Anesthesiology critical care medicine certification requires completion of a
one-year fellowship
in critical care medicine and passing the
critical care medicine exam.
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1.
Basic Pathophysiology
A.
Central Nervous System
1.
Altered mental status; encephalopathy; delirium
4.
Degenerative disease of the brain (e.g., Alzheimer disease, Parkinson disease)
5.
Traumatic brain injury (TBI)
7.
Intracranial compliance, mass lesion
8.
Neuromuscular disorders
9.
Seizures and status epilepticus
11.
Stroke
12.
Vascular malformations (e.g., aneurysms, AV malformations)
B.
Cardiovascular
1.
Cardiac transplantation
2.
Congenital heart disease in adults
3.
Coronary artery disease, myocardial ischemia/infarction
4.
Deep Vein Thrombosis (DVT)
5.
Hypertension
a.
Pulmonary hypertension
6.
Infection/inflammation
7.
Myocardial function/dysfunction
8.
Peripheral vascular disease
9.
Rhythm disturbances
b.
Supraventricular tachyarrhythmias, including atrial flutter, atrial fibrillation
c.
Heart block, partial or complete
d.
Junctional or nodal rhythm
e.
Pulseless Electrical Activity (PEA)
f.
Ventricular tachycardia/fibrillation
g.
Other conduction abnormalities (e.g., WPW)
10.
Shock states
b.
Distributive (e.g., sepsis, neurogenic/spinal, anaphylactic/anaphylactoid)
c.
Hypovolemic (e.g., hemorrhagic shock)
d.
Obstructive (e.g., pulmonary embolism)
11.
Structural
c.
Valvular
c.
Hypertrophic cardiomyopathy (HOCM, ASH, IHSS)
a.
Pulmonic insufficiency
4.
Tricuspid valve dysfunction
12.
Oxygen supply and demand
13.
Trauma
14.
Other (e.g., pulsus paradoxus)
C.
Pulmonary
1.
Airway diseases
4.
Infection
2.
Health-care associated
5.
Inflammatory and autoimmune diseases
7.
Airway disruption
b.
Pneumothorax, volutrauma
c.
Bronchopleural fistula
9.
Chest trauma (e.g., pulmonary contusion, flail chest)
10.
Pulmonary mechanics (including assessment of work of breathing)
11.
Respiratory failure
b.
Hypoxemic (acute and chronic)
c.
Hypercapnic (acute and chronic)
d.
Other ventilation-perfusion abnormalities
e.
Transfusion-Related Lung Injury
1.
Transfusion-Related Acute Lung Injury (TRALI)
2.
Transfusion associated circulatory overload (TACO)
D.
Renal
2.
Renal failure
3.
Renal tubular acidosis
E.
Hematologic/Oncologic
1.
Bone marrow/stem cell transplantation
2.
Coagulopathies
2.
Isolated factor abnormalities
3.
Vitamin K dependent coagulopathy
4.
Hemoglobin abnormalities
e.
Other hemoglobinopathies (e.g., sickle cell disease, Thalassemia)
5.
Platelet abnormalities
1.
Heparin-induced thrombocytopenia
2.
Other (e.g., thrombotic thrombocytopenic purpura, ITP)
F.
Obstetric
1.
Complications of pregnancy
a.
Coagulopathy, bleeding disorders
b.
Emboli (amniotic fluid, thromboemboli, other)
c.
Liver function abnormalities (e.g., acute fatty liver, HELLP)
d.
Pre-eclampsia/eclampsia
2.
Physiologic changes associated with pregnancy
3.
Respiratory physiology of pregnancy
G.
Endocrine
1.
Adrenal
2.
Diabetes mellitus
a.
Hyperglycemia, including diabetic ketoacidosis (DKA), nonketotic hyperglycemic coma (NKHC)
3.
Pituitary
b.
Diabetes Insipidus, including central, nephrogenic
d.
