The objective is to train housestaff in didactic and technical aspects of post-operative management of patients after cardiothoracic surgery, as well as in acute cardiac medical care. This includes management of surgical complications, pacemakers, arrhythmias, and coagulation disorders and post-operative respiratory and renal insufficiency.
The fellows are expected to go to the OR at least once per week, get a working knowledge of the cardiopulmonary bypass for the intra-operative and post-operative management and of anesthetic techniques applicable to cardiovascular illness.
The rounds are at 6:30 AM and 8:00 PM everyday. The fellows are encouraged to attend the Chairman's rounds in Moses CSICU on Saturday at 8:00 AM. The fellows are required to attend the Monday Cardiothoracic Conference is at 7:00 AM, and are encouraged to attend the Cardiac Cath Conference and Cardiology Grand Rounds. Critical Care Medicine provides a monthly conference on Monday morning dealing with in-depth review of a Critical Care topic relevant to acute cardiac care. The in-house call for this rotation is every fourth night.
The most frequent diagnoses at the time of admission to the CSICU are coronary artery bypass graft, valvular surgery and thoracic surgery. In addition, there is a rapidly expanding heart transplant program and a ventricular assist device (VAD) program. The fellows are exposed to management of perioperative cardiac failure and cardiogenic shock, post-operative emergencies including cardiac tamponade and hemorrhage, severe respiratory failure and renal failure. Acute cardiac medical intensive care diagnoses include myocardial infarction, unstable angina, cardiogenic shock and complex arrhthymias.
Goals and Objectives
The educational purpose of this rotation is to develop full competence in evaluation, diagnosis and treatment of patients with severe cardiac disease requiring medical and surgical correction and critical care support.
The principle teaching method is thorough case management of all patients including history, physical exam, and interpretation of laboratory tests and cardiorespiratory physiology data. Teaching rounds, unit based conferences for both clinical and administrative management, increased involvement in house staff instruction, and mastery of technical aspects of major required procedures are mandatory. Fellows are required to prepare for teaching rounds by supplementing case based understanding with review of major textbooks and current peer reviewed literature.
Fellows are required to attend all curriculum conferences, and competently prepare their presentations under faculty supervision while on this rotation.
Faculty will provide supervision to fellows on site from 7am through 12 midnight every day.
To instruct the fellows in staffing and directing a university hospital heart transplant cardiothoracic ICU using large volume of support technologies including IABP, ECMO, and VAD.
- PATIENT CARE: competent coordination and leadership of a university hospital heart center intensive care unit
- MEDICAL KNOWLEDGE: state-of-the-art diagnostic and therapeutic knowledge with focus on cardiac physiology and organ support
- PROFESSIONALISM: ethical and compassionate care delivery in a collaborative practice model
- INTERPERSONAL SKILLS: highly effective interpersonal communication directed at developing a leadership profile and consensus while standardizing care
- PRACTICE BASED LEARNING AND IMPROVEMENT: data collection and analysis in a highly competitive surgical specialty field
- SYSTEMS BASED PRACTICE: effective delivery of academic cardiothoracic intensive care
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