Cardiovascular and Thoracic Intensive Care ...


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Cardiovascular and Thoracic Intensive Care ...

  1. 1. MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953 MDR-953 Cardiac Anesthesiology/Critical Care Elective Table of Contents 1. Clerkship Welcome Letter p.2 2. Course Description (unabridged) p.3-6 1. Overview 2. Course Design 3. Goals/Objectives 4. Location 5. Participating Faculty 6. Prerequisites 7. Expectations 8. Student Evaluations/Grading 9. Educational Resources 3. Lecture Schedule p.7 4. Recommended Self-Learning Schedule/Checklist p.8 5. Competency Checklist p.9 6. Anesthesiology Library Access Card/CD-ROM Sign-out Form p.10
  2. 2. MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953 Welcome to the Cardiac Anesthesiology/Cardiac Surgical Intensive Care Elective! We look forward to providing you the opportunity for a diverse and challenging learning experience. For the next four weeks, we want you to integrate into each of your respective teams. For the first 2 weeks, you will be in either the Cardiothoracic-Surgery-ICU (SICU-B/CSICU) or the Cardiothoracic Operating Rooms (OR’s 72,73,74). For the second 2 weeks of the rotation, you will switch locations. Please be vigilant about completing your checklists and reviewing the learning resources provided. In addition, one time every 2 weeks you will participate in a patient simulation session related to the management of patients in the operating room or ICU. I will be your contact in the Cardiothoracic operating rooms and Dr. Martinez-Ruiz ( will be your contact in the SICU-B. Please contact me by email ( the week prior to starting the rotation to arrange assignments. Victor Chacon (Medical Student Education in Anesthesiology, Trauma 2nd Floor; 585-1191; can also be contacted for further information. You will find it helpful to review the flowing prior to the start of the rotation: 1.Cardiac Physiology 2.Respiratory Physiology 3.Airway Anatomy 4.Airway Management on the following website: Please check the website for the course outline, additional educational resources, lecture schedule and the contacts list for the rotation. I will meet with you throughout the rotation to ensure that the educational objectives are being met. Please let me know if you should have any questions or concerns. Again, we look forward to working with you and plan to provide you with an exceptional learning experience. Enjoy!! Sincerely, Jonathan Katz, M.D., D.M.D. Clerkship Director – Cardiac Anesthesiology/Critical Care Elective Associate Residency Program Director Assistant Professor Cardiovascular and Thoracic Anesthesiology Department of Anesthesiology, Perioperative Medicine and Pain Medicine University of Miami / Jackson Memorial Hospital 2
  3. 3. TITLE: Cardiac Anesthesiology/Critical Care Medical Student Elective COURSE CODE: MDR 953 CLERKSHIP DIRECTOR: Jonathan Katz, M.D., D.M.D. TELEPHONE/FAX: 305-585-6973 EMAIL: CONTACT: Victor Chacon / ( 305-585-1191) LENGTH OF ELECTIVE: 4 weeks (4 Credits) - Offered all year PREREQUISITE: 2-week Core Anesthesiology, Surgery, Internal Medicine NUMBER OF STUDENTS: 2 INTERVIEWING TIME: Yes – 3 days with prior notification TYPE:Clinical COURSE DESCRIPTION 1. Overview: • During this rotation the student will be exposed to the principles and the practice of cardiothoracic anesthesia, applied cardiovascular physiology and pharmacology, and the management of the cardiothoracic surgical patient in the post-surgical ICU setting. • The course will provide the student exposure to and experience performing the preoperative assessment, intraoperative management and postoperative intensive care management of cardiothoracic surgical patients from the perspective of the cardiac anesthesiologist and critical care specialist. The student will work with faculty, fellows, and residents delivering anesthetic care to adult patients undergoing cardiovascular and thoracic procedures in the operating room and be responsible for direct day-to-day patient care in the ICU. 2. Course Design: • The student will initially spend 2 weeks in the OR participating in the preoperative and intraoperative care of at least one CT surgery patient per day and the following 2 weeks in the Cardiac-Surgery-ICU assisting in the postoperative management of CT surgery patients. • Didactics: o Several Core Topics (listed below) will be covered during this rotation. These topics will be discussed during the existing departmental lecture series, journal club sessions, departmental Grand Rounds and M&M conferences, all of which the student will be required to attend. Core Topics not covered within these sessions will be discussed with the students in small group settings by either the cardiac anesthesia fellows or attendings. o Core Topics/Learning Seminars: 1. Pre-Op Evaluation of CT patient (OR) 2. General Cardio-pulmonary Physiology (OR/ICU) 3. Hemodynamics (OR/ICU) 4. Cardio-pulmonary Bypass (OR) 5. Invasive Monitoring/TEE (OR/ICU) 6. Ventilation (OR/ICU) 7. General Support of patient in the ICU (Fluids/Hemodynamics/Electrolytes/Nutrition/etc.) 8. Pharmacology (w/ focus on intra-op cardiac pharmacology) (OR) o Anesthesiology Simulation Lab sessions once every two weeks. Continued  Departmental Sessions: o TEE Lecture Series: Tuesday 12:00pm 3
