ANE02 Critical Care
Dr. David Bowton
NOTE: This rotation is for students who do NOT attend WFSM.
Rotation Director: David L. Bowton, M.D., FCCM, FCCP
[This experience is available only to non-WFU students and only at times when WFU students are not fully scheduled doing Neurosurgical or Cardiothoracic Surgery Intensive Care. This extramural elective should be requested through the WFSM Office of Student Services.]
Program Outline: The critical care elective rotation provides the student with a four week exposure to critical care medicine in the NeuroCritical Care or Cardiothoracic Intensive Care Units of The Wake Forest Baptist Medical Center. The objective of this clerkship is to expose students to patient care in the NeuroCritical Care or Cardiothoracic Intensive Care setting, with emphasis on patient management issues including differential diagnosis, rational laboratory and radiological testing, acute and chronic management of patients with multiple medical and surgical problems. Issues such as ventilator management, acute pharmacologic therapy for hemodynamic instability, effective antimicrobial therapy, nutritional support, and multisystem dysfunction will be addressed, within the context of patients who have life-threatening neurological or cardiovascular disorders. 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. Responsibility for supervision of students will lie with the house staff and faculty from the Critical Care section of the Department of Anesthesiology. 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.
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.
Objectives: 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. 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.
Prerequisites: Year 3
Length of Program: 4 weeks
Maximum Number of Students: 2 per rotation
When Offered: All rotations
Report to: Anesthesia Critical Care secretary one to two days before rotation begins (716-6533) to pick up orientation materials, etc. Office is located across from ICU 5A on the 5th floor of the North Tower.