Panhypopituitarism (postpartum, other)
4.
Thyroid function abnormalities
a.
Critical illness effects on thyroid function
b.
Hyperthyroidism, including thyroid storm
c.
Hypothyroidism, including myxedema
5.
Other (e.g., carcinoid)
H.
Gastrointestinal
1.
Abdominal compartment syndrome/Intra-abdominal hypertension
2.
Bowel disorders
c.
Pseudomembranous colitis
3.
Gall bladder disease (stones, cholecystitis)
4.
Stomach
b.
GI motility dysfunction
1.
Diarrhea, nausea, vomiting
5.
Pancreas
6.
Hepatic
a.
Hepatic dysfunction/failure (acute and chronic)
b.
Hepatic encephalopathy
d.
Hepatocellular carcinoma
I.
Dermatologic
3.
Infection
b.
Necrotizing soft tissue infection
4.
Stevens Johnson Syndrome
J.
Immunologic
1.
Autoimmune
a.
Mixed connective tissue disease
b.
Rheumatoid arthritis (RA)
c.
Systemic Lupus Erythematosis (SLE)
2.
Immune suppression
a.
Acquired (e.g., HIV, AIDS)
3.
Graft vs. host disease
K.
Acid-base and electrolyte abnormalities
1.
Acid-base abnormalities
2.
Electrolyte abnormalities
2.
Critical Illness Diagnosis and Management
A.
Central Nervous System
1.
Diagnoses
4.
Other (e.g., hypoxic/metabolic encephalopathy)
c.
Degenerative disease of the brain (e.g., Alzheimer disease, Parkinson disease)
d.
Traumatic brain injury (TBI) (subarachnoid, subdural, epidural hematoma)
3.
Meningitis/ventriculitis
f.
Neuromuscular disorders
1.
Critical illness polyneuropathy/myopathy
3.
Guillain-Barré syndrome
g.
Seizures and status epilepticus
1.
Hemorrhagic (Subarachnoid, hypertensive, hemorrhagic conversion)
j.
Tumors (supratentorial, infratentorial, spinal)
k.
Vascular malformations (e.g., aneurysms, AV malformations)
l.
Pituitary disorders (e.g., acromegaly, infarction)
m.
Other psychiatric disorders (e.g., depression, anxiety, PTSD)
2.
Diagnostic modalities
e.
Other imaging (e.g., CT, CTA, MRI, MRA)
f.
Jugular venous saturation
h.
Nerve conduction studies/EMG
i.
Nuclear medicine studies (e.g., cerebral blood flow)
3.
Management strategies
c.
ICP-controlling medications
d.
Interventional radiology (e.g., coiling, clipping, vasospasm therapies)
g.
Surgical interventions
i.
Plasmapheresis/plasma exchange
j.
Other therapies, e.g., CSF drainage
1.
Tricyclic antidepressants
m.
Neuromuscular blocking drugs
B.
Cardiovascular
1.
Diagnoses
a.
Cardiac transplantation, rejection, complications
b.
Congenital heart disease in adults
c.
Coronary artery disease, myocardial ischemia/infarction
1.
Pulmonary hypertension
f.
Myocardial function/dysfunction
g.
Peripheral vascular disease
2.
Atrial flutter/fibrillation
3.
Supraventricular tachyarrhythmias, other
5.
Junctional or nodal rhythm
6.
Pulseless Electrical Activity (PEA)
7.
Ventricular tachycardia/fibrillation
8.
Other conduction abnormalities (e.g., WPW)
2.
Distributive (e.g., sepsis, neurogenic/spinal, anaphylactic/anaphylactoid)
3.
Hypovolemic (e.g., hemorrhagic shock)
4.
Obstructive (e.g., pulmonary embolism)
j.
Structural
4.
Non-infectious myocarditis
5.
Papillary muscle dysfunction
7.
Stress-induced cardiomyopathy (e.g., Takotsubo cardiomyopathy)
9.
