ICU04 Cardiothoracic Surgery Intensive Care Unit
Dr. David Bowton
Rotation Director: David L. Bowton, M.D., FCCM, FCCP
Program Outline: The objective of this clerkship is to expose students to patient care in the Intensive Care setting, with emphasis on patient management issues, such as differential diagnosis, rational laboratory and radiologic testing, acute and chronic management of patients undergoing cardiac and thoracic surgery. Issues such as ventilator management, acute pharmacologic therapy for hemodynamic instability, effective antimicrobial therapy, nutritional support, and multisystem dysfunction will be addressed. Students will participate as an integral part of the Critical Care team that actively co-manages the patients in the Cardiothoracic Intensive Care Unit (CT-ICU). 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, patient disposition, and family health care dynamics. Responsibility for supervision of students will lie with the Anesthesiology and Cardiothoracic Surgery house staff and faculty. Attendance at the daily Intensive Care lecture series, given by faculty members from the Critical Care Section of the Department of Anesthesiology is required.
Students will be exposed to and have the opportunity to care for patients with a wide variety of life-threatening cardiac illnesses, for example: acute hemodynamic swings associated with cardiac surgery, cardiogenic shock, acute myocardial infarction, congestive heart failure, valvular disease, ventricular and supraventricular arrhythmias, cardiac tamponade, aortic dissection, aortic aneurysm, hypertensive emergency. There is also extensive exposure to coagulation abnormalities associated with cardiac bypass. The CT-ICU experience includes care of patients who have recovered from their initial cardiac or thoracic surgery but have returned to the ICU because of other medical and surgical illnesses.
Students will be exposed to and have the opportunity to observe, participate in, or perform a variety of procedures, such as arterial line placement, central line placement, hemodialysis catheter placement, PA catheter placement, intra-aortic balloon pump use, cardiac catheterization, endotracheal intubation, thoracentesis, paracentesis, lumbar puncture, temporary cardiac pacemaker utilization.
Students may also spend time in the Patient Simulation Laboratory (PSL), where they will have the opportunity to learn and practice management skills relating to acute cardiovascular, pulmonary, renal and neurologic intensive care. Airway management skills such as mask ventilation, endotracheal intubation, and ventilator management will be emphasized.
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 above, and may not observe, participate in or perform all of the procedures listed above.
Prerequisites: Completion of Years 1-3
Length of Program: 4 weeks
Maximum Number of Students: 2 per rotation
When Offered: All rotations