Critical Care
PGY1
Didactic
1. Identify pertinent venous anatomy as it relates to the placement of central
venous lines (i.e. Internal Jugular, Subclavian, and femoral). Know the
relation between venous structures and associated arterial and bony
anatomy.
2. Identify the pertinent arterial anatomy as it relates to the placement of
arterial lines (i.e. radial, femoral, brachial, DP/PT). Define and understand
the utility of an Allen’s test as it relates to the decision to place an arterial
line. Discuss the strengths and weaknesses of each anatomic location.
3. Identify the electrolyte components and their respective concentrations of
commonly utilized IVF (i.e. Lactated Ringers, Normal Saline).
4. Utilize a basic chemistry panel to identify metabolic versus respiratory
abnormalities and manage basic electrolyte imbalances (K, Na, Cl, Ca, Mg)
5. Identify classes of shock and associated hemodynamics, describe treatment
intervention based on class of shock
6. Readily understand the fundamentals of ICP monitoring and the calculation
of CPP
7. Identify and recognize common arrhythmias including v-tach, v-fib, a-fib.
8. Understand the interpretation of all components of an ABG
9. Basic management of acute a-fib and role of pharmacologic therapy
(amiodarone vs diltiazem, mechanism of each). When and how to use
synchronized cardioversion in the acute setting.
Technical
1. Placement of Central Line (Subclavian, IJ and Femoral Locations)
2. Placement of Arterial Line (radial, femoral)
PGY2
Didactic
1. Be conversant with the interpretation and calculation of quantitative
oximetry. Know the definition and normal values of CO, CI, SVR, SVRI, wedge
Pressure, PAP.
2. Understand the Basics of Ventilator Management and how changing
parameters effects ventilation and oxygenation (Volume and Pressure
Control).
3. Be able to discuss the diagnosis and treatment of intra-abdominal
hypertension including evaluation of bladder pressure, elevated ventilator
pressures, and signs of altered organ perfusion.
4. Describe how to treat an abnormal intracranial pressure.
5. Pharmacodynamics and pharmacokinetics of action of the most commonly
used pressers/ionotropes: dopamine, neo, norepinephrine, epi, milrinone
vasopressin, and dobutamine. Understand the potency of these agents on
target receptors and disease processes for which they are most applicable.
6. Understand the common sedatives used in the ICU and their
advantages/disadvantages for safe ICU sedation (propofol,
dexmedetomidine, versed, ativan, fentanyl, etomidate, ketamine)
7. Review and understand the surviving sepsis guideline and have an
understanding of when palliative care should be initiated based on mortality
numbers for each additional failed organ system.
8. Describe indications for bronchoscopy and interpretation of pulmonary
culture results. Be familiar with criteria for diagnosis of ventilator associated
pneumonia (VAP), rates of VAP based upon disease process and duration of
ventilation, strategies for prevention of VAP, and evidence based treatment
strategies.
Technical
1. Placement of a pulmonary aretery (Swan-Ganz) catheter
2. Performing Five Lobe Fiberoptic Bronchoscopy
PGY3
Didactic
1. Be conversant with Normal 4-Chamber cardiac pressures.
2. Understand the indications and contraindications for placement of an
aortic balloon pump.
3. Be able to draw an aortic pressure curve in the presence of an intra-aortic
balloon pump.
4. Understand how to write and manage TPN along with indications for use
versus indications for enteral access (this includes an understanding of
total carbohydrate and protein needs for patients in catabolic and
maintenance states)
5. Describe how to perform bag mask ventilation, LMA placement, bougie,
and glidescope for difficult airways
Technical
1. Placement of an intra-aortic Balloon pump and potential complications.
2. Be able to perform a Diagnostic Peritoneal Lavage and interpret findings.
3. Be able to describe indications for and perform an emergent
cricothyroidotomy.
PGY4/5
Didactic
1. Medical/critical care management of portal hypertensive and liver failure
patients inclusive of fluid management and indications for TIPS.
2. Management of the anuric acute renal failure pt with respect to initiation
of medical therapeutics vs modes of dialysis (i.e. HD, CRRT, CVVHD).
3. Comprehensive management of multisystem organ failure, coagulopathy,
nutritional and metabolic calculations including Harris-Benedict
equation.
4. Understanding of the West Zones of the lung and the application of lateral
rotational kinetic therapy and prone positioning
5. Understand indications for and utility of advanced modes of ventilation
(i.e. Bilevel and High Frequency Oscillatory Ventilation)
6. Understand additional techniques for dealing with difficult issues in
oxygenation and ventilation: transtracheal insufflation, nitric oxide.
7. Indications for ECMO in the pediatric vs. adult population
Technical
1. Placement of a Sengstaken-Blakemore tube, management, and potential
complication
*Please note that is the expectation that each pgy level will have already
mastered the concepts for the levels below their year and be able to teach those
concepts to their junior residents.