Pediatric Critical Care
Rotation Specific Objectives
Department of Pediatrics
McMaster University
MEDICAL EXPERT
A. The resident demonstrates knowledge of:
1. Pathophysiology of respiratory failure, shock, coma, fluid and electrolyte
balance, sepsis, coagulation disorders, ICU related infections, major
metabolic derangements
2. Pathophysiology of cardiorespiratory arrest.
3. Pathophysiology of multi-system trauma.
4. Physiology of normal lung function and gas exchange.
5. Principles of and indications for mechanical ventilation.
6. Principles of sedation and analgesia in the critically ill patient.
7. Principles of the role of nutrition in the critically ill patient.
8. Understanding and interpretation of invasive and non-invasive
cardiorespiratory monitoring.
PGY3 rotation: all of above AND
1.
2.
3.
4.
Principles of rapid sequence induction in the critically ill patient.
Determination of brain death and principles of organ donation.
Principles of inter-hospital transport of the critically ill patient.
Refine expertise in principles of care of
i. Airway management
ii. Cardiorespiratory arrest
iii. Multisystem trauma
iv. mechanical ventilation, esp non-conventional
v. complex/technology dependent pediatric patient
B. The resident demonstrates skill proficiency at:
1.
2.
3.
4.
Recognition of the critically ill patient.
Cardiorespiratory resuscitation.
Airway management (bag/valve/mask ventilation, endotracheal intubation)
Management of the patient with a tracheostomy tube, including
tracheostomy tube replacement.
5. Insertion and care of indwelling catheters (intravenous, intraarterial, central
venous, intraosseous)
6. Delivery of synchronized cardioversion/defibrillation.
7. C-spine immobilization and splinting of fractures
1
PGY3 rotation: all of above AND
Refine expertise in
i.
Principles of Rapid Sequence Induction
ii.
Cardiopulmonary Resuscitation
C. The resident is able to manage acutely:
1. Cardiorespiratory arrest
2. Single organ failure including coma, respiratory failure, shock, oliguric renal
failure, hepatic failure, coagulopathy
3. Moderate head injury, status epilepticus
4. Airway obstruction
5. Fluid and electrolyte imbalance
6. Metabolic derangements
7. Hypothermia, burns and inhalational injury
8. Submersion injury
9. Toxic Ingestion
10.Anaphylaxis
11.Sepsis
12.Multi-system trauma
PGY3 rotation: all of above AND
1.
2.
3.
4.
Multisystem Organ Failure
Severe Head Injury
ARDS
Renal Failure requiring renal replacement therapy
D. The resident is able to complete:
1. Rapid, pointed examination of airway, breathing and circulation.
2. Thorough examination of upper airway, cardiorespiratory and abdominal and
neurologic systems.
3. A systematic approach to the primary and secondary survey in the pediatric
trauma patient.
COMMUNICATOR
1. Ability to elicit a succinct and relevant history of presenting illness for the
critically ill patient.
2. Able to present a clear and concise verbal summary of the presenting
history, clinical findings and management plan.
3. Communication of significant changes in clinical status to the attending staff
physician
4. Communicates clearly with Consulting services.
5. Written and electronic documentation complete, concise and clear.
6. Maintains open communication with the entire health care team.
7. Delivers thorough and efficient morning and evening handover.
8. Delivers complete handover at time of patient transfer.
9. Participation in all family meetings.
PGY3 rotation: all of above AND
10.Effective and sensitive communication with families experiencing the
expected or unexpected death of a child.
COLLABORATOR
1. Demonstrates an ability and willingness to collaborate with the entire health
care team including sub-specialty medical and surgical services, nursing
staff and all allied health care staff.
MANAGER
1. Demonstrates ability to prioritize between the need for thorough history and
initiation of management.
2. Demonstrates ability to coordinate and lead the team during routine care
and emergencies
PGY3 rotation: above AND
1. Understands and facilitates good bed management.
2. Demonstrates ability to triage care when dealing with multiple critically ill
patients
HEALTH ADVOCATE
1. Recognizes quality of life issues amongst critically ill children and promotes
discussion of these issues with the health care team and family.
2. Recognizes possible non-accidental injury and communicates such to the
McMaster Children’s Hospital CAAP team and CAS.
PGY3 rotation: all of above AND
1. Demonstrates effective utilization of resources facilitating transition of
technology dependent patients out of the ICU setting.
2. Demonstrates awareness of issues surrounding consent to organ donation in
brain dead patient.
SCHOLAR
1. Demonstrates proficiency with electronic literature searches.
2. Utilizes evidence-based current standards in day-to-day patient
management
PGY3 rotation: all of above AND
1. Teaches and mentors junior residents and other learners in Unit
PROFESSIONAL
1. Treats all members of the health care team with respect and fosters a
trusting, safe work environment.
2. Recognizes personal limitations and demonstrates a willingness to seek out
and accept support in a timely manner.
3. Demonstrates sensitivity around the emotional impact of critically ill children
on family members.
4. Demonstrates respect for patient and family wishes surrounding end of life
decision-making.
5. Appreciates and understands ethical issues encountered in care of the
critically ill child.
PGY3 rotation: all of above AND
1. Demonstrates ability to support family members dealing with the loss of a
child.