cardiovascular icu elective rotation

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University of Alberta

Division of Critical Care Medicine

Adult Critical Care Medicine Resident Training Program

CARDIOVASCULAR ICU ELECTIVE ROTATION

The rotation occurs in the Cardiovascular ICU at the University Hospital. The 19 bed unit uses a semi-closed medical model and is staffed by Intensivists and Advanced Nurse

Practitioners. Cardiac surgery residents provide night time and weekend coverage. The unit provides care for more than 1400 cardiac surgery cases per year.

EDUCATIONAL OBJECTIVES

Medical Expert / Clinical Decision Maker

Knowledge Base:

Coronary Artery Bypass Surgery

Understand indications for cardiac surgery and interpretation of cardiovascular data

Differences between on and off pump surgery

Understand the differences between arterial and venous revascularization

Diseases of the Aortic, Mitral, Tricuspid and Pulmonary Valves

Understand pathophysiology, surgical options and management of valvular heart disease

Diseases of the Aorta

Management of aortic dissection, aortic arch and descending thoracic aortic surgery

Cardiac Anesthesia

Understand preoperative assessment of the cardiac surgical patient

Understand etiology and treatment of perioperative cardiac arrhythmias

Hemodynamic monitoring and its’ indications

Principles of transesophageal echocardiography

Effects of inhalation anesthetics on systemic hemodynamics & coronary circulation

Understand use of opioids in cardiac anesthesia

Cardiopulmonary bypass and its’ implications

Management of coagulation and bleeding disorders

Extracorporeal devices, intraaortic balloons, and related technologies

Myocardial protection during cardiopulmonary bypass

Postoperative Management of the Cardiac Surgical Patient

Initial assessment and management and the stabilization phase (first 4

 hours)

Weaning phase and postextubation phase, and difficult to wean patient

Management strategies for hypotension and hypertension

Electrocardiograph monitoring and interpretation

Management strategies for dysrhythmias

Common infections

Management of oliguria and acute renal failure in cardiac surgical patients

Neurocognitive deficits, their etiology and management options

Hyperglycemia and management in cardiac surgical patient

Fast-track recovery following cardiac surgery

Guidelines, indications, and treatment options for transfusion following cardiac surgery

University of Alberta

Division of Critical Care Medicine

Adult Critical Care Medicine Resident Training Program

Transplantation

Understand transplant immunology and the use of immunosuppressive

 agents in solid organ transplantation

Specific critical care problems in heart, heart-lung, and lung transplant recipients

Diagnosis and treatment of rejection and infection in transplant recipients

Psychiatric Issues in the Cardiac Surgical Patient

Diagnosis and treatment of anxiety, depression agitation and delirium

Skills

Hemodynamic monitoring and management of postoperative cardiac surgery patient

Postoperative management of the heart, lung, heart-lung transplant patient

Intra - aortic balloon pump management

Cardioversion

Temporary pacemakers

Chest tube insertion

Extra corporeal devices

Fiberoptic bronchoscopy

Communicator/Collaborator a.

Communicate effectively with:

Patients and families

Health care personnel in the cardiovascular ICU and wards

Medical staff (Cardiac Surgeons) and consulting services b.

Prepare accurate and legible documentation c.

Function effectively in a team environment in the Cardiovascular ICU

Manager a.

b.

c.

Use health care resources (cost) effectively

Sets realistic priorities

Use time effectively

Health Advocate a.

b.

Intervene on behalf of patients with respect to their care

Recognize and respond appropriately in situations with regard to patient safety

Scholar a.

b.

Assess & critically appraise health & medical information

Use information effectively in clinical decision-making

University of Alberta

Division of Critical Care Medicine

Adult Critical Care Medicine Resident Training Program

July 2008

Professional a.

b.

c.

d.

e.

f.

Demonstrate integrity, honesty, compassion and respect for diversity

Fulfill medical, legal & professional obligations of the specialist

Demonstrate reliability and conscientiousness

Understand the principles of bioethics and apply these in clinical situations

Have awareness of personal limitations and seek advice when necessary

Assess own performance and have insight into attaining professional standards

University of Alberta

Division of Critical Care Medicine

Adult Critical Care Medicine Resident Training Program

IN-TRAINING EVALUATION REPORT

Name of Resident:

Hospital:

EXPECTATIONS: (for rotation/level of training)

Program Director: Dr. Darren Hudson

Rotation: Cardiovascular ICU

Period: to __________

A. MEDICAL EXPERT a) basic science knowledge b) clinical knowledge c) selects appropriate monitoring d) recognition and management of emergency situations

B. COMMUNICATOR a) communicates effectively with patients, families & health care workers b) prepares documentation that is accurate and legible

C. COLLABORATOR a) consults and delegates effectively b) functions effectively in a team environment

D. MANAGER a) makes cost effective use of health care resources based on sound judgement b) sets realistic priorities and uses time effectively to optimize performance

E. HEALTH ADVOCATE a) intervenes on behalf of patients with respect to their care b) recognizes & responds appropriately in situations with regard to patient safety

F. SCHOLAR a) develops & implements an ongoing and effective personal learning strategy b) assesses & critically appraises health & medical information c) uses information effectively in clinical decision-making d) teaches effectively in clinical environment

G. PROFESSIONAL a) demonstrates integrity, honesty, compassion and respect for diversity b) fulfills medical, legal & professional obligations of the specialist c) demonstrates reliability and conscientiousness d) understands principles of bioethics and applies these in clinical situations e) is aware of personal limitations and seeks advice when necessary f) assesses own performance and has insight into attaining professional standards

H. PROCEDURAL AND TECHNICAL SKILLS Cardiovascular ICU a) Intra aortic balloon pump management b) Temporary pacing c) Hemodynamic monitoring and management d) Cardioversion e) Chest tube insertion f) Fiberoptic bronchoscopy g)

Comments: (your comments especially relating to ratings 0, 1 and 4 are specifically requested).

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University of Alberta

Division of Critical Care Medicine

Adult Critical Care Medicine Resident Training Program

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