The night and weekend call staffing consists of a CCM attending from 7:00 AM to 12 midnight daily plus 24 hour coverage by a CCM fellow and a CCM PA.
The objective is to train housestaff in didactic and technical aspects of management of patients with critical medical and surgical illness. The rounds start at 7:30 AM on weekdays and weekends immediately following the daily 7:00 AM Critical Care Service report. The average night call for fellows on this rotation is every fourth night. This unit is a model of a university hospital teaching unit in a tertiary referral academic center, and is structured as a combined medical-surgical ICU which is the predominant national model of critical care practice for hospitals of this size.
In addition to clinical exposure and teaching, fellows will participate in clinical research for study patients admitted or transferred to this unit, development of database and upgrading of computer skills on equipment located in the fellow's office. Fluoroscopy access is through the adjacent CCU and in the last two beds. The Critical Care fellows office/conference room is shared with the P.A. team, and contains a library, computer system for medical literature search and other necessary educational materials.
Close relationships exist with the adjacent Echocardiography lab and Coronary Care Unit. The most frequent diagnoses at the time of admission to the MSICU are severe respiratory failure, septic shock, endocrine and metabolic emergencies, hemorrhagic shock, oncologic emergencies, and neuromuscular crises. The major surgical diagnoses are extensive vascular and intra-abdominal procedures, thoracic surgery and spine surgery.
This ICU serves as the Obstetric-Gynecology ICU for Montefiore due to the prescence of high-risk Obstetrics Center and of the Regional Neonatal ICU on site.
Goals and Objectives
The educational purpose of this rotation is to develop full competence in evaluation, diagnosis and treatment of patients with medical-surgical critical illness in the setting of a tertiary referral voluntary hospital in a closed unit setting.
The combined medical-surgical format is crucial for administrative and management training of the fellows, who also have a major role in administering the post-anesthesia care unit under the supervision of Critical Care faculty.
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.
Same as the Moses MICU and Moses SICU, with the crucial added component obstetric ICU and combined medical-surgical community hospital format component of Critical Care design.
To instruct the fellows in the requirements to staff and direct a general community hospital medical-surgical ICU, which is the primary model of critical care, practice in the U.S. Additional experience in managing patients with obstetric-gynecologic emergencies.
In addition to the reading lists for the Moses MICU and SICU:
- Maternal Mortality and Morbidity Review Committee. Pregnancy-associated mortality. Medical causes of death 1995–1998. Matern Mortal Morb Rev Mass (1):1, 2000.
- Donaldson JO: Neurologic emergencies in pregnancy. Obstet Gynecol Clin North Am 18(2):199, 1991.
- Barton JR, Sibai BM: Care of the pregnancy complicating HELLP syndrome. Obstet Gynecol Clin North Am 18(2):165, 1991.
- Masson RG. Amniotic fluid embolism. Clin Chest Med 1992; 13: 657-665.
- Nelson-Piercy C. Asthma in pregnancy. Thorax 2001;56(4): 325-328.
- Position Statement: The use of newer asthma and allergy medications during pregnancy. Ann Allergy Asthma Immunol 2000; 84:475-480.
- Ginsberg JS, Greer I, et al. Use of antithrombotic agents during pregnancy. Chest 2001;119(Supp 1): 122S-131S.
- Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353:1258-1265.
- Deblieux PM, Summer WR. Acute respiratory failure in pregnancy. Clin Obstet Gynecol 1996;39(1): 143-152.
- Ramsey PS, et al. Pneumonia in pregnancy. Obstet Gynecol Clin North Am 2001;28(3): 553-559.
- Andres RL, Miles A et al. Venous thromboembolism and pregnancy. Obstet Gynecol Clin North Am 2001;28(3): 613-630.