Pediatric ICU
To meet the rotational
goals and objectives, the anesthesia resident will be expected to actively
participate in the pediatric ICU team duties including call
responsibilities, ward and emergency consultations, and care of the
pediatric ICU patients. The resident will be expected to assume a
progressive increase in patient care responsibilities as they become more
senior residents, such that a PGY4 and PGY5 resident should be assuming an
active teaching role for more junior residents and function as a resource
and consultative role for other residents.
In addition to common
core knowledge content identified for adult critical care rotations, the
following specific pediatric rotational goals and objectives listed below
should be reviewed during the four-week block pediatric ICU rotation.
The clinical exposure to each of the knowledge content areas will vary and
is not expected to be an-inclusive.
Knowledge:
1.
To gain an appreciation of the anatomical, physiological, and
pharmacological differences in the pediatric patient specifically with
respect to the:
Cardiovascular system: Physiology of the transitional circulation
and developmental changes in the electrocardiogram
Pulmonary system: Developmental changes in the mechanics of
breathing, in the anatomy of the upper airway, and the growth and
development of the bronchoalveolar units
Renal system: Developmental changes in renal function
Hematologic system: Developmental changes in fetal – adult
hemoglobins
2.
To gain an appreciation of the pathophysiology, differential
diagnosis, investigation and management of:
Cardiac:
Congenital heart disease; congestive, cyanotic
Persistent fetal circulation
Pulmonary hypertension
Respiratory:
Hyaline membrane disease
Bronchopulmonary displasia
Sudden infant death syndrome
Bronchiolitis
Croup
Epiglottitis
Pertussis
Tonsillar airway obstruction
Cystic fibrosis
Congenital abnormalities of the airway causing
stridor: Vascular rings, tracheomalacia
Neurological:
Congenital neuromuscular disorders requiring
mechanical ventilation (e.g., M.D.)
Seizure disorders; febrile and other
Reye’s syndrome
Intraventricular hemorrhage
Subdural hematomas: traumatic and other
Congenital CNS malformations requiring surgery:
Meningomyelocele
Hydrocephalus
Craniosynostosis
Gastrointestinal (Congenital
and acquired abnormalities):
Congenital:
Omphalocele
Gastroschisis
Tracheoesophageal fistula
Esophageal atresia
Diaphragmatic hernia
Hirschsprung's disease
Acquired:
Necrotizing enterocolitis
Midgut volvulus
Diarrheal dehydration
Hyperbilirubinemia
Renal:
Developmental changes in renal function and in
expected urine output in ml/kg/hr
Hemolytic uremic syndrome
Congenital anomalies and disorders of function
Fluid and electrolyte requirements according to
age and specific management of common pediatric disorders
Metabolic / Endocrine:
Inborn errors of metabolism
Nutritional requirements of the pediatric
patient
Infectious Disease:
Beta-streptococcal and Escherichia coli
meningitis and pneumonia
Chlamydial pneumonia and neonatal herpes
infection
Haemophilus influenzae meningitis, pneumonia and
septic shock
Hematological
Sickle cell and its complications
Childhood leukemias and tumors
Developmental changes in normal values
Developmental changes in immunocompetence
Trauma / Burns:
Shaking injury
Subarachnoid hemorrhage
Pediatric burns
3.
To enhance the residents knowledge base with respect to the
indications for, and rationale use of the following drugs in the critical
care setting:
Antibiotics
Analgesics (appropriate for pediatric patients)
Sedatives (appropriate for pediatric patients)
Diuretics
Vasodilators
Vasopressors
Steroids
Drugs used to decrease gastric acid or protect
the gastric mucosa
4.
To gain an understanding of the principles and rationale management
of:
Oxygen therapy, including pediatric oxyhoods
Non-invasive mechanical ventilatory support
Cuffed vs. non-cuffed endotracheal tubes
Nasal vs. oral intubation
Volume vs. pressure controlled ventilation
Invasive mechanical ventilatory support
Weaning from ventilatory support
Nutritional support of the critically ill
pediatric patient (including enteral and perenteral support / indications
/ complications)
Age related differences in drug metabolism and
toxicity
5.
To develop an understanding of the indications, limitations,
interpretation, of monitors used in the critically ill pediatric patient
including:
Pulse oximetry and end tidal CO2 monitoring
Urine output, temperature, ECG, and automated
non-invasive BP monitoring
X-ray, CT and MRI evaluation of the critically
ill pediatric patient
Invasive arterial blood pressure monitoring
Central venous pressure monitoring
Arterial and venous blood gas analysis
EEG and ICP monitoring
|
