Resident Resources



PICU Resident Rotation

Alfred I DuPont Hospital for Children

Nemours Foundation

Resident Resources

Introduction to PICU Rotation

Residents given PICU Core Curriculum (see separate attached file)

Outlines expectations of residents and general educational plans

Residents given folder with additional information

PICU Procedure and Primary Patient Logs.

PICU Resident Systems Based Learning Project Quality Improvement Case Analysis form.

InfoLink information.

Copy of combined resident and critical care attending progress note form. This form is used to prepare for patient care rounds and for presenting patients’ clinical course on rounds.

Request to discuss TPN details on patient care rounds

Daily Goals sheet

Mechanical Ventilation Weaning Guidelines

PICU Order Entry Flow Sheet for writing orders during busy PICU times

Process for Patient Transfer Out of PICU

Alfred I DuPont Hospital for Children Transfer of responsibility for Patient Care and Medication Reconciliation Memo

Visiting residents receive Beeper, Proxy Card, Parking Passes, Meal Cards. (Pediatric and Medicine-Pediatric residents already have these resources).

Visiting medical students receive Proxy Card and Parking Pass.

Exposure to a pediatric medical-surgical PICU population

Participation in multidisciplinary-team care of critically ill children and adolescents

Clinical supervision by board-certified pediatric critical care medicine physicians 24 hours a day

Exposure to pediatric critical care fellows

PICU Resident Rotation Web Site*



Overview

Faculty

Curriculum

Orientation

Outcomes

Outcomes Measurement

Resources

Content

Administrative Issues

General information

Patient responsibilities

Transfer Out of PICU Algorithm

Solid Organ Transplant Handbook

Lectures and Presentations (in-house power-point presentations)

Pediatric Toxicology

Critical Care Respiratory

Diabetic Ketoacidosis

Post-op Liver transplantation

Multiple Organ Dysfunction

Narcotic Withdrawal and Methadone taper

Nutrition in Critical Care

Pediatric Shock

Respiratory Failure

Septic Shock and MOF in Newborns and Children

Sold Organ Transplantation, Pharmocologist’s View

SIRS and ARDS in the PICU

Traumatic Brain Injury

Evidence Based Clinical Practice

Definition and Skills

Asking a Focused Clinical Question

Literature Search Strategies

Summary Criteria

Reports

2001-2002 through 2007-2008

Contact Information

Links

PCCM web site

PICU Rotation Time Line

Pediatric Critical Care Goals for PICU Resident Rotation

Code Blue Roles

Presenting Difficult PICU Cases on Rounds

Daily Note

Difficult Airway Cart

Pre-Rotation Questionnaire

PICU Post Test

*Internet site is reviewed and updated yearly in June/July

Interactive case-based bedside teaching

Supervised participation in critical care procedures: intubation, central venous line placement, arterial line placement, chest tube placement

Radiology reviews patient XRAYs in PICU (Monday-Friday)

PICU Mock Code (Fridays, 1400) (availability depends on PICU acuity)

Evidence Based Journal Club (monthly)

Presented by Pediatric Critical Care Medicine Attendings and Fellows and PICU Nurses

Monthly lecture by Pediatric Critical Care Fellows

Internet access to Society of Critical Care Medicine power-point presentations for residents participating in a PICU resident Rotation



