Surgical Critical Care Curriculum and Goals

Surgical critical care deals with complex surgical and medical problems in critically ill surgical patients. Our surgical critical care program provides the educational, clinical, and administrative resources to allow residents to develop advanced proficiency in the management of critically ill surgical patients.

Our residents acquire advanced knowledge and skills needed to manage critically ill surgical patients. This includes mastery of (1) the use of advanced technology and instrumentation to monitor the physiologic status of children or adults, including those in the neonatal, pediatric, child-bearing, or advanced years; (2) organizational and administrative aspects of a critical care unit; and (3) ethical, economic, and legal issues as they pertain to critical care.

Goals

Residents completing our surgical critical care program will be expected to:

• • Teach the specialty of surgical critical care;
  • Undertake investigations into the various areas of surgical critical care, such as new instrumentation, identification of important physiologic parameters, evaluation of pharmacologic agents in critically ill patients, or health outcomes and/or health policy issues related to surgical critical care;
  • Administer a surgical critical care unit and appoint, educate, and supervise specialized personnel, establish policy and procedures for the unit, and coordinate the activities of the unit with other administrative units within the hospital.

Didactic Curriculum

This program provides residents opportunities to acquire advanced knowledge of the following aspects of critical care, particularly as related to the management of patients with homodynamic instability, multiple system organ failure, and complex coexisting medical problems:

• • Biostatistics and experimental design 
  • Cardiorespiratory resuscitation
  • Critical obstetric and gynecologic disorders
  • Critical pediatric surgical conditions
  • Ethical and legal aspects of surgical critical care
  • Hematologic and coagulation disorder
  • Inhalation and immersion injuries
  • Metabolic, nutritional, and endocrine effects of critical illness
  • Monitoring and medical instrumentation
  • Pharmacokinetics and dynamics of drug metabolism and excretion in critical illness
  • Physiology, pathophysiology, diagnosis, and therapy of disorders of the cardiovascular, endocrine, gastrointestinal, genitourinary, immune, musculoskeletal, neurological, and respiratory systems, as well as infectious disease
  • Principles and techniques of administration and management
  • Trauma, thermal, electrical, and radiation injuries

Clinical Components

This program provides supervised training that enables residents to gain competence in the performance and application of these critical care skills: 

• • Circulatory: invasive and noninvasive monitoring techniques, including trans-esophageal and pericardial cardiac ultrasound and application of transvenous pacemakers; computations of cardiac output and of systemic and pulmonary vascular resistance; monitoring electrocardiograms and management of cardiac assist devices
  • Gastrointestinal: utilization of gastrointestinal intubation and endoscopic techniques in the management of the critically ill patient; application of enteral feedings; management of stomas, fistulas, and percutaneous catheter devices 
  • Hematologic: application of autotransfusion; assessment of coagulation status; appropriate use of component therapy 
  • Infectious disease: classification of infections and application of isolation techniques, pharmacokinetics, drug interactions, and management of antibiotic therapy during organ failure; nosocomial infections; indications for applications of hyperbaric oxygen therapy
  • Miscellaneous: use of special beds for specific injuries; employment of pneumatic antishock garments, traction, and fixation devices
  • Monitoring/bioengineering: use and calibration of transducers, amplifiers, and recorders
  • Neurological: the performance of complete neurological examinations; the use of intracranial pressure monitoring techniques and of the electroencephalogram to evaluate cerebral function; application of hypothermia in the management of cerebral trauma 
  • Nutritional: application of parenteral and enteral nutrition; monitoring and assessing metabolism and nutrition
  • Renal: evaluation of renal function; peritoneal dialysis and hemofiltration; knowledge of the indications and complications of hemodialysis
  • Respiratory: airway management, including endoscopy and management of respiratory system