Goals and Objectives of the Critical Care Rotation
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Introduction The Anesthesiology residents critical care rotation is 2 month experience occurring during the CA2 and CA3 years.

Site The rotation occurs in the Intensive Care Unit at the George Washington University.

Rotation Director Christopher Junker, M.D., Assistant Professor

Faculty

Christopher Junker, M.D

Michael Seneff, M.D

Lakhmir Chawla, M.D., Assistant Professor

Bruce Abell, M.D., Assistant Professor

Guierrmo Gutierrez, M.D., Professor

Educational Activities

Daily teaching rounds

- physiological concepts can be integrated with the physical examination

- data obtained at the bedside is used to understand of the diagnostic and therapeutic options

- formal didactic sessions, scheduled 4 days a week cover the educational objectives outlined below.  

Educational Objectives

1. Critical Care Monitoring

•  Understand the function of both non-invasive and invasive blood pressure monitoring systems

•  Be able to trouble-shoot hemodynamic monitoring systems

•  Be able to list the indications for and complications of central venous and pulmonary artery pressure monitoring

•  Understand the various methods of cardiac output determination

•  Be able to interpret arterial blood gases

•  Understand the basic principles of oximetry

•  Interpret mixed venous blood gasses and other indices of tissue oxygenation

2. Cardiac Disorders

•  Identify and develop a differential diagnosis for shock

•  Describe the diagnosis and treatment of myocardial ischemia and infarction

•  Describe the diagnosis and treatment of each major type of dysrhythmia

3. Respiratory

•  Describe the four types of respiratory failure and the basis of their treatment

•  Learn how to manage the airway in the ICU and how it differs from the OR

•  Be able to distinguish respiratory, metabolic, and mixed acid-base disorders

•  Understand and be able to describe the primary modes of mechanical ventilation and know the settings for each mode

•  Describe the definition, diagnosis, and pathophysiology of Acute Lung Injury and Acute Respiratory Distress Syndrome

•  Describe the current treatment for Acute Lung Injury and Acute Respiratory Distress Syndrome

•  Develop a differential diagnosis for the etiology of increased airway pressures

•  Discuss management strategies for acute obstructive airway diseases

•  Describe the approach to liberation from mechanical ventilation

•  Develop an algorhythm for the workup of a pleural effusion

•  Describe the indications for chest tube thoracostomy

•  Understand the function of chest tube drainage systems

4. Infectious Disease

•  Describe the pathophysiology and treatment of sepsis and septic shock

•  Describe the risk factors, prevention, diagnosis, and treatment of ventilator associated pneumonia and line sepsis

5. Endocrine

•  Describe the management of blood glucose in critically ill patients

•  Describe a strategy for detection and treatment of adrenal insufficiency in the ICU

6. Renal

•  Develop a differential diagnosis for acute oliguria and azotemia in the ICU

•  Describe the treatment of Acute Renal Failure in the ICU

7. Landmark Papers in support of current standard of Critical Care Pracitc.:   The following literature will be discussed during the rotation and trainees should be conversant in the primary findings and clinical application of the following articles.   Pertinent articles are added as appropriate:

•  Efficacy and Safety of Recombinant Human Activated Protein C for Severe Sepsis, Bernard G. R. et. al.; The Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group, N Engl J Med 2001; 344:699-709.

•  Intensive Insulin Therapy in Critically Ill Patients, Van den Berghe G. et. al., N Engl J Med 2001; 345:1359-1367.

•  Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome, The Acute Respiratory Distress Syndrome Network
  N Engl J Med 2000; 342:1301-1308.

•  Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock, Rivers E. et. al.; The Early Goal - Directed Therapy Collaborative Group, N Engl J Med 2001; 345:1368-1377.

•  Effect of Treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock, Annane D. et. al., JAMA 2002; 288:862-871.

8. Procedural Competencies

•  Understand the indications, site considerations, complications, and be able to place an arterial catheter, central venous catheter, and pulmonary artery catheter

•  Understand unique aspects of Critical Care Airway Management