  4. 4. o Anesthesiology Grand Rounds/M&M: Thursday 6:45am, RMSB 5th Fl. Aud. o CVT Anesthesia Journal Club: Friday 6:30am, JMH Cafeteria o ICU Core Lecture Series: Friday 12:00pm SICU-B Conference Room  Extra-Departmental Sessions: o Cardiology Case Presentation Conference: Monday 12:00pm, JMH C-403 o ECG Conference: Tuesday 12:00pm, JMH C-403 o CVT Surgery Grand Rounds/M&M: Thursday 7:00am, ET 3rd Fl. Surgery Office • Recommended Text or Reading: o A list of recommended articles and selected readings will be made available during the rotation. Students will have access to the Anesthesiology Library, which has numerous texts available for reference, in addition to an ‘Introduction to TEE’ CD-ROM. The faculty and guest lecturers will also provide handouts. 3. Goals/Objectives: • The goal of this course is to educate students on the anesthetic considerations related to cardiothoracic surgery and familiarize the students to the management of cardiothoracic surgical patients in the post- surgical ICU setting. • During the OR portion of the course, the student will participate in preoperative evaluations and be involved with the intra-operative management of the patient. It will also be important for the student to follow the post-operative course of the patients. • During the ICU portion of the course, the student will make rounds each day, perform evaluations of postoperative patients, and help in their management. Students will be expected to present at daily rounds. • After this clerkship, the student should be able to:  Clinical skill/procedural goals: • On rounds, give an oral presentation of an ICU patient in a succinct, focused manner, including H&P, assessment and plan. • Write an ICU admission note/progress note which clearly summarizes the pertinent ICU problems and delineates the student’s thought process about appropriate diagnostic and therapeutic plans • Describe or demonstrate techniques for placement of monitoring lines and devices including arterial lines, central lines, and central line guidewire exchange. • Perform a literature search on an ICU patient’s diagnosis, treatment, or prognosis and describe how to use the information to care for the patient. • Write initial mechanical ventilation orders for patients with the following conditions: ARDS, respiratory failure, COPD, asthma, post-op patients and be able to explain the rationale for the settings. • Identify preoperative risk factors for cardiac surgery • Discuss the indications for invasive monitoring during cardiac surgery • Form a preoperative plan specific to the patient for hemodynamic monitoring of cardiac surgery • Demonstrate an understanding of cardiovascular pathophysiology and the implications for the administration of general anesthesia • Be able to recognize basic cardiac anatomy and gross pathology on transesophageal echocardiographic evaluation  Knowledge/cognitive goals: • Students will be expected to demonstrate knowledge of airway management, acute cardio-respiratory failure responses, interpretation of blood gas and other monitoring data, mechanical ventilation, respiratory therapy, management of pain and sedation, emergency resuscitation, nutrition, invasive hemodynamic monitoring using arterial, central venous pressure and pulmonary artery catheters, management of major postoperative problems such as bleeding and sepsis, and an understanding of organ system failure and shock. Continued 4
  5. 5. 4. Location: • The rotation will take place in several venues including, but not limited to, the JMH Operating Rooms designated for CT surgery, the pre-op holding area, the Simulation lab in the JMH Patient Safety Center, and the post-surgical CT-ICU. Students may also be assigned to cases in the VAMC operating rooms and VA-SICU. 5. Participating Faculty: This course will be taught by a multidisciplinary team of faculty from the Department of Anesthesiology consisting of intensivists, fellowship trained cardiac anesthesiologists, experts in medical simulation training, in addition to several additional members of the UM Department of Anesthesiology faculty including but not limited to: • Jonathan Katz, M.D., D.M.D., Fellowship-trained Cardiac Anesthesiologist, will be the course coordinator. • Ricardo