Clinical Experience

Surgical Critical Care Fellowship

Clinical Training

The clinical and didactic training is intended to expand the knowledge of the fellow in all areas of critical care. The fellow will rotate for nine months on the pediatric surgical service, managing the critically ill neonates and the children in the Pediatric Intensive Care Unit.

The remaining three months are spent off service in a different unit each month:

Neonatal Intensive Care Unit
Pediatric Intensive Care Unit
Adult Surgical Critical Care Unit at University Health and St. Luke's Hospital

Neonatal Intensive Care Unit Rotation

Goals

To introduce the surgical critical care (SCC) resident to the neonatology intensivists, residents and nursing personnel. This will aid in the residents ability to integrate their expertise into the management of the surgical critical care patients.
To familiarize the SCC resident with general disease processes seen in neonatal patients, specifically medical in nature.
To provide the SCC resident the opportunity for the initial evaluation, physical examination, diagnostic evaluation and medical decision making of newborns with critical illnesses.
To allow the SCC resident to learn the medical management of cardiovascular support for neonates requiring pharmacologic or cardiac assist device intervention.
To provide the SCC with an understanding of the physiologic alterations associated with neonatal pulmonary diseases, and an understanding of lung mechanics and ventilation support in this population.
To teach the SCC resident basic NICU procedures related to the care of the newborn patient.
To give the SCC resident the opportunity to learn the fluid, electrolyte and nutritional requirements in severely premature, premature and term infants.

Objectives

Learn the personnel framework of a neonatal intensive care unit, to include neonatology, nursing, respiratory therapy, dietary services, pharmacy and ancillary staff.
Understand basic newborn transitional physiology (closure of patent foramen ovale, ductus arteriosus and pulmonary compliance/perfusion).
Become proficient in identifying normal and abnormal physical exam findings for premature and term infants.
Develop a methodical approach to the initial and daily evaluation and decision making process for the NICU patient.
Learn the indications for cardiac support,and become proficient in the utilization of pharmacologic support when indicated. Also, exposure to extracorporeal membrane oxygenator will be obtained.
Become skilled at understanding arterial and venous blood gas analysis in premature and term newborns and management of the various ventilators (high-frequency oscillator, Servo and Dragger) to appropriately effect change in neonates requiring ventilatory assist.
Learn how fluid, serum electrolyte and urine output requirements change during the management and ongoing care of the critically ill newborn and institute resuscitation and interventions appropriately for severely premature, premature and term infants.
Gain the knowledge required to provide adequate and appropriate nutritional support to all infants with regard to gestational age and severity of illness

Pediatric Intensive Care Unit Rotation

Goals

To allow the SCC resident to familiarize themselves with the pediatric critical care physicians, pediatric residents and nursing personnel of the PICU, providing effective interactions that will enable him/her to utilize the experience in the PICU to improve the management of future surgical critical care patients.
To familiarize the SCC resident with common pediatric diseases that lead to care requiring a critical care environment.
To provide the SCC resident the opportunity for the initial evaluation, physical examination, diagnostic evaluation and medical decision making of these critical illnesses in the pediatric population.
To allow the SCC resident to learn the medical management of cardiovascular support (pharmacologic and/or external assist (ECMO)) for infants and children with severe illness such as sepsis, metabolic abnormalities and congenital anomalies.
To provide the SCC with an understanding of pulmonary physiology as it relates to the pediatric critical care patient, as well as an understanding of lung mechanics and ventilation support in this population.
To teach the SCC resident basic PICU procedures related to the initial and subsequent care of infants and children requiring intensive critical care
To give the SCC resident the opportunity to learn the dynamics of fluid, electrolyte and nutritional requirements and management in severely ill pediatric patients.

Objectives

Learn the basics of cardiorespiratory resuscitation and emergency airway management in infants and children.
Recognize shock and understand the pathophysiology responsible for the clinical and physical findings.
Learn to interpret systemic arterial, central venous, intracranial and cerebral perfusion pressures and initiate management decisions to reach a desired affect.
Develop a methodical approach to the initial and daily evaluation and decision making process for the critically ill pediatric patient.
Learn the indications for cardiac support, and become proficient in the utilization of pharmacologic support when indicated.
Become skilled at interpreting arterial and venous blood gas analysis in the pediatric intensive-care patient, manage their ventilation to change their physiology and optimize the pulmonary function.
Learn how fluid, serum electrolyte, and urine output requirements change during the management and ongoing care of the pediatric intensive care patient and institute resuscitation and interventions appropriately.
Gain the knowledge required to provide adequate and appropriate nutritional support to the critically ill infant or child.
Learn how immunodeficiencies may lead to and/or affect the management of critical ill infants and children. This should include neoplastic, as well as infectious, etiologies.

Cardiac Intensive Care Rotation

Goals

To familiarize the SCC resident with the common congenital heart lesions
To provide the SCC resident the opportunity for the initial evaluation, physical examination, diagnostic evaluation and medical decision making of congenital heart disorders (CHD)
To allow the SCC resident to learn the intensive and multidrug management for cardiovascular support (pharmacologic and/or ECMO) for infants and children with severe CHD both preoperatively and postoperatively
To provide the SCC with an understanding of cardiac and pulmonary anatomy and physiology as it relates to the CHD patient
To provide an understanding of lung mechanics and ventilation support in this unique population
To give the SCC resident the opportunity to learn the dynamics of fluid management in children with CHD
To afford the SCC resident the experience to learn the management of the electrolyte imbalances and nutritional requirements in CHD pediatric patients.

Objectives

Learn the basics of cardiorespiratory resuscitation and emergency airway management in infants and children with CHD
Learn to interpret systemic arterial and central venous pressures in infants and children with CHD, and implement management decisions to improve their perfusion depending on the congenital heart defect present
Develop a methodical approach to the initial and daily evaluation and decision making process for the decompensated CHD patient
Learn the indications for cardiac support and become proficient in the utilization of pharmacologic support when indicated
Become skilled at interpreting arterial and venous blood gas analysis for CHD patients and manage their ventilation to improve their physiology and pulmonary function
Learn how fluid shifts and changes in intravascular, interstitial and extravascular volumes affect the CHD patient
Become proficient with the management of serum electrolyte and urine output during the various stages of repair and/or management of the CHD patient. Also, institute resuscitation and interventions appropriately
Gain the knowledge required to provide adequate and appropriate nutritional support to the infant or child with congenital heart lesions.