The goal of the 4th year critical care elective is to allow the student to gain an appreciation and familiarity with the thought processes and procedures which physicians utilize in the care of their critically ill patients in the intensive care unit. Each student’s experience will be unique, predicated upon the patients for whom he/she cares during the rotation. Each student may not care for a patient with each diagnosis listed, and may not observe, participate in or perform all of the procedures.
The objectives include:
- To gain experience in obtaining a history, performing a focused clinical exam, and developing a treatment plan for assigned patients in the intensive care unit.
- To appreciate the dynamic nature of critically ill patients, through performance of daily evaluations of assigned patients, and presentation of these patients on rounds.
- To integrate acquired patient data and medical knowledge, generate appropriately broad differential diagnoses for a number of clinical problems, and propose changes in patient care based upon clinical reasoning and rational laboratory and radiological examinations.
- To gain experience in insertion of invasive pressure monitors such as arterial lines, central venous and pulmonary artery catheters, and interpretation of the data obtained from these monitors.
- To increase the knowledge base relating to issues in critical care medicine, and gain experience and confidence in applying this knowledge to diagnosis and treatment of a variety of patient care issues relating to care of patients in the intensive care unit.
- To gain an appreciation of the complex physician-patient-family dynamics involved in the management of critically ill and dying patients.
- To gain an understanding of the roles of the critical care physician in the management of medical and surgical intensive care patients.
Emphasis on patient management issues may include:
- Differential diagnosis
- Rational laboratory and radiological testing
- Chronic management of patients with multiple medical and surgical problems
Issues within the context of patients who have life-threatening neurological or cardiovascular disorders will also be addressed and may include:
- Ventilator management
- Acute pharmacologic therapy for hemodynamic instability
- Effective antimicrobial therapy
- Nutritional support
- Multisystem dysfunction
Responsibility for supervision of students will lie with the house staff and faculty from the Critical Care section of the Department of Anesthesiology.
Students will participate as an integral part of the Critical Care Team that co-manages the patients in these intensive care units. Students will assume supervised responsibility for evaluation, diagnostic testing, initiation and evaluation of therapy, and be exposed to patient-care issues such as End of Life decisions, organ donation, and family health care dynamics.
Patient Simulation Laboratory (PSL)
Students may also spend time in the Patient Simulation Laboratory (PSL), a state of the art, computerized patient care room featuring a life-like fully interactive patient, capable of nearly all anatomic, physiologic and pharmacologic responses. Patient care scenarios such as acute myocardial infarction, cardiac arrest, anaphylaxis or traumatic injury can all be realistically duplicated.
The student will personally evaluate the patient, generate a differential diagnosis, institute therapy, personally perform all interventions, and analyze the effectiveness of the therapy. Feedback in the form of videotaping of the PSL session facilitates identification of individual strengths and areas for potential improvement.
Attendance at the daily Intensive Care lecture series, given by faculty members from the Critical Care Section of the Department of Anesthesiology is required. A didactic lecture series covering the essentials of respiratory and cardiovascular physiology, intracranial pressure control, acid-base and fluid balance, sepsis, mechanical ventilation, poisoning, renal failure, and other common medical emergencies is given three times weekly by the critical care faculty.