The goal of this rotation is to expose the student to the daily management of critically ill patients in a surgical critical care setting in a Level 1 Trauma Center. The student will learn basic management principles in hemodynamic and neurological monitoring and manipulation, respiratory failure and mechanical ventilation, renal and endocrine pathophysiology as well as with broader topics including ethics and end-of-life care.

Learning Objectives

Topic Learning Objectives

Systems-Based Approach to Critically Ill Patients

The student will learn to:

  • Develop an organized approach to the patients that he/she follows daily in the ICU
  • Present patients accordingly by organ system, in a problem-focused manner, incorporating objective and subjective data into a formulated plan

Neurological Failure

The student will outline the neurological pathophysiology seen in patients in surgical critical care units, ranging from post-operative nerve palsies to delirium to acute herniation, with emphasis on both diagnostic and treatment modalities.

Hemodynamic Monitoring

The student will gain an understanding of:

  • The general principles of hemodynamic monitoring for critically ill patients with variable etiologies, including trauma, sepsis and acute respiratory distress syndrome
  • Important hemodynamic variables and markers of resuscitation
  • Available invasive and non-invasive monitoring modalities
  • The appropriate use of fluids and vasoactive drugs

Respiratory Failure

The student will learn the etiology and pathophysiology of:

  • Respiratory failure, with emphasis on ventilatory management of respiratory failure (including lung protective ventilation, ventilator weaning and associated morbidities)
  • Acute lung injury

Acute Renal Failure

The student will:

  • Learn the etiology, pathogenesis and treatment for acute renal failure in both post-operative as well as critically ill patient populations
  • Develop a basic understanding of the tenets of fluid management in critically ill patients as it relates to renal function, including the indications and options for dialysis

Ethics in the ICU

The student will witness the ethical issues posed in the intensive care unit and the roles that the members of the critical care team play in a variety of circumstances ranging from patient-family choice disparity to end-of-life care.

Activities

The student will participate in activities in both the clinical and non-clinical settings.

Setting Description

Clinical

The student will follow and actively participate in the care of 1-2 patients daily. Participation includes pre-rounding to gather overnight events and data, presentation of patients during rounds using a systems-based approach, participation in the daily plan formulation, and subsequent management throughout the day.

Non-clinical

The student will participate in formal lectures twice weekly with the ICU teams. He/she will also attend a weekly Journal Club for house staff and students covering both classical as well as contemporary critical care literature. The student will be encouraged to read on topics of interest, particularly those that relate to his/her patients, and report back to team members.

Evaluation

The student will be evaluated weekly by a senior member (fellow or attending) on the team through a written evaluation, but he/she should seek out daily feedback. A final evaluation meeting will be held at the conclusion of the rotation.