Martinez-Ruiz, M.D., Assistant Professor of Anesthesiology with Board Certification in Critical Care Medicine will assist Dr. Katz in coordinating the Cardiac Surgical ICU portion of the elective. • Frank Rosemeier, M.D., CVT Anesthesiology and Critical Care Medicine Faculty. • Daniel Castillo, M.D., Assistant Professor of Anesthesiology with Board Certification in Critical Care Medicine will assist Dr. Katz in coordinating the Simulation Training and Evaluation Sessions. • Jay Grossman, M.D., CVT Anesthesiology • John Sciarra M.D., CVT Anesthesiology • Brantley Dollar M.D., CVT Anesthesiology • Julie Oppenheimer M.D., Assistant Professor of Anesthesiology, VAMC, Preceptor for Medical Student Simulator Training Sessions • There will be two Cardiac Anesthesiology Fellows who will mentor one medical student during the OR portion of the course and will also be responsible for covering core lecture topics not otherwise covered in the exiting departmental lecture series. 6. Prerequisites: • See above 7. Expectations: • Upon completion of this 4 week elective, the student will be expected to have: • Performed and presented a preoperative evaluation of a patient for cardiac surgery • Formulate a basic anesthetic plan for the cardiac surgical patient • Observed coronary artery bypass surgery • Observed cardiopulmonary bypass • Observed central venous cannulation (5) • Observed arterial line insertion (5) • Observed the use of ultrasound for venous access • Observed the use of Perioperative Transesophageal Echocardiography in the management of the cardiac surgical patient • Participated in Patient Simulation (1 session every 2 weeks) in the Patient Safety Center • Attended Conferences for Cardiac and CSICU residents/fellows • Followed at least one patient in the CSICU daily • Presented at least one patient in the CSICU daily • Actively participated in daily rounds • Completed daily/admission notes • Demonstrated specific understanding of sterile technique with regard to invasive procedures in the ICU setting 5
  6. 6. Continued 8. Student evaluations and grading: • Students will be subjectively evaluated by the course coordinator and assisting faculty and fellows at the 2- week and 4-week intervals. • Students will be required to evaluate the course and participating faculty at the 2-week and 4-week intervals. • Grading will be Pass/Fail and based on: • Timely submission of Evaluations and Competency Checklist • Attendance to all scheduled sessions • Performance in simulation sessions • Motivation and involvement with patient management • Patient evaluation and presentation skills 9. Educational Resources: Useful Internet Links: Cardiac Physiology and Monitoring Transesophageal Echocardiography ECG The Pulmonary Artery Catheter Education Project Thoracic Anesthesiology Society of Cardiovascular Anesthesiologists (SCA) SCA Education links: Reference Books: (Not required) Available in Anes Library Cardiac Surgery in the Adult by Cohn and Edmunds (FREE On-line Textbook) Clinical Anesthesiology (Paperback) by Morgan, Mikhail, Murray Copies of CV Physiology and Anesthesia for CV/Thoracic Surgery Chapters Available in Anes Lib, additional copies may be requested from course coordinator. Critical Care Medicine by Marini, Wheeler – Textbook generously donated by Dr. Silverman This text may be signed-out for the two week ICU segment of the course Board Stiff TEE -- Transesophageal Echocardiography (Paperback) by Christopher J. Gallagher Kaplan's Cardiac Anesthesia (Hardcover) by Joel A. Kaplan, David L. Reich, Carol L. Lake, Steven N. Konstadt 6
  7. 7. Additional Educational Resources: Introduction to Trans-Esophageal Echocardiography CD-ROM o Copy available for sign-out at the beginning of the elective. - $20 replacement fee will apply if lost o Additional copy available in Anesthesiology Library for use on Library computers. Anesthesiology Library Access Card o Must be checked out and returned at the end of the elective o $20 replacement fee will apply if lost Lecture and Conference Schedule Monday: (12 Noon) Cardiology Case Presentation Conference - JMH C-403 Tuesday: (12 Noon) ECG Conference - JMH C-403 Wednesday: No formally scheduled lectures Thursday: (6:45 am) Anesthesiology Grand Rounds Rosensteil Bldg 5th Floor Auditorium OR (7:00am) Cardiothoracic Surgery Grand Rounds East Tower 3rd Floor Surgical Offices *Attend one of these each week. Friday: (6:30am) CVT Anesthesia Journal Club- Jackson Cafeteria (12 Noon) CS-ICU Noon Conference - SICU B Conference Room 7
