中華民國急救加護醫學會重症醫學訓練核心內容86.10.05第八屆第二次會員大會決議通過壹、前言一位重症專科醫師必須有能力在加護病房中對重症病人做到生命現象的維持與改進，此包括心肺功能的監視及治療，了解重大壓力(敗血症、外傷)下的生理反應，包括代謝、營養、凝血及電解質，並予矯正。對危急病人的疾病必須能做鑑別診斷與計劃治療，在適當時機會診其他專科醫師共同合作治療病人。貳、重症的訓練一、執行技術(一)呼吸的處理1.在無氣管內管情形下維持呼吸道暢通(ambumask/larygealmask)2.緊急氣道之建立3.氧氣治療4.各型呼吸器使用5.環狀軟骨切開術(二)胸管之建立(Insertionofchesttube)(三)中央靜脈導管之建立與判讀(四)肺動脈導管之建立與判讀(五)動脈導管之建立與判讀(六)心包脈積水穿刺(七)暫時性心律調節(八)心臟電擊(九)主動脈幫浦放置二、臨床經驗及認知在加護病房中所需之技術與AdvancedCardiacLifeSupport有許多重複之處，故所有人必須先通過ACLS之訓練。成為一個重症專科醫師必須包括以下訓練內容。(一)Cardiovascular1.RecognitionandAcuteManagementofa.Shock(allforms)b.Cardiacarrhythmiac.Cardiogenicpulmonaryedemad.Acutecoronarysyndromee.Hypertensiveemergencies2.Principlesofa.Vasoactiveandinotropictherapyb.Arterial,centralvenous,andpulmonaryarterycatheterizationandmonitoringc.Cardiovascularphysiologyinthecriticallyillpatient(二)Respiratory1.RecognitionandAcuteManagementofa.Acuteandchronicrespiratoryfailureb.Statusasthmaticusc.Inhalationinjuryd.Upperairwayobstructione.Neardrowningf.Acuterespiratorydistresssyndromeg.Pulmonaryembolism2.Interpretationofa.Pulmonaryfunctiontestsb.Arterialbloodgasanalysisc.Respiratorymonitor3.PrinciplesandApplicationofa.Oxygentherapyb.Mechanicalventilation(invasiveandnoninvasive)includingindications,modes,complications,andweaningc.Chestphysicaltherapy(三)Renal1.RecognitionandAcuteManagementofa.Fluidandelectrolytedisturbancesb.Renalfailurec.Acid-basedisorders2.Principlesofa.Drugdosinginrenalfailureb.Fluidandelectrolytetherapyinthecriticallyillpatientc.Dialysis(四)CentralNervousSystem1.RecognitionandAcuteManagementofa.Consciousdisturbanceb.Drugoverdosec.Acutehydrocephalusd.Braindeathevaluatione.Persistentvegetativestatef.Cerebralvascularaccidentsg.Seizureh.CentralnervoussysteminfectionI.Increasedintracranialpressure(IICP)j.Spinalcordlesion(五)MetabolicandEndocrine1.RecognitionandAcuteManagementofa.Adrenalcrisesb.DiabeticEmergenciesc.Thyroidstormandmyxedemacomad.Hypercalcemiacris