ROTATION INFORMATION
DEPARTMENT OF ANESTHESIA
RESIDENCT TRAINING PROGRAM
UNIVERSITY OF MANITOBA
CORONARY CARE UNIT
INTRODUCTION
The University of Manitoba Training Program for Residents in Anesthesia has been
developed in accordance with the guidelines of the Royal College of Physicians and
Surgeons of Canada. Along with the other Critical Care rotations, this Coronary Care
rotation is designed to allow the resident to:
a) develop primary skills (patient assessment, use of laboratory tests, special
investigations, and technical skills) with critically ill patients
b) participate in the team management of patients and, when appropriate, supervise more
junior members of the team (the opportunities for these are more limited in anesthesia
rotations)
c) acquire both general medical knowledge, and specific Critical Care knowledge,
necessary to function as a competent consultant in anesthesia.
GOALS AND OBJECTIVES
The following Rotation Specific Goals and Objectives for Coronary Care, provide
specialty specific emphasis to particular components of the general Program Goals and
Objectives.
Please refer also to the National Curriculum for Canadian Anesthesia Residency for more
information on expected knowledge and skills.
All appropriate Program Goals and Objectives also apply to this rotation.
1. Medical Expert/Clinical Decision Maker
By the end of this rotation, the resident will be able to:
A. Investigate and manage the following problems, and give a rationale for the
treatment plan based upon an understanding of the etiology, pathophysiology,
diagnosis, treatment and complications of:
i. Cardiac emergencies including
a. Arrest
b. Arrhythmias
c. Ischemia
d. Acute Coronary syndromes – angina, STEMI, NSTEMI
e. Failure
f. Tamponade
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B.
C.
D.
E.
F.
G.
H.
g. valve dysfunction
h. severe hypotension
i. severe hypertension.
ii. Shock
iii. Coexisting non-cardiac disease
iv. Sepsis
v. Acid-base, fluid and electrolyte disorders
vi. Renal disease, preservation and support
vii. Coagulation disorders and blood and component replacement
therapy
Apply an organized method of assessment of critically ill patients and
communicate a succinct evaluation and management plan to Attending Staff.
Formulate and implement an appropriate plan for patient management based
on understanding of the critical illness, coexisting problems, and patient
factors such as anxiety, discomfort, culture, language, ethnicity, age, and
gender
Manage the transportation of the critically ill
Perform the following technical skills for Invasive and noninvasive
physiological monitoring in the critical care setting
i. Arterial catheterization
ii. Central venous cathetherization (IJ and subclavian)
iii. Pulmonary artery catherization
Identify the indications for and interpret the information derived from
common diagnostic tests and monitoring systems used in critical care units
i. EKG
ii. Chest x-ray
iii. Echocardiography
iv. myocardial scans
v. coronary angiography
vi. 5-lead EKG monitor
vii. Invasive pressure and cardiac output
Correctly prescribe and administer the following agents, and provide a
rationale based upon the pharmacology, indications, relative differences,
contraindications and complications
i. Antiarrythmics
ii. Antihypertensives
iii. Vasodiloators
iv. Inotropes
v. Antibiotics
vi. cardioversion and defibrillation
vii. temporary pacemakers
viii. Positive pressure ventilation
Appropriately prescribe the following and provide a rationale based upon the
indications, relative differences, contraindications and complications
i. IABP
ii. Angioplasty
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2. Communicator
By the end of this rotation the resident will be able to:
A. Establish a therapeutic relationship with cardiac patients emphasizing
understanding, trust, empathy, and confidentiality
B. Elicit and synthesize relevant information from the patient and/or family, and
be able to assess and take into account, the impact of a patient's age, gender,
ethnocultural background, social supports, and emotional influences on
cardiac illness
C. Discuss appropriate information with the patient, his/her family to facilitate
the optimal management plan for the care of the patient
D. Obtain complete informed consent for all treatments and procedures
3. Collaborator
By the end of this rotation, the resident will be able to perform the following:
A. Communicate a succinct assessment and management plan to Attending Staff
and to other physicians requesting consultation.
B. Effectively consult with other physicians and health care professionals and
demonstrate appropriate judgment regarding the assessment of cardiac disease
C. Coordinate the care of cardiac patients with other members of the care team,
especially cardiologists, surgeons, or other physicians requesting consultation,
and nurses, as well as staff in the intensive care unit, ward, step-down unit,
and in off-site locations such as the cardiac catheterization laboratory
D. Manage urgent and crisis situations such as hemodynamic instability or
cardiac arrhythmia, as a team member or leader
4. Manager
By the end of this rotation, the resident will be able to perform the following:
A. Manage time and assign priorities for:
i. Efficient use of time for patient assessment
ii. Changes in response to emergencies
B. Make treatment plans that take into account cost-effective use of medical
resources such as drug or other therapeutic choices
5. Health Advocate
By the end of this rotation, the resident will be able to perform the following:
A. Recognize and explain the importance of broad health and societal issues with
impact on the care of the patient with cardiac disease including:
i. Risk factors and demographics which contribute to the development
of cardiovascular disease
ii. Lifestyle changes and programs which aid in the prevention of
cardiovascular disease
iii. Factors that identify high-risk patients
iv. Short-term and long-term programs for postoperative health
maintenance
B. Intervene on behalf of patients regarding their care and safety
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6. Scholar
By the end of this rotation, the resident will be able to perform the following:
A. Develop, implement, and monitor a personal continuing education strategy
B. Formulate questions for ongoing appraisal
C. Search and critically appraise current cardiology literature, and apply new
knowledge based on appropriate evidence
D. Demonstrate effective oral presentation of case reports, journal club, or rounds
with sound synthesis of pertinent information
E. Facilitate learning of patients, housestaff, students and other professionals
7. Professional
Throughout this rotation, the resident shall:
A.
B.
C.
D.
E.
Deliver highest quality care with integrity, honesty, and compassion
Demonstrate appropriate interpersonal and professional behavior
Practice medicine ethically consistent with the obligations of a physician
Be aware of the ethical and legal aspects of patient care
Show recognition of personal limits through appropriate consultation (with
staff supervisors, other physicians, and other health professionals) and show
appropriate respect for those consulted
F. Demonstrate including the patient in discussions of care management
G. Recognize potential conflict in patient care situations, professional
relationships, and value systems, and demonstrate the ability to discuss and
resolve differences of opinion. Additionally, be able to accept constructive
feedback and criticism and implement appropriate advice
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