| Anesthesiology Critical Care Medicine Fellowship
Director: Nicholas G. Bircher, MD
Fellows will:
- State the etiology, describe the pathophysiology, demonstrate the appropriate management and evaluate the outcomes of patients with:
- Cardiovascular instability including arrhythmias, myocardial infarction, congestive heart failure, vascular abnormalities, and shock.
- Respiratory failure including acute respiratory distress syndrome, chronic obstructive lung disease, respiratory muscle weakness, pneumonia and pulmonary embolus.
- Renal insufficiency; acute and chronic.
- Central nervous system pathology including encephalopathy, cerebral vascular accidents and brain death.
- Metabolic, endocrine and electrolyte abnormalities.
- Infectious diseases including sepsis and septic shock. Differentiate treatment plans for patients who are immunocompetent versus immunosuppressed.
- Hematologic disorders including anemia, neutropenia, thrombocytopenia and thrombocytosis.
- Gastrointestinal diseases including acute and chronic liver failure, pancreatitis, cholecystitis, gastritis, peptic ulcer disease, and upper and lower gastrointestinal hemorrhage.
- Genitourinary pathology.
- Obstetric and gynecological disorders.
- Trauma.
- Thermal injuries.
- Pediatric emergenices, including neonatal problems.
- Nutritional disorders.
- Oncologic complications.
- Life threatening geriatric problems.
- Psychiatric disorders causing special ICU problems.
- Ethical and legal problems.
- Demonstrate effective:
- Resuscitation skills including advanced cardiopulmonary resuscitation, advanced trauma life support, pediatric life support and crisis management.
- Airway management using bag and mask ventilation in non-intubated, conscious and unconscious, paralyzed and non-paralyzed patients.
- Laryngoscopy and intubation.
- Ventilator management including the use of volume and pressure modes and the use of supplemental oxygen.
- Implement treatment and adjust ventilator modes to manage elevated airway pressures.
- Interpretation of pulmonary function tests.
- Management of tension pneumothorax and summarize indications for placement of chest thoracostomy tubes.
- Fiberoptic laryngotracheobronchoscopy for emergency therapeurtic interventions.
- Sterile technique and insertion of arterial, central venous, hemodialysis and pulmonary artery catheters.
- Interpretation of central venous and pulmonary artery catheter data.
- Interpretation of electrocardiograms.
- Insertion of emergent transvenous temporary cardiac pacemakers.
- Pharmacologic support of circulation.
- Management of patients on intra-aortic balloon pump.
- 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 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, clarifying goals of Advanced Directives, setting treatment goals with patient's surrogate.
- Interactions and communications with members of:
- The nursing staff
- Anesthesia staff following patient transport from the OR or Recovery Room.
- The Primary Care team
- Respiratory Therapy
- Nutrition support
- CORE (Center for Organ Recovery and Education)
- Physical Therapy
- 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.
- Evaluate, critique and interpret medical literature. Discuss biostatistics and debate experimental design.
- Participate in research projects, clinical trials occurring on patients in the ICU.
- Provide consultation in daily patient care as emergent situations.
- Participate in all educational activities including core lecture series, educational workshops, educational modules, Journal Club, Grand Rounds, Research Conferences, and Quality Improvement Conferences.
- Complete mandatory procedure forms verifying satisfactory performance with endotracheal intubation, central venous, pulmonary artery and arterial line insertion and chest thoracostomy insertion.
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