acute syndromes associated with neoplastic disease and/or antineoplastic therapy
F) Acute disorders of the immunosuppressed patient
G) Sickle cell crisis
H) Plasmapharesis
9. Gastrointestinal acute disorders
A) Acute pancreatitis
B) Upper gastrointestinal bleeding, including variceal bleeding
C) Lower gastrointestinal bleeding
D) Acute hepatic failure
E) Toxic megacolon
F) Acute perforations of the gastrointestinal tract
G) Ruptured esophagus
H) Acute inflammatory diseases of the intestine
I) Acute vascular disorders of the intestine
11. Trauma, Burns (medical management)
A) Management of multisystem trauma
B) CNS trauma (Brain and spinal cord)
C) Skeletal trauma including the spine
D) Chest trauma
1. Blunt
2. Penetrating
3. Cardiac
E) Abdominal trauma including blunt and penetrating
F) Crush injury
G) Burns
12. Perioperative problems and anaesthetic complications (medical management)
13. Pharmacokinetics and dynamics: drug metabolism, toxicity and excretion in critical
illness
14. Monitoring, bioengineering, biostatistics
A) Prognostic indices and severity scores
B) Invasive cardiovascular monitoring
C) Noninvasive cardiovascular monitoring including ECG
D) Electrical safety
E) Brain monitoring including intracranial pressure, cerebral blood flow, cerebral metabolic rate etc.
F) Respiratory monitoring
G) Metabolic monitoring (Oxygen consumption, CO2 production, respiratory quotient)
H) Imaging techniques (e.g. chest x-rays, radionuclide studies, CT scans, angiography, etc.)
15. Ethical and legal aspects of Critical Care Medicine
16. Psychological aspects of Critical Care Medicine
A) Patient
B) Family
C) Health-care team
D) Communication skill
17. Administrative and management principles and techniques
A. Guidelines for trainee physicians in Critical Care Medicine
B. Organization and staffing critical care units (special care units)
C. Medical record-keeping in special care units
D. Priorities in care of the critically ill or injured
18. Practical Procedures:
I. Assessment of cardiopulmonary function (ECG, Pulse oximetry, Capnometry, Echocardiography, Doppler study, etc.)
II. Cardiopulmonary resuscitation and defibrillation & cardioversion
III. Imaging ( X-ray, CT scan, MRI interpretation)
IV. Transcutaneous cardiac pacemaker placement
V. Invasive pressure monitoring (Arterial, Central venous & Pulmonary arterial)
VI. Peritoneal dialysis
VII. Oxygen therapy
VIII. Mechanical ventilation
IX. Airway management
X. Fibro-optic bronchoscopy/ Bronchoalveolar lavage
XI. Pain control, sedation & paralysis
XII. Blood gas analysis
XIII. Tube thoracostomy
XIV. Abdominal paracentesis, Thoracentesis, Peritoneal & Pleural biopsy
XV. Venous cut down
XVI. Pericardiocentesis
XVII. Cricothyrotomy
XVIII. Intra-arterial cannulation
XIX. Central venous line placement
XX. Pulmonary artery catheter placement
XXI. Lumber puncture
19. PHYSICS AND CLINICAL MEASUREMENTS:
Trainees should understand the physical principles upon which methods of clinical measurement are based. Knowledge of clinical measurement techniques should be limited to principles and basic methods.
A. Mathematical concepts: Sinusoids, exponentials and parabolas
B. Exponential functions and logarithms
C. Basic measurement concepts: linearity, drift, hysteresis, signal:noise ratio, dynamic response
D. SI units. Fundamental and derived units
E. Simple mechanics: Mass, Force, work and power
F. Heat: simple calorimetry, conduction, convection, radiation, mechanical equivalent of heat, laws of thermodynamics
G. Physics of gases, absolute and relative pressure, The gas laws. Tripple point: critical temperature. Density and viscosity of gases. Laminar and turbulent flow. The Bernoulli principle.