  8. 8. MDR-953 Recommended Self-Learning Schedule and Checklist Name: ________________________ Rotation Month: ________________  The following is a suggested schedule of learning resources to be reviewed during this elective. It is neither a comprehensive list nor a mandatory schedule, but merely should be used as a weekly guide to cover certain integral topics relevant to this elective.  In the Anesthesiology Library, all of the following website links are saved in the ‘favorites’ section under ‘Cardiac Anes-Critical Care-MDR953’.  Ask Ms. Avilette Rodriguez in the Anesthesiology Library for the in-house copy of the TEE CD-ROM and heaphones, or use your signed-out copy.  To help us improve the educational aspect of this elective, please accurately check-off the learning resources you were able to complete and circle during which segment (OR / ICU) it was completed. Please turn this form in at the conclusion of the elective - Your progress will by no means affect your grade or evaluation. **Prior to the start of the course, please review the following core topics available on:**  Airway Anatomy  Respiratory Physiology  Airway Management Week 1 Tuesday: OR / ICU Invasive Cardiac Monitoring Review esiology-Elective/home.cfm  Invasive Cardiac Monitoring: The Physiology Behind the Practice  Invasive Cardiac Monitoring: Procedures and Complications Thursday: OR / ICU TEE CD-ROM (20 images):  Introduction  Myocardial Wall Motion  Left Ventricle  Mitral Valve Week 2 Tuesday: OR / ICU Pulmonary Artery Catheter Education Project Complete Registration and Level I:  Lesson A  Lesson D  Lesson B  Lesson E  Lesson C  Lesson F Thursday: OR / ICU TEE CD-ROM (14 images):  LAA, LUPV, ME Bicaval  Aorta  Coronary Sinus  Right Ventricle  Aortic Valve Week 3 Tuesday: OR / ICU Pulmonary Artery Catheter Education Project Complete Level II:  Lesson A  Lesson D  Lesson B  Lesson E  Lesson C Thursday: OR / ICU UCSF TEE Primer:  Introduction  Valve Pathology  Insertion  Other Pathology  Anatomy 1  Devices  Anatomy 2  Masses  Short Axis Week 4 Tuesday: OR / ICU Society of Cardiovascular Anesthesiologists Intraoperative Exam: A-J  A  E  I  B  F  J  C  G  D  H Thursday: OR / ICU Society of Cardiovascular Anesthesiologists Intraoperative Exam: K-T  K  O  S  L  P  T 8
  9. 9.  M  Q  N  R 9
  10. 10. Cardiac Anesthesiology/Critical Care Elective (MDR953) Competency Checklist Name: _______________________________ Rotation Dates: _____________________ Operating Room Date Patient Initials or Attending/Fellow Signature Performed and Presented a Preoperative Evaluation of a Patient for Cardiac Surgery Formulate Basic Anesthetic Plan for the Cardiac Surgical Patient Observed Coronary Artery Bypass Surgery Observed Cardiopulmonary Bypass Observed Central Venous Cannulation (5) / / / / Observed Use of Ultrasound for Venous Access Observed Arterial Line Insertion (5) / / / / Observed the use of Perioperative Transesophageal Echocardiography Participated in Patient Simulation (1 session during 2 weeks) Attended Departmental Conferences CSICU Date Patient Initials or Attending/Fellow Signature Followed At Least One Patient daily Presented At Least One Patient daily Actively Participated in Rounds daily Completed Daily/Admission Notes Demonstrate Specific Understanding of Sterile Technique Participated in Patient Simulation (1 session during 2 weeks) Student Signature: ______________________ OR Segment Faculty:________________________ ICU Segment Faculty:________________________ 10
  11. 11. Cardiac Anesthesiology/Critical Care Elective (MDR-953) Anesthesiology Library Access Card/Intro to TEE CD-ROM/Critical Care Text Sign-out Form Name: ___________________________ C-number: _______________________ Phone: ___________________________ E-mail: __________________________ Access Card ID#: __________________ I, the above named student, agree to use the Anesthesiology Department provided ‘Introduction to TEE CD-ROM’ and the ‘Anesthesiology Library Access Card’ during my scheduled 4-week Cardiac Anesthesiology/Critical Care Elective and will return the CD-ROM and ‘Access Card’ to Brandy Bluett (office: SW-303, on, or before, the last day of the elective. I understand that I will receive an incomplete for the course until both the CD-ROM and the Access Card are returned. If either the Access Card or CD-ROM is lost, I will be responsible for immediately notifying Brandy Bluett and reimbursing the Department a $20 fee for each. Sign-out: Signed: ___________________________________ Date: _____________________ Returned: Signed: ___________________________________ Date: _____________________ You also have the option of signing out the ‘Critical Care Medicine: The Essentials’ text (donated to the course by Dr. Silverman) for the 2-week ICU segment to be returned at the end of those two weeks. If the text is lost, you will be responsible for reimbursing the Department the $52.00 replacement fee. Sign-out: Signed: ___________________________________ Date: _____________________ Returned: Signed: ___________________________________ Date: _____________________ 11