During this rotation, a Pediatric Critical Care Fellow will rotate in the Pediatric Intensive Care Unit (PICU) and Cardiovascular Intensive Care Unit (CVICU).  The rotation will apply patient case management and discussion, literature review, and self-study to learn core concepts.

In both units, please arrive at 7:30am.  If on call, you can stay until 11:30am the next day to complete a 24+4-hour shift to comply with ACGME guidelines.

Fellows are expected to:

  1. Be familiar with all patients in the PICU / CVICU
  2. Work closely with nurse practitioners and residents in patient management
  3. Lead rounds at least once a week (PICU)
  4. Take in-house call
  5. Be present for rounds, including when post-call

Basic objectives for fellows include:

  1. Learning about pediatric critical care disease states and appropriate management
  2. Communicating effectively with attendings, residents, respiratory therapy, and nursing
  3. Utilizing necessary diagnostic tests
  4. Participating in procedures

Clinical areas that the fellow should become familiar with during this rotation include:

  • Respiratory
    • Airway including the use of airway devices, adjuncts, and endotracheal tubes
    • Acute respiratory failure
    • Chronic respiratory failure
    • Status asthmaticus
    • Upper airway obstruction, including foreign bodies and infection
    • Near drowning
    • Acute respiratory distress syndrome
    • Bronchiolitis
    • Arterial blood gas analysis
    • Oxygen therapy
    • Mechanical ventilation (invasive and noninvasive) including indications, modes, complications, and weaning
  • Cardiovascular
    • Shock (all forms)
    • Cardiac arrhythmias
    • Acute cardiomyopathies
    • Hypertensive emergencies
    • Vasoactive and inotropic therapy
    • Arterial and ventral venous catheterization and monitoring
    • Cardiovascular physiology in the critically ill patient
    • Extracorporeal membrane oxygenation
    • Removing chest tubes
    • Removing CVLs
    • Management of temporary external pacing
  • Fluids / electrolytes / nutrition
    • Fluid and electrolyte disorders
    • Acid-base disorders
    • Renal failure
    • Drug dosing in renal failure
    • Dialysis
    • Diabetes insipidus
    • Syndrome of inappropriate antidiuretic hormone (SIADH)
    • Adrenal insufficiency
    • Diabetic ketoacidosis
    • Principles of alimentation
      • Enteral
      • Parenteral
    • Central Nervous System
      • Coma
      • Drug overdose
      • Acute hydrocephalus
      • Brain death evaluation
      • Intracranial vascular accidents
      • Status epilepticus
      • Intracranial infection
      • Intracranial hypertension
      • Traumatic brain injury
      • Spinal cord injury
    • Infectious Disease
      • Sepsis
      • Hospital-acquired and opportunistic infections
      • Antibiotic selections and dosage schedules for the critically ill patient
    • Hematologic
      • Defects in hemostasis
      • Hemolytic disorders
      • Hematologic dysplasias and their complications
      • Sickle cell crisis
      • Thrombotic disorders
      • Anticoagulation and fibrinolytic therapy
      • Blood component therapy
      • Plasmapheresis for acute disorders including neurologic and hematologic diseases
    • Gastrointestinal
      • Gastrointestinal bleeding
      • Hepatic failure
      • Perforation of viscus organs
      • Pancreatitis
      • Prophylaxis against stress ulcers
    • Sedation, Analgesia, and Neuromuscular Blockade
      • Management of airway during sedation
      • Pharmacology of muscle relaxants, sedatives, analgesics
      • Care of children during sedation
    • Monitoring
      • Indications and usage of non-invasive modalities, including pulse oximetry, capnography
      • Indications and usage of invasive monitoring, including central venous pressure, arterial pressure
    • Trauma and Acute Injury
      • Pulmonary embolism
      • Pneumothorax
      • Cardiac tamponade
    • Procedural Skills
      • Maintenance of an open airway in the nonintubated patient
      • Bag mask ventilation
      • Endotracheal intubation
      • Arterial puncture and cannulation
      • Peripheral catheters
      • Central venous catheters
      • Tube thoracostomy / needle aspiration of the thorax
      • Use of intracranial monitors
      • Continuous hemofiltration / dialysis
      • Procedural sedation
      • Resuscitation using advanced life support skills
    • Quality
      • Assessment of quality of care
      • Assessment of performance
    • Ethical and Legal Aspects of Critical Care
      • Do-not-resuscitate orders
      • Principles of informed consent
      • Withholding and withdrawing life support
      • Advance directive
      • Child abuse and neglect
      • Effects of life-threatening illness on patients and their families
      • Death and dying
    • Scholarly Activity
      • Analysis of literature
      • Assimilate new knowledge and concepts