H. Freezing point, melting point, latent heat. Vapour pressure. Colligative properties, osmometry
I. Basic concepts of electricity and magnetism. Capacitance, inductance and impedence. Amplifiers. Band width, filters. Amplification of biological potentials: ECG, EMG, EEG. Sources of electrical interference
J. Processing, storage and display of physiological measurements. Bridge circuits.
K. Basic principles of lasers
L. Principles of cardiac pacemakers and defibrillators
M. Electrical hazards: causes and prevention. Electrocution, fires and explosions. Diathermy and its safe use.
N. Principles of pressure tyransducers. Measurement of pressure. Direct and indirect methods of blood pressure measurement. Pulmonary artery pressure.
O. Measurement of volume and flow of gases and liquids. The pneumotachograph and other respirometers. Peak flow measurement. Spirometry. Cardiac output.
P. Measurement of temperature and humidity
Q. Measurement of gas concentrations, especially oxygen, carbon dioxide, nitrogen, nitrous oxide, volatile anesthetic agents
R. Measurement of pH, pCO2, pO2
S. Simple tests of pulmonary function
T. Capnography
U. Pulse oxymetry
V. Measurement of neuromuscular blockade
W. Assessment of pain
20. Training Certification:
• ACLS (Advanced Cardiac Life Support)
• ATLS (Advanced Trauma Life Support) - if available.
MD CCM COURSE
TRAINING
Training Opportunities for MD CCM student and Honorary Doctors
Clinical Training
The Critical Care Medicine Department at BIRDEM Hospital offers 2 year training for MD(critical care medicine) student. The program is designed to provide clinical training in the care of patients with multisystem organ dysfunction and to produce independent clinical investigators through advanced training.
Didactic Components of Core Critical Care training
Monthly Departmental journal club
Monthly Departmental Morbidity and Mortality Meeting
Monthly Departmental Infection Control Committee Meeting
Monthly Departmental Academic &Research Committee Meeting
Fortnightly Clinical and Academic lectures
Fortnightly Case Presentation
Other Weekly Case Presentation at Hospital Auditorium
Monitoring Patient-oriented research study
Core Procedure Skills
Procedural skills are learned through cognitive and practical activities:
Airway Management
Maintenance of an open airway in non intubated patient
Ventilation by bag mask system
Tracheal intubation
Management of pneumothorax
Management of tracheotomy acute &chronic care
Use of Fibreoptic laryngoscope
Bedside Use of Fibreoptic Bronchoscopy
Endoscopy
Colonoscopy
Ventilator Management utilizing a variety of Ventilator modes & mechanical ventilators.
Utilizing Noninvasive mechanical ventilators
Using EtCO2
Plural fluid aspiration
Ascitic fluid aspiration
Intra Abdominal pressure Measurement
Pleural Biopsy
Peritoneal dialysis
Tube thoracotomy
Lumber puncture
Management of Epidural Catheter
Bedside Echo &USG
Initiation & management of Continuous renal replacement therapy (CRRT)
Arterial blood gas analysis
Central Venous oxygen saturation measurement
CVP Measurement
Central venous Catheter Incertion
Peripherally Inserted Central venous Catheter (PICC)
Hemodialysis Catheter
Arterial line
Measurement of Invasive & Non Invasive blood pressure (Arterial line)
Electrocardiogram interpretation
Using Monophasic & Biphasic diffibrilator
Cardiovertion-direct current and chemical
Nutrition assessment utilizing metabolic chart
Decubitus Ulcer staging & prevention & management
Research Training:
The Critical Care Medicine department conducts active research programs. Currently the department has successfully completed MOSAICS (Management of severe sepsis in Asia,s Intensive Care Units) Study.
Major Topics of Research Interest within the department include:
Scoring system for critically ill patient
Antibiogram
Efficacy study of infection control program
Study about CRRT
Study about BAL
UTI
VAP
CRBSI (Catheter related blood strem Infection)
AKI (Acute Kidney Injury)
Severe sepsis &septic shock
Application:
Applications consist of a curriculum vitae and letters of recommendation.
Curriculum vitas can’t be submitted online. For details, please visit: www.birdemccm.org
For more information, please contact:
Department of Critical Care Medicine
BIRDEM Hospital
122 Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000
Phone: 8616641-50, ext-2399,2344,2396
MD CCM Course - BIRDEM
