The goal is to provide residents in internal medicine and fellows in pulmonary/critical care medicine with experience in managing critically ill patients, utilizing mechanical ventilators, interpreting hemodynamic data in the acute care setting, and appropriate use of subspecialty consultation in the intensive care setting. It is assumed that residents and fellows will also gain experience in managing the acute problems associated with pulmonary diseases during this rotation.
Respiratory Failure
Recognize impending respiratory failure by both clinical and laboratory data, learn airway management, gain experience in principles of mechanical ventilation, learn to use noninvasive and invasive monitoring techniques, recognize and treat complications of mechanical ventilation, and gain experience in the use of sedatives and paralytics in the ICU.
Hemodynamic Monitoring
Recognize the need for hemodynamic monitoring, gain experience gaining central venous access and placing right heart catheters, learn to interpret hemodynamic data from right heart catheters, gain experience in using vasoactive drugs, and gain experience placing and using arterial lines.
Managing Acute Intoxications
Recognize the major overdose syndromes, learn the acute management of drug overdoses including appropriate use of gastric lavage and charcoal infusions, learn about common antidotes and resources available for managing less common intoxicants, and learn when consultative subspecialty assistance such as dialysis is useful.
Support of Multiorgan System Failure
Learn to recognize patients at high risk for multiorgan system failure, learn to seek appropriate subspecialty and specialty consultation for these patients, gain experience working with consultants on multiorgan system failure patients, and interact with surgeons on pre- and postoperative management.
Basic Nutritional Support
Gain experience in calculating caloric requirements in acutely ill patients, providing either enteral or parenteral nutritional support and gain experience in monitoring nutrition in the MICU.
Basic and Advanced cardiopulmonary Resuscitation
Appropriate use of resuscitation in the ICU, gain experience in performing both basic and advanced CPR in the ICU.
Ethical Decision Making
Gain experience in surrogate decision-making, withdrawing and withholding supportive care, and criteria for brain death. Gain experience working with families and interested parties in these areas.