Systemic oxygen supply and demand
11.
Valvular
3.
Hypertrophic cardiomyopathy (HOCM, ASH, IHSS)
c.
Pulmonic valve disease
d.
Tricuspid valve disease
12.
Other (e.g., Noncardiogenic pulmonary edema, pulsus paradoxus)
2.
Diagnostic modalities
a.
Hemodynamic monitoring
2.
Cardiac output monitoring
5.
Pulse pressure/stroke volume variation
2.
Interventional imaging
3.
Management strategies
a.
Anticoagulants and antithrombotics
3.
Thrombin inhibitors (e.g., bivalirudin, argatroban)
7.
Direct Oral Anticoagulants (DOACs)
d.
Circulatory support systems
2.
Pacemakers/defibrillators
b.
External defibrillators
d.
Transvenous/epicardial
3.
Left or right ventricular assist device (open or percutaneous)
4.
Intraaortic balloon pump
f.
Vasoactive or modulating drugs
2.
Inotropes/chronotropes/lusitropes
4.
Vasodilators (systemic or pulmonary)
C.
Pulmonary
1.
Diagnoses
b.
Airway disruption (e.g., pneumothorax, volutrauma)
d.
Chest trauma (e.g., pulmonary contusion, flail chest)
f.
Infection
b.
Health care associated
g.
Inflammatory and autoimmune diseases
h.
Lung and chest wall tumors
i.
Lung transplantation (rejection, complications)
2.
Hypercapnic (acute and chronic)
3.
Hypoxic (acute and chronic)
2.
Diagnostic modalities
a.
Blood gas (arterial, venous)
d.
Laryngoscopy and bronchoscopy
e.
Pulmonary function studies/pulmonary mechanics
3.
Management strategies
a.
Antimicrobials/antivirals/antifungals
b.
Management of bronchopleural and bronchocutaneous fistulae
c.
Pleural drainage and evacuation (e.g., thoracentesis, chest tube placement)
e.
Vaccination (Pneumovax)
f.
Ventilatory support
1.
Invasive ventilation modes
a.
Airway pressure-release ventilation
c.
High-frequency/oscillation
e.
Pressure-support ventilation
3.
Spontaneous breathing trials
4.
Other ventilator strategies
a.
Differential lung ventilation
b.
Positioning (e.g., prone)
g.
Extracorporeal support (e.g., VV ECMO)
D.
Renal
1.
Diagnoses
1.
Contrast induced-nephropathy
5.
Renal tubular acidosis
d.
Renal transplantation (e.g., rejection)
2.
Diagnostic modalities
a.
Electrolytes, osmolarity, and specific gravity (serum, urine)
3.
Management strategies
a.
Fluid and electrolyte management
b.
Pharmacologic therapies
1.
Antimicrobials/antifungals
c.
Renal replacement therapies
1.
Continuous renal replacement therapies including ultrafiltration
2.
Intermittent hemodialysis
E.
Hematologic/Oncologic
1.
Diagnoses
a.
Bone marrow/stem cell transplantation (rejection, complications)
b.
Coagulopathies
b.
Isolated factor abnormalities
d.
Hemoglobin abnormalities
5.
Other hemoglobinopathies (e.g., sickle cell disease, Thalassemia)
f.
Platelet abnormalities
1.
Thrombocytopenia (including HIT)
3.
Other (e.g., thrombocytopenic purpura, ITP)
h.
White blood cell disorder
2.
Diagnostic modalities
a.
Bone marrow biopsy, culture
b.
Coagulation studies (e.g., PT, PTT, TEG, ROTEM, factor levels)
c.
Routine blood studies (e.g., CBC, platelets)
3.
Management strategies
a.
Anticoagulants
4.
Thrombin inhibitors (e.g., argatroban)
c.
Plasmapheresis/plasma exchange
d.
Transfusion and factor replacement
e.
IVC filters, other mechanical devices
F.
