PEDIATRIC CRITICAL CARE ROTATION OVERVIEW

 

 

GENERAL

The PICU rotation can be a difficult one.  When residents work together as a team and help one another, the rotation becomes much easier and patient care improves.  If there are ever any problems or concerns, the Attendings/PNP are ALWAYS available to discuss such issues.

 

 

GOALS AND OBJECTIVES

o   Obtain an understanding of the pathophysiology of various critical illnesses in children

o   Learn to recognize, triage, and stabilize critically ill children and to realize one’s own limits of knowledge, skills, and stressors

o   Become familiar with invasive procedures and monitoring in the PICU

o   Become familiar with ethical issues within the PICU

o   Learn to read, critique, and apply medical literature appropriately

o   Participate as an integral member of the PICU team

 

 

CURRICULUM CONTENT

 

Respiratory Failure

o   Pathophysiology of different types of respiratory failure and their treatments

o   Bag mask ventilation and various modes of invasive and noninvasive positive pressure ventilation;

o   Interpretation of arterial blood gasses

 

Circulatory Failure

o   Types of shock and their manifestations

o   Evaluation and resuscitation of children in shock

o   Monitoring of shock states

o   Use of Vasopressors and Inotropes

 

Repair of Congenital Heart Disease

o   Types and post-operative management issues

 

Acute Brain Injury

o   Causes and pathophysiology of various types of brain injury

o   Clinical signs of high intracranial pressure

o   Monitoring and management of high ICP

 

Sedation, Analgesia and Paralysis

o   Strategies and pharmacology of various sedatives and analgesics

o   Use and complications of paralytic agents

 

Metabolic/Endocrinologic Abnormalities

o   Pathophysiology and treatment

 

Hematologic and Oncologic Abnormalities

o   Evaluation and management of bleeding disorders

o   Management of oncologic emergencies

 

Renal Failure

o   Pathophysiology and treatment

 

Ethics

o   Discussion of relevant ethical issues seen with the critically ill child

 

 

LECTURES

The major teaching method is case-based instruction/discussion at the bedside.  In addition, core lectures will be given periodically by the PICU Attendings or assigned to the residents. Attendance is mandatory for all those not in clinic.

 

Residents will also participate as “Nurse for a Day” with an experienced PICU nurse.

 

 

EVALUATION METHODS

The resident will be evaluated on his or her clinical and procedural skills, interest in learning and reading, organizational skills, and interactions with other members of the medical staff as well as patients and their families. These evaluations will occur via direct observation by the PICU Attendings/PNP and will be reported on departmental evaluation forms at the end of each rotation.  If a resident wishes feedback earlier in the rotation, he or she can ask an Attending/PNP for this information at anytime during the rotation

 

 

CURRICULUM EVALUATIONS

 The PICU faculty will review the curriculum and the recommended reading list periodically.  Resident feedback may be elicited one-on-one at the end of the rotation, so that appropriate changes may be made.  Evaluations of the rotation will also be solicited at Residency Administrative Meetings, and residents are asked to provide feedback in their twice-annual evaluation of rotations.

 

 

CLINICAL RESPONSIBILITIES

 

Morning Rounds: 7 AM.  Every patient should be rounded on and appropriate lab values and radiographic studies’ results should be obtained.  IT IS ESSENTIAL FOR THE RESIDENTS TO EXAMINE EACH VENTILATOR AND IV PUMP TO ENSURE THE PROPER SETTINGS ARE IN PLACE AND BEING RECORDED.

 

Afternoon Rounds:  3-4 PM on weekdays.  Post-call residents and residents in clinic are not required to attend PM rounds.

 

Daytime Responsibilities:  Residents should frequently round on their patients in addition to completing the day’s tasks prescribed during rounds

               

Admissions

All PICU admissions are admitted under the PICU Attending’s name.  The Attending should be notified of all potential admissions by the ER, 11 North senior resident, etc prior to acceptance.  The PICU resident will contact the Attending once the new admission is evaluated and the resident has a treatment plan.  It is the responsibility of the admitting resident to contact the patient’s PMD of the PICU admission either at the time of admission or the following morning.

 

Admission orders are the same as on the general pediatric ward.  These orders should have ventilator settings (when appropriate) and drug doses should be double-checked.  In a code situation, orders may be written after the event but must include times and dosages of medicines given – nursing staff will have this information

 

Transfer/Discharge Notes

Any patient transferred or discharged from the PICU is to have a transfer/discharge summary and appropriate orders.  These may be written prior to the patient’s actual departure from the PICU and held by the resident.  It is the responsibility of the transferring resident to sign out to the accepting resident and Attending.

 

Unit Coverage

A resident must be in the PICU at all times.  Exceptions to this are during resident administrative meetings and when an Attending/PNP is present within the PICU