Rotation on the Pediatric Critical Care Service (1 month)

  1. At the conclusion of the rotation, the fellow will be able to demonstrate the appropriate management according to best evidence based practice and evaluate the outcomes of patients with the following conditions. The fellow will acquire sufficient knowledge in the rotation so as to pass the exam for added board certification in surgical critical care at end of his or her training
    • Cardiovascular instability including arrhythmias in the pediatric patient
    • Respiratory failure including acute respiratory distress syndrome (Acute Lung Injury) in the pediatric patient
    • Pediatric renal disease
    • Pediatric central nervous system pathology including encephalopathy, meningitis, traumatic brain injury and brain death.
    • Metabolic, endocrine and electrolyte abnormalities.
    • Infectious diseases including sepsis and septic shock in pediatric patients
    • Hematologic disorders including anemia, neutropenia, thrombocytopenia and thrombocytosis. The fellow will also be aware of the indications for blood transfusion in the pediatric patient
    • Gastrointestinal diseases including acute and chronic liver failure
    • Traumatic injuries, both blunt and penetrating, and the complications peculiar to pediatric patients with traumatic injuries including the stress response and post-traumatic stress disorder
    • Nutritional disorders, and options for nutritional care of pediatric patients
    • Oncologic complications in the child with cancer
    • Psychiatric disorders specific to the pediatric and adolescent patient
    • Ethical and legal problems issues in the Pediatric ICU, including end of life issues in the dying child.
  2. At the conclusion of the rotation, the fellow will be able to demonstrate adequate competence in:
    • Resuscitation skills including advanced cardiopulmonary resuscitation, advanced trauma life support, pediatric acute life support and crisis management.
    • Airway management using bag and mask ventilation in non-intubated, conscious and unconscious, paralyzed and non-paralyzed pediatric patients.
    • Laryngoscopy and intubation of the pediatric patient
    • Ventilator management including the use of volume and pressure modes and the use of supplemental oxygen. The fellow will be expected to implement treatment and adjust ventilator modes to manage elevated airway pressures. The fellow will be familiar with the following salvage modes of ventilating the patient with refractory hypoxemia: prone positioning, high frequency oscillatory ventilation, and bilevel ventilation.
    • Interpretation of pulmonary function tests.
    • Placement of chest thoracostomy tubes.
    • Fiberoptic laryngotracheobronchoscopy for diagnostic and emergency therapeutic interventions.
    • Sterile technique and insertion of arterial and central venous catheters
    • Interpretation of central venous and pulmonary artery catheter data.
    • Interpretation of electrocardiograms. Pharmacologic support of circulation.
    • Interpretation of arterial blood gas, venous blood gas and other laboratory data.
    • Monitoring and management of patients with central venous system monitors, including intracranial pressure monitoring.
    • Use of pharmacologic agents in the management of Pediatric ICU patients, including pharmacokinetics, dynamics, metabolism and excretion of these agents.
    • Management of patients with acute allergic reactions and/or anaphylaxis.
    • Management of patients requiring massive fluid and blood product resuscitation.
    • Application of ethical principles including informed consent, implementation of Do Not Resuscitate Orders, withholding or withdrawing life support and clarifying goals of Advanced Directives, setting treatment goals with patient's surrogate.
    • Pre- and interhospital transportation of critically ill patients.
    • Administrative techniques including gatekeeping, triaging, quality assurance, and policy implementation.
    • Teaching of medical students and residents assigned to the Intensive Care Units.
  3. Evaluate, critique and interpret the critical care literature as it applies to patients in a typical pediatric intensive care unit
  4. Provide consultation in daily patient care as emergent situations warrant.
  5. Participate in all educational activities in the unit including core lecture series, educational workshops, educational modules, Journal Club, Grand Rounds, Research Conferences, and Quality Improvement Conferences. The fellow will be involved in various quality assurance initiatives and will be expected to lead discharge planning rounds.
  6. Complete mandatory procedure logbooks verifying primary critical care responsibility of pediatric patients sufficient to establish qualifications in surgical critical care.
  7. The fellow shall have a maximum of five patients to which he or she is primarily responsible, but may assist residents in the care of other patients if the needs of the patient or the educational needs of the resident manifest.