Obstetric
1.
Diagnoses
a.
Coagulopathy, bleeding disorders
b.
Emboli (amniotic fluid, thromboemboli, other)
c.
Liver function abnormalities (e.g., acute fatty liver, HELLP)
d.
Pre-eclampsia/eclampsia
f.
Trauma in obstetric patients
2.
Diagnostic modalities
a.
Laboratory studies (serum, urine)
3.
Management strategies
c.
Antihypertensive therapy
G.
Endocrine
1.
Diagnoses
1.
Hyperglycemia [diabetic ketoacidosis (DKA), non-ketotic hyperglycemic coma (NKHC)]
2.
Diabetes insipidus (central, nephrogenic)
d.
Thyroid function abnormalities
1.
Critical illness effects on thyroid function
2.
Hyperthyroidism, including thyroid storm
3.
Hypothyroidism, including myxedema
2.
Diagnostic modalities
b.
Laboratory studies (serum, urine)
3.
Management strategies
b.
Hormone replacement therapy
2.
Oral hypoglycemic agents
d.
Steroids (glucocorticoid and mineralocorticoid)
H.
Gastrointestinal
1.
Diagnoses
a.
Abdominal compartment syndrome
c.
Gall bladder disease (stones, cholecystitis)
e.
GI hemorrhage (upper, lower)
f.
GI motility dysfunction, GERD
1.
Dysfunction/failure, acute and chronic
2.
Hepatic encephalopathy
4.
Hepatocellular carcinoma
6.
Liver transplantation, rejection, complications
i.
Abdominal trauma (i.e., splenic, liver, bowel injuries)
2.
Diagnostic modalities
a.
Abdominal pressure measurement (bladder pressure, other)
b.
Assessment of bowel motility
c.
Endoscopy, upper, lower
d.
Imaging (CT, MRI, x-ray, nuclear medicine studies, ultrasound)
e.
Interventional radiology
1.
Coagulation parameters
3.
Nutritional assessment (albumin, prealbumin)
4.
Routine blood studies (CBC, electrolytes, renal function)
5.
Stool assessment (occult blood, C. diff toxin)
6.
Serology (hepatitis, HIV)
7.
Additional relevant studies (e.g., amylase, lipase)
h.
Endoscopy (upper, lower); ERCP
i.
Imaging (x-ray, CT, MRI, ultrasound)
j.
Paracentesis, diagnostic
3.
Management strategies
a.
Blood product selection and administration
b.
Diuretics, renal replacement therapies
c.
Endoscopy, upper, lower with therapeutic intervention
d.
Immunotherapy (e.g., IgG)
e.
Interventional radiology (embolization, coiling)
f.
Management of increased intra-abdominal pressure
g.
Nutritional support (enteral, parenteral)
h.
Paracentesis, therapeutic
i.
Pharmacologic management
2.
GI blood flow modulators
3.
Immunologic therapy, steroids
j.
Surgical intervention (timing, therapeutic options)
k.
Vaccination (e.g., hepatitis)
I.
Dermatologic
1.
Diagnoses
b.
Disruption of the skin barrier, including decubiti, Stevens-Johnson syndrome
2.
Necrotizing soft tissue infection
d.
Inflammatory diseases of the skin
e.
Stevens Johnson Syndrome
2.
Diagnostic modalities, laboratory studies
3.
Management strategies
3.
Immunotherapies (systemic and topical)
b.
Fluids and resuscitation
c.
Wound care (surgical and other)
J.
Immunologic
1.
Diagnoses
1.
Mixed connective tissue disease
b.
Graft vs. host disease
c.
Immune suppression (e.g., HIV, AIDS)
2.
Diagnostic modalities
a.
Biopsy, selective aspiration
3.
Management strategies
2.
Antimicrobial prophylaxis
4.
Immunosuppression (glucocorticoids, antimetabolites, calcineurin inhibitors)
K.
