OUTLINE FOR DESCRIPTION OF ROTATION
ROTATION: Critical Care Unit (ICU)
CORE PRECEPTORS: Paul
Guzzetta, MD ICU/Pulmonology
Michael
Flatley, MD ICU/Pulmonology
Jane
Neumann, MD
Pulmonology
Bill Burns, MD Cardiology
Tom
Palmer, MD Cardiology
Richard
Staudacher, MD
Cardiology
Terry
Zarling, MD Cardiology
DURATION: One
Month (Late PG-2 or PG-3)
1. GOALS/OBJECTIVES:
-
Develop
confidence and leadership skills in providing comprehensive and coordinated
care for acutely ill patients, ensuring timely consultation and intervention
and functioning within the limits of your expertise and training.
-
Provide
rapid and efficient evaluation and initial intervention of severely ill
patients.
-
Recognize
the limits of care for rural or non-tertiary care environments for the
development of effective triage skills and referral to tertiary environments
when necessary.
-
Manages
efficiently common ICU problems such as respiratory failure, CHF, thrombolytics
for MI, 5 causes of shock, common sources of severe infections (i.e. pneumonia,
pylonephritis, GI sepsis and abscesses, etc.) severe metabolic derangements
(i.e. electrolyte, acute renal failure, DKA), etc.
-
Become
competent in common ICU procedures such as arterial line placement, intubation
and ventilator management, central venous access, and if available,
thoracenthesis, paracentesis and lumbar puncture.
-
Strengthen
professional skills that will help ensure effective interactions with other
specialists, effective daily communications, conflict management and clarifying
with others the role that the family physician will play in overseeing care.
2. EXPECTATIONS: Only licensed late
second or early third-year residents will be able to take the ICU rotation.
Four residents will be on the rotation at a time. One resident will
be designated each night to cover the ICU for 24 hours. Weekend and weekday
shifts will be split evenly between the residents. Call will be in-house. Residents will meet their ACGME required
clinic times by taking clinic in the afternoon and evening. This will free all
of the residents for Monday, Tuesday, Thursday, and Friday teaching rounds.
The residents will complete an admission
history and physical on every ICU patient the attending physicians
participating in the rotation have. They will also write a consult note on each
ICU patient the attending physicians are asked to see. The residents will then
follow that patient along through their entire ICU stay. If one resident
experiences a particularly heavy call night, that resident will share patients
brought onto the service with a resident who does not have many patients. The
new resident will then continue with continuity care.
The residents will make every effort to round and write
a note on the ICU patients each morning before the attending physician arrives
in the ICU.
Consultation with attending physician is
required when the resident is unsure of the appropriate orders to write or if
the care team has concerns about the orders.
Attending physicians involved in the
rotation will make every effort to involve residents in the diagnostic and
treatment decisions made about their respective patients, and with any
procedures that are done.
Residents will be involved in every code
in the ICU, and as much as they are able, they will go to codes in the
emergency room and other hospital units.
Residents will document every ICU case
they see, including diagnoses and procedures.
-
Response to codes: Residents will respond to all codes in
the ICU, IMC, and ER and medical floors. To prevent conflicts with admissions,
the resident who is to be on-call the next day will respond codes in the morning, and the on-call resident will respond to codes
throughout the night.
3. PREPARATION/TEXTS:
-
Fundamental Critical Care Support (fccs) Course Text: Standardized
Curriculum of the Principles of Critical Care; Society of Critical Care
Medicine; Second Edition, June, 2000
Articles/Readings:
-
Acute
MI
-
CHF
-
COPD
-
ACLS
-
Arrythmias:
diagnosis and treatment in the ICU
-
Acute
and chronic renal failure management
-
Art
line/Central Line
-
Chest
Tube
-
Line
Placement central line, art line
-
Pericardiocentesis
-
Pressors
and anti-hypertensives
-
Stabilization
of patient in shock
-
Swans,
management & placement
-
Thoracentesis:
How to perform. therapeutic
and diagnostic.
