Critical Care

Critical care education is an area of focus for the residency involving intensive clinical experience combined with mandatory and supplemental didactics. The resident curriculum contains mandatory rotations in the medical, trauma/surgical, and pediatric intensive care units over the course of the three-year residency. There is an optional elective rotation on critical care topics that is tailored to the resident’s area of interest. We now offer a critical care distinction track, providing optional experience for residents through exposure to experiences in the clinical, administrative, and educational missions of critical care in the emergency department.

Objectives: 

Airway: Develop a working knowledge of basic and advanced airway management theory, skills, and algorithms. Gain an understanding of the pharmacokinetics/dynamics of drugs commonly used for RSI, sedation assisted intubation, post intubation sedation, and peri-intubation hemodynamic compromise. Participate in skills lab with different intubation devices.

Breathing: Develop a working knowledge of noninvasive ventilation techniques and indications, blood gas and acid-base analysis, and both basic and advanced ventilator management.

Circulation: Enhance understanding of etiologies, diagnosis, and management of shock. Gain working knowledge of the pharmacologic and mechanical treatments of shock. Develop an understanding of both noninvasive and invasive hemodynamic monitoring. Prepare to discuss current treatment modalities for in-hospital and out of hospital cardiac arrest. Participate in skills lab for vascular access, shock management, and bedside ultrasound, transvenous pacing, etc. Understand how to set up, interpret, and troubleshoot invasive monitors (CVP, art line, etc.), IV pumps, etc.

Disability: Gain knowledge of intricacies regarding neurologic trauma, shock, and catastrophes.

Clinical Experience: 

Clinically, residents are encouraged to manage the critically ill patients from the beginning of their intern year rather than a strict role-defined graded responsibility model. During the third year, residents rotate though the "Resuscitation Captain" shift. This resuscitation captain is responsible for assisting their colleagues in the management, resuscitation, and procedures on all critically ill patients in the emergency department. This shift provides the residents the opportunity to have dedicated time to manage the critically ill without the responsibility of charting or maintaining the flow of the department. This allows for real-time education through bedside teaching and self-directed learning and has been incredibly popular. At the end of the shift the resident gives a 15-20 minute "daily teaching" on a topic of their choice.

Didactic Experience: 

Didactics include a monthly lecture by critical care medicine faculty, panel discussions, simulation lab time, case discussions over email or dinner, and journal clubs.

A resident elective is offered for those residents interested in one-on-one time with the critical care medicine faculty. All second- or third-year residents are eligible for this elective after they have completed one of their mandatory ICU rotations. The rotation is tailored to the interests of the resident and consists of small group discussions and lectures, readings, hands-on simulation, and hands-on skills lab.  Residents interested in a critical care medicine fellowship may rotate through the MICU on a "sub-fellow" basis to gain exposure to that experience.

Evaluation Process: 

Sample Topics (tailored to the resident's areas of interest):

At the end of the rotation, the resident prepares and delivers a lecture of their choosing regarding an area of resuscitation in which they are interested:

Airway management

  • Basic airway management
  • Advanced airway management
  • Peri-intubation considerations
  • RSI, sedation only, awake intubation pharmacology
  • Post intubation sedation

Pulmonary

  • Oxygen delivery devices
  • Blood gas and acid base analysis
  • NIPPV uses and management
  • Basic and advanced ventilator management
  • Advanced ventilatory and gas exchange strategies (ECMO, Oscillators, etc.)
  • Chest imaging (CT, X-ray, US)

Cardiac

  • Hemodynamic monitoring (invasive and noninvasive)
  • Left heart failure
  • Right heart failure and pulmonary hypertension
  • Arrhythmia management
  • Cardiac arrest, both in hospital and out of hospital
  • Bedside Echocardiography
  • Transvenous pacing
  • Acute Coronary Syndrome and Pulmonary Embolism management/diagnosis
  • Pharmacology related to shock management and arrhythmias

GI/Renal/GU

  • Acute kidney injury/renal failure
  • Renal replacement therapy
  • OB/GYN catastrophes

Endocrine

  • Endocrinopathies
  • Metabolic catastrophes

Heme/Onc

  • Hematologic catastrophes
  • Oncology critical care
  • Hemorrhage management
  • Massive transfusion and damage control resuscitation

Neurologic

  • ICH management
  • CPP and ICP management

Tox/Pharmacy

  • Management of various overdoses
  • Pressors/vasoactive agents
  • HTN crises
  • Resuscitation pearls