INTENSIVE CARE MEDICINE ROTATION

 

Contacts: Roman Melamed (612) 863-4020, page/text through anwpaging.com, or email (obtain email address through medical education office)

 

Subspecialty clinic: none

 

Resident continuity clinic: Thursday morning for the G3 and Friday morning for the G1, a three week minimum notice, given to Anne is required for the G1 if you are planning on taking vacation time (no vacation is allowed during this rotation for the G3, see below).

 

Vacation policy: G3 residents may not take vacation during this rotation.  G1 residents can take up to a week off, but no more than one block of time, regardless of how long it is.  This block has to be scheduled at the beginning of the rotation.  Residency administration and the long call intensivist have to be informed as soon as possible in cases of illness or family emergency. 

 

Conference:

1. Monthly critical care conference. See resident conference schedule for dates.

2. Multidisciplinary rounds every Tuesday 9:00 – 10:00 St. 20 Conference Room. Contact Sarah Pangarakis, RN, CCNP 612-863-4020 or page her for details.

 

Performance Expectations: This is a ward rotation with no call or weekend responsibilities. The workday is 7:00 - 5:00 or until the work is done whichever is later. Please come to the Intensivist office at 7 am for the morning report and your daily assignment. No new patients will be assigned after 4:30 pm. Attendance at teaching conferences is encouraged but patient care responsibilities take precedent. The resident on service is expected to be physically present in the ICU most of the time and should be available for house officer responsibilities for station 20. The ICU resident is anticipated to care for 4-8 patients at a time depending on the resident’s level of training and the complexity of the patients.

 

Educational Goals and Objectives:

 

 

Educational objectives

Assessment method

Patient Care

1) Perform admissions, consults and follow up visits on a broad range of ICU patients. The patients should be staffed, and the encounters should be documented in the chart.

2) Perform common ICU procedures (i.e. arterial lines, central lines, pulmonary artery catheters, thoracentesis, and paracentesis). Supervision will be provided by the ICU staff or another physician with the expertise in a specific procedure. The resident is expected to understand the indications, contraindications, risks and benefits of the procedure. The resident will learn the basics of hemodynamic monitoring in the ICU, approach to the airway management and principles of invasive and non-invasive mechanical ventilation.

3) Develop a systemic approach to the care of the ICU patient and will participate in the collaborative model of patient care by attending multidisciplinary rounds.

1) Global faculty assessment

2) Direct faculty bedside observation

Medical Knowledge

1) Demonstrate knowledge of basic and clinical sciences, understanding of complex mechanisms of the disease, and ability to use evidence-based approach in clinical decision-making. The resident will review core topics listed below using daily attending rounds, didactic sessions with the ICU staff, resources provided by the SCCM and independent reading.

Global faculty assessment

Practice-Based Learning and Improvement

1) Demonstrate insight into knowledge deficiencies and limitations

2) Use information technology to answer clinical questions

Global faculty assessment

Interpersonal and Communication Skills

1) Refine the skills necessary to present patients and topics informally and formally to another physician or group.

2) Refine the skills necessary for the effective communication with the patients and families.

Global faculty assessment

Professionalism

1) Demonstrate respect  and compassion in patient care

2) Demonstrate ability to handle multiple responsibilities

Global faculty assessment

Systems-Based Practice

1) Understand systems unique to this subspecialty

2) Participate in multidisciplinary rounds to experience and understand the collaborative model of patient care

Global faculty assessment

 

CORE TOPICS

1. Hemodynamic monitoring in the ICU (CVP and PAC wave form analysis; cardiac output; interpretation of hemodynamic data)

2. Shock (types of shock and approach to management)

3. Sepsis guidelines

4. Respiratory failure (hypoxemia, hypercapnea, V/Q mismatch, shunt, dead space) and respiratory monitoring (pulse oxymetry, end-tidal CO2, arterial and venous blood gas)

5. Ventilator management (modes; initial settings; alarms; PEEP, plateau pressure and intrinsic PEEP; weaning; use in specific conditions: obstructive lung disease, ARDS)

6. Approach to airway management (indications for intubation; evaluation of the airway; approach to difficult airway; patient with tracheostomy)

7. Evaluation and treatment of pneumonia in the ICU (guidelines for CAP and health care associated pneumonia; VAP)

8. Intoxication and overdose

9. Gastrointestinal bleeding and transfusion therapy
10. Evaluation and management of delirium / agitation in the ICU

11. Nutrition

12. DVT/stress ulcer prophylaxis in the ICU

 

RESOURCES:

 

1. The recommended journal articles are provided in the resident folders that can be found in the Intensivist office on St. 20.

 

2.  Adult RICU on-line training course provided by the Society of Critical Care Medicine. It can be found at www.learnicu.org or accessed from the SCCM website.  Please complete the pre-test within the first 2 days of your rotation, and the post- test by the end of the rotation. The results of the tests will not affect your evaluation, but you are encouraged to do your best. If you are not registered yet, please use this link:

http://sccmwww.sccm.org/lms/NewUser.aspx?progid=94

 

3. Helpful textbooks:

1. Parillo J, Dellinger R: Critical Care Medicine: Principles of Diagnosis and      Management in Adults, 2002

2. Irwin and Rippe’s Intensive Care Medicine, 2003

3. Paul L Marino: The ICU book

4. Scott W. Sharkey: A Guide to Interpretation of Hemodynamic Data in the Coronary Care Unit, 1997

5. Lawrence Martin: All You Really Need to Know to Interpret Arterial Blood Gases

6. Marini J, Wheeler A:  Critical Care Medicine 2nd edition

7. Irwin S et al: Procedures and Techniques in Intensive Care Medicine 2nd edition

8. Vukmir R: Airway Management in the Critically Ill, 2001

 

 

We are happy to have you as part of our team. Please do not hesitate to ask questions or make suggestions. We hope that this rotation will be an important part of your training.

 

ANW INTENSIVISTS