-
Transfusion:
when to use what blood product. Transfusion reactions
-
Indications,
when to intubate
-
Weaning
vents
-
Bipap,
Cpap
-
Changing
vent settings based on Blood gasses
4. TYPICAL DAY/WEEK:
-
Residents
will be available until noon to meet with their preceptors every morning; there
will be no post call clinic afternoons.
-
2
mornings per week of CCU; 2 mornings per week of Pulmonary; and 1 morning per
week of Nephro attending teaching if possible
-
Clinic
should be, “no clinic on call or post call”
-
Residents
will attempt to make morning conferences when the service is lighter.
5. WORK-UPS/WRITE-UPS: History and physical and consult notes
written and dictated within 24 hours of admission. Interval notes daily at
least.
6. PROCEDURES: Every attention should be made to focus on
gaining skills that the resident will likely use in their
future practice.
-
Dos: Codes,
Intubate, Lines, Thoracentesis, Paracentesis
-
Do Nots: Caths, CV Surgery,
EP Study
7. AVAILABLE EDUCATIONAL
EXPERIENCES/CONFERENCES: Residents will be expected to go to afternoon
conferences on Wednesday when not on-call or post-call. Residents will define
with participating faculty a schedule of the defined topics for lecture.
8. IMPACT OF OFFICE SCHEDULE: Residents
should still be able to be involved in all residency related functions. All resident
activities will be supervised by rotation preceptors so that residents are able
to call the attending in for support when needed for unstable patients.
Progress notes and plans will be reviewed and signed for all patient
encounters.
9. CALL AND SHARED
CALL:
-
With
4 residents, every 4th weekend
-
24
Hour in-house call (vs. home call)
-
Clinic
Call when not on call or post-call
-
Every
attempt will be made to avoid Moonlighting
-
Rotation
would be preceptor-based; need to provide continuity for entire month
10. WEEKEND
REQUIREMENTS: With 4 residents, call could be divided by weekend, or
weekend days could be split up. Every attempt will be made to avoid
moonlighting.
11. VACATION/TIME OFF:
None.
12. EVALUATION:
Evaluation will be based on
active participation in work-ups, quality of write-ups, decision-making, and
care of patients on the service.
13.
CRITERIA FOR
SUCCESSFUL COMPLETION: Meeting goals, objectives and expectations as outlined
above, and confirmation of same via satisfactory evaluations from preceptors
involved.
14. SUPERVISION: All resident activities will be
supervised by rotation preceptors so that residents are able to call the
attending in for support when needed for unstable patients. Progress notes and
plans will be reviewed and signed for all patient encounters.
17.
LIST OF TOPICS FOR PRECEPTORS TO LECTURE ON: To be further
defined.
-
Stabilization
of patient in shock
-
ACLS
-
ATLS
-
Intubation,
vent management and weaning
-
Swans,
placement & management
-
Placement
and use of Arterial lines/Central lines
-
Placement
and weaning of Chest Tubes
-
Diagnostic
and therapeuticThoracentesis
-
Pericardiocentesis
-
Proper
use of drips
-
Pressors
-
Vasodilators
-
Insulin
drips
-
Diuretic
trips
-
Etc.
-
Proper
use of blood products/IV fluids
Revised: 06/1/05
– LSL:lmc
ICU Lectures
Lecture
Given By
|
Lecture Topic |
|
|
Acute
MI |
|
|
CHF |
|
|
COPD |
|
|
Arrythmias: diagnosis and treatment in the
ICU
|
|
|
Acute
and chronic renal failure management |
|
|
Art
line/Central Line placement |
|
|
Chest
Tube placement and management |
|
|
Pericardiocentesis |
|
|
Pressors
and anti-hypertensives in the ICU |
|
|
Sedatives
and paralytics in the ICU/Intubated patients |
|
|
Stabilization
of patient in shock |
|
|
Swan-Ganz
Catheters placement and management |
|
|
Thoracentesis:
How to perform & therapeutic and diagnostic studies |
|
|
Transfusion:
when to use what blood product Transfusion
reactions |
|
|
Intubation:
indications, procedure, when to trach
and how to extubate |
|
|
Changing
vent settings based on Blood gasses |
|
|
Weaning
vents |
|
|
Bipap,
Cpap |