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|Stony Brook Pediatrics | |
|Pediatric Intensive Care Rotation | |
|Level-Based Goals and Objectives | |
| | |
|Primary Goals for this Rotation |Competencies |
|GOAL I: Resuscitation and Stabilization (PICU). Recognize the critically ill patient and initiate appropriate | |
|stabilization and/or resuscitative measures. | |
|PL-2: | K |
|Describe the common causes of acute deterioration in the previously stable patient in the PICU. | |
| | K, PC |
|Explain and perform resuscitation and stabilization, particularly airway management, volume replacement and | |
|resuscitative pharmacology. | |
|PL-2: Explain and perform resuscitation and stabilization with direct faculty supervision and assistance | |
|PL-3: Explain and perform resuscitation and stabilization with indirect faculty supervision with immediate | |
|supervision available and less assistance than the PL-2 | |
| | K, PC, IPC |
|PL-2: Function appropriately in codes and resuscitations as part of the PICU team and as a code leader. | |
|PL-3: Function appropriately and act as a leader for junior residents. | |
|GOAL II: Common Signs and Symptoms