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CSICU
The rotation in the Cardiac Surgical Unit is not an
anaesthesia rotation. It is considered
as a rotation in the intensive care unit. The overall objective of the
rotation is to enhance the resident’s understanding and management of
postoperative events, particularly those related to the respiratory and
cardiovascular systems, following cardiac surgery. While residents will
be exposed to many topics that are unique to cardiac surgical
population, they will also be exposed to many clinical entities that
apply to the care of other types of surgical patients.
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A.
Mandatory Clinical Objectives
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Objectives
Checklist
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A-1. To gain experience in the early postoperative care of patients
undergoing coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB), valvular heart surgery, minimally
invasive direct coronary artery bypass (MIDCAB), orthotopic heart
transplant and major thoracic vascular procedures. You must become
familiar with the management of the most frequent early
complications including hypothermia, shivering, hypertension, low
cardiac output and coagulopathy. |
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A-2. To gain
experience in the management of major postoperative complications
leading to prolonged length of stay in the intensive care unit
following cardiac and major thoracic vascular procedures. |
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A-3. To develop early postoperative care
strategies appropriate for the various patients risk categories:
e.g. early versus late extubation, sedation with short versus long
acting medications, postoperative use of muscle relaxants, etc. |
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A-4. To gain some experience in the management
of the respiratory changes and complications associated with
cardiopulmonary bypass and cardiac surgery. |
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A-5. To
develop advanced knowledge of inotropic drugs used for support of
cardiac surgical patients: dopamine, dobutamine, norepinephrine,
epinephrine, milrinone, etc. |
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A-6. To gain
experience in the use of intra-aortic pump (IABP) in the cardiac
surgical patients: you must become familiar with the indications for
IABP, its functioning, its effects on the cardiovascular system and
its associated complications. You must learn how to wean a patient
from the IABP and how to remove the IABP catheter. |
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A-7 To enhance the experience in invasive hemodynamic monitoring
with regular pulmonary artery catheters and with catheters which allow
continuous measurement of cardiac output and mixed venous oxygen
saturation. |
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A-8. To gain
experience in the diagnosis and treatment of supraventricular and
ventricular arrhythmias following cardiac surgery. |
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A-9. To gain
experience in the use of atrial, ventricular and dual chamber
temporary pacemakers and their role in cardioversion for
supraventricular tachycardia. |
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A-10. To gain
experience in the prophylaxis and treatment of infection after cardiac
surgery. |
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A-11. To gain
experience in the enteral and parenteral nutrition of the cardiac
surgical patients requiring prolonged intensive care. |
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A-12. To acquire
experience in performing bronchoscopy in the intensive care unit. |
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A-13. To develop a
consultant approach with cardiac surgical colleagues (residents and
staff) when caring for the cardiac surgical patients. This is usually
done through combined rounds at the beginning and the end of the day. |
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B. Optional
Clinical Objectives |
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B-1. To be exposed to advanced means of
mechanical support of the cardiac surgical patient: ventricular assist
devices (VAD) and the total artificial heart (TAB). |
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B-2. To gain some
experience in the use of nitric oxide for patients with pulmonary
hypertension undergoing heart transplant or pulmonary
thromboendarterectomy. |
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B-3. To gain some
experience in the treatment of renal failure after cardiac surgery.
This includes the use of intermittent hemodialysis, continuous
veno-venous hemodialysis and the placement of the appropriate cannula
to use those techniques of dialysis. |
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B-4. To gain
experience in removing and inserting chest tubes in cardiac surgical
patients. |
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C. Mandatory
Reading |
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C-1. Kaplan JA,
Guffin A. Treatment of perioperative left ventricular failure. In:
Kaplan JA. Cardiac Anesthesia, 3rd ed. Philadelphia, WB Saunders
Company, 1993:1058-1094. |
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C-2. Shapiro BA,
Vender JS. Postoperative respiratory management. In: Kaplan
JA. Cardiac Anesthesia, 3rd ed. Philadelphia, WB Saunders
Company, 1993: 1149-1167. |
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C-3. Levy JH,
Salmenpera MT, Bailey JM, et al. Postoperative circulatory control.
In: Kaplan JA. Cardiac Anesthesia, 3rd ed.
Philadelphia, WB Saunders Company, 1993: 1168 - 1193. |
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D. Optional
Reading |
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D-1. Galla JD,
Silvay G, Griepp RB, et al. Circulatory assist devices. In:
Kaplan JA. Cardiac Anesthesia, 3rd ed. Philadelphia, WB
Saunders Company, 1993: 1122 - 1148, with an emphasis on the IABP pp.
1126 - 1134. |
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At mid-term during the rotation, it is the resident's
responsibility to determine if her or his work schedule has been or will
be appropriate to achieve the rotation clinical objectives. If the
resident realizes that the rotation has not allowed or will not allow the
achievement of the clinical objectives, she or he must inform the Director
of the Cardiac Surgical Unit who will make adjustments to the work
schedule accordingly. At the end of the rotation, the resident must
complete the objective checklist and leave it with the Division Secretary
in Room H213. The final resident evaluation report will not be
completed
by the resident coordinator unless the objective checklist has been
completed.
Resident's Name:
Resident's Signature:
Date:
Signature of Resident's Coordinator:
Date:
Please, note that
the residents' coordinator in the Cardiac Surgical Unit is the Director of
the unit.
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