Airway

Mechanical Ventilation

HFOV

Respiratory Failure

ARDS

Blood gas Analysis

Shock States

Shock and Sepsis

Cardiogenic Shock

DIC

Vasoactive Drugs

Arrythmias

Fluid and Electrolyte Emergencies

Sedation/Analgesia and Neuromuscular Blockade

Enteral and Parenteral Butrition

Hyponatremia

Head Injury

Coma

Guidelines for Medical Management Traumatic Brain Injury

Spinal Cord Injury

Renal Failure

Hepatic Failure

Asthma

Status Epilepticus

Thromboembolic Dosorders

DKA

Toxicology

Strokes in Children

Oncologic Emergencies

Sickle Cell, critical care

Pharmokinetics / Pharmodynamics

Endocrine Emergencies

Extracorporeal Life Support

Renal Replacement Therapy

Post-Op Cardiac Management

Single Ventricle Physiology

Pulmonary Artery Catheterization

Stabilization and Transport

Pediatric Disaster and terrorism Preparedness

Medical errors-The PICU Perspective

Ethics in PICU

Pediatric Office Emergencies

Textbooks available in PICU

Pediatric Critical Care

Third Edition

Fuhrman/Zimmerman

Pediatric Critical Care Medicine

Slonim / Pollock

Pediatric Intensive Care, Third Edition

Mark C. Rogers

The Difficult Pediatric Airway

Anesthesiology Clinics of North America

Jalil Riazi, MD, Editor

1999

Principles and Practice of Mechanical Ventilation

2nd Edition

Tobin

Management of Pediatric Trauma

Buntain

Illustrated Textbook of Pediatric Emergency and Critical Care Procedures

Dieckmann, Fiser, Selbst

Textbook of Pediatric Emergency Medicine

Ludwig Fleisher

The Pharmacologic Approach to Critically Ill Patients

Chernow, Third Edition

Principles and Practice of Intensive Care Monitoring

Tobin

Supportive Care of Children with Cancer

Current Therapy and Guidelines from the Children's Cancer Group

2nd Edition, 1997

Edited by Arthur R. Ablin M

Proxy Card access to medical library, ground floor Alfred I DuPont Hospital for Children

Internet access to InfoLink, an integrated resource that combines clinical applications, medical search engines, specific PICU educational material and evidence based medical textbooks and learning modules. Each resident receives material that will guide them through the InfoLink available resources. Below is a partial list of resources on InfoLink.

EPIC

Radiology I-Site

Lexicomp

Micromedex

Escription

Epocrates

Medical Calculator

Up To Date

Dynamed

STA!Ref

Practice Guidelines

ACPJ

Cochrane Library

MD Consult

OVID

CINAHL

PubMed

Google Scholar

Gene Tests

OMIM

Nemours eJournals

Dermatology textbook

Pediatric Critical Care Medicine

Literature

Interesting Cases

Evidence Based Journal Club

Web connections for critical care

PICU Rotation (link)

SCCM power-point lectures (link)

Critical Care Projects

Infant Botulism Treatment and Prevention Program

Mechanical Ventilation Weaning Protocol

PICU Evidence Based Guideline Conferences.

Internet access to our previous reviews:

Steroids and Septic Shock.

Use of Saline in Suctioning Artifical Airways.

Severe Traumatic Brain Injury in Children: Management and Monitoring.

Review of Evidence for Daily Interruption of Continuous Sedation in Mechanically Ventilated Children.

Mucous Plugs in Kid’s Airways, What’s the Evidence for Treatment.

Insulin Infusion Protocols in the PICU.

Oral Decontamination to Prevent Ventilator Associated Pneumonia.

Induced Hypothermia (NeuroProtectant).

CVP and Intravascular Volume.

Is There Evidence for the Use of N-acetylcysteine as a Protectant Agent

Against Contrast Induced Nephropathy?

Ventilator Associated Pneumonia.

PICU Nursing web site

PICU Case of the Week (under construction)

PICU Article Collection

Pertinent articles that we can enter and maintain. Mainly sepsis, ARDS, TBI.

Users’ Guide to The Medical Literature

Learning Modules (Evidence Literacy)

Calculators used in evidence based medicine

Searching medical engines

Personal Evidence Project – Developing a Critically Appraised Topic

Rational Clinical Exam

Individual Workspace

URL Search

ACGME Resident Duty Hours followed

Each pediatric critical care physician completes an on-line specific program evaluation for each resident at the completion of their PICU rotation. Evaluations are based on the ACGME six competencies :Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems Based Practice.

Requests of Residents

Prior to beginning the PICU rotation, complete 8 hours of internet based instructions regarding EPIC electronic medical record.

Review Resident PICU Core Curriculum

Complete on-line Pre-Rotation Questionnaire at the beginning of their rotation

Maintain a PICU Procedure Log and List of Primary Patients responsible for (age and diagnoses) and hand it in at the end of their PICU rotation

During patient care rounds, ask focused clinical questions about patient clinical problems, find medical literature that addresses these questions, using evidence based medicine techniques evaluate the validity, results and patient applicability of the information and bring information back to the PICU team.

Participate in Quality Improvement Case Analysis that identifies a PICU system problem.

At the end of their PICU rotation, complete on-line SCCM national test for residents who have completed a PICU rotation

Return Beeper and Proxy Card.

Complete their respective residency program’s on-line evaluation of the PICU rotation

Monitoring of PICU Resident Rotation

If completed, Pre-Rotation Questionnaires, SCCM post-test scores, critical care procedures done and critical care patient logs entered into our Access Data Base. (Partial data from1992 to present). We also have partial data of residents’ evaluations of the PICU rotation that was collected before individual programs developed their individual on-line forms.

Since 1992, we sent a survey to physicians now in practice who participated in our PICU rotation as residents. Survey requested information about their need to use pediatric critical care knowledge and skills in their practice settings. If survey returned, data entered into our Access data Base.

Presently, we request from their respective program directors a yearly summary of their residents’ evaluations of the PICU rotation

Reports of our PICU Rotation overview and plans 2001-2008 are available on our PICU Resident Rotation Web Site, under Reports.



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