Acid-base and electrolyte abnormalities
1.
Diagnoses
a.
Acid-base abnormalities
b.
Electrolyte abnormalities
2.
Diagnostic modalities
3.
Electrolytes, osmolarity, and specific gravity (serum, urine)
3.
Management strategies
a.
Appropriate renal and endocrine strategies
b.
Electrolyte management
3.
Specialized Areas
A.
Biostatistics
1.
Number needed to treat
6.
Positive Predictive Value/Negative Predictive Value
7.
Sensitivity, specificity
8.
Statistical significance (p-value)
10.
Statistical tests
a.
Non-parametric (e.g., Wilcoxon, Mann Whitney U test, Chi squared, Kaplan Meier curve)
b.
Parametric (e.g., t-test, ANOVA)
11.
Type 1 and type 2 errors
B.
Disaster Management
2.
Biologic, chemical, and nuclear exposures
3.
Epidemic (e.g., COVID-19, SARS, bird flu, toxic exposures)
C.
Drowning
D.
ICU Ethics
5.
Living will/DPOA/Healthcare surrogate
7.
Palliative care, hospice
E.
ICU Management and Organization
1.
Clinical care bundles and guidelines (e.g., sepsis, catheter management)
4.
HIPAA (privacy and security)
6.
Outcome and performance measures (HCAPS)
7.
Regulatory requirements
8.
Scoring systems (e.g., APACHE, SOFA)
9.
Sedation/analgesia/delirium assessment (e.g., CAM-ICU, RASS)
10.
Triage and resource utilization
F.
Infection Control
1.
Environmental exposures
2.
Isolation techniques
a.
General/universal precautions
c.
Specific isolation procedures
4.
Nosocomial infections
a.
Catheter associated infections
b.
Pneumonia (ventilator associated, hospital associated, etc.)
c.
UTI, catheter-associated UTI
G.
Life Support and Resuscitation
H.
Nutrition Management
1.
Enteral and parenteral nutrition (formula, caloric intake)
2.
Metabolic assessment (basal and stress energy requirements)
I.
Pain and Sedation Management
1.
Systemic analgesia (indications, contraindications, complications)
2.
Regional analgesia (indications, contraindications, complications
J.
Pharmacology (Indications, Contraindications, and Complications)
1.
Antidepressants
a.
Tricyclic antidepressants
2.
Antimicrobials
2.
Gram-negative organisms
3.
Gram-positive organisms
4.
Spirochetal and rickettsial
c.
Antimicrobial resistance
f.
Prophylactic antimicrobials
4.
Genetic considerations
5.
Pharmacokinetics and pharmacodynamics and drug metabolism
6.
Neuromuscular blocking drugs
K.
Poisonings, Toxic Ingestion, Overdoses
L.
Procedures
1.
Airway
b.
Tracheostomy and cricothyrotomy
2.
Monitoring techniques and troubleshooting (e.g., cardiac, neurologic, etc.)
3.
Ultrasound (indications, physics and interpretation)
a.
Cardiac (transthoracic, transesophageal)
d.
Abdominal, including gastric
4.
Vascular access
M.
Thermoregulation
1.
Hyperthermia
c.
Malignant hyperthermia
d.
Neuroleptic malignant syndrome
2.
Hypothermia
N.
Diversity, Equity, and Inclusion (DEI) in health care
1.
Barriers
a.
Systematic racism, colorism/shadeism, sexism, discrimination against sexual orientation, gender identity,language, national origin, ethnicity, religion, immigration/citizenship status, age, familial status, and disability
b.
Bias; Implicit bias, microaggression, stereotype threat
2.
Approaches to improvement; interventions at individual, inter-personal, community, organizational and policy levels; cultural and gender competency, upstander vs. bystander, allyship vs. performative action, tokenism vs. representation, assortativity vs. homophily
4.
DEI in academia
b.
Scholarship; Representation of diversity and race related topics in research, Importance of language in reports discussing racial inequities
O.
Healthcare Disparities
1.
Social determinants of health considerations in assessment and management of patients – race, language, education status, religion, housing, nutrition, geographic location, rural vs. urban, access to and quality of care, health coverage
2.
Maternal healthcare disparities; Maternal mortality and morbidity, Pain management
3.
Child and adolescent healthcare disparities
4.
ICU disparities and outcomes
P.
Ethics and Medico-Legal Issues
1.
Professionalism: definitions and teaching
a.
Disclosure of errors or adverse events
b.
Professional behavior: honesty, integrity, compassion, respect, altruism, conflicts of interest, response to marketing
c.
Recognizing limitations in expertise and need to seek guidance
d.
Personal role in reporting unsafe conditions and fitness for work
e.
Recognizing and responding to unprofessional behavior
f.
Evidence-based practice
2.
Patient autonomy and decision making
a.
Principles of informed consent and shared decision making
b.
Advance Directives, Do Not Resuscitate (DNR) Orders, medical orders for life-sustaining treatment
c.
Health care proxy laws and limitations
d.
Patients Refusing Transfusion or Other Treatments
3.
Legal and regulatory issues
a.
Elements of medical malpractice: duty, breath of duty, causation, damages
b.
Legal actions and consequences, National Practitioner Data Bank, Closed Claims findings, professional liability insurance
c.
Understanding laws related to controlled substances, including opioids and cannabinoids
d.
Patient privacy issues: principles of confidentiality, access to records, protected health information
e.
The Health Insurance Portability and Accountability Act (HIPAA)
4.
Primary Certification, Recertification, Maintenance of Certification and Related Issues (Professional Standing, Lifelong Learning, Cognitive Knowledge, Clinical Practice Assessment, Systems-Based Practice)
5.
Research ethics
a.
Principles of justice, autonomy, beneficence, nonmalfeasance
b.
Ethical standards in research design: scientific validity, fair subject selection, favorable risk-benefit profile
c.
Review and implementation of trials, the institutional review board
d.
Informed consent in research
e.
Conflicts of interest and financial disclosure
6.
Clinician wellness and self-care
a.
Diagnosis and treatment of burnout
c.
Adaptations for clinical disability
Q.
Practice Management
1.
Costs of medical/anesthesia care
a.
Understanding principles of healthcare funding and payment
b.
Cost-conscious practice
2.
Efficient OR staffing and scheduling
a.
Subspecialization issues: pediatrics, cardiac, regional, obstetric coverage
b.
Anesthesia care team and scope of practice
3.
Population health: perioperative surgical home and enhanced recovery
a.
Population based health determinants, resources to improve access
b.
Health care disparities between populations
4.
Clinical informatics
a.
Electronic medical record systems: costs and benefits
b.
Artificial intelligence and machine learning
5.
Documentation, coding, and billing
a.
Compliance with documentation requirements
b.
Accuracy, clarity, specificity of medical records
c.
Coding integrity, audits, and insurance denials
R.
Quality Improvement and Patient Safety
1.
Definitions
a.
Medical error, adverse events, sentinel events, misuse of medications and technology
b.
Human factors and mindfulness
c.
Systems thinking and technology design
2.
Medication errors: assessment and prevention
a.
Medication reconciliation
b.
Information technology to reduce medication errors
3.
Crisis Management and Teamwork
b.
Crisis manuals and other cognitive aids
e.
Preoperative and procedural checklists
4.
Quality Improvement (QI) Basics
a.
Design, Analysis, and implementation of QI projects
d.
Patient satisfaction measurement
e.
Value-based care incentives, pay-for-performance
5.
Performance Assessment
a.
Individual benchmarking
b.
Group and facility scorecards
1.
Federal Quality Payment Program
6.
Change Management Methods
a.
Peer review and morbidity and mortality Conferences
e.
Failure mode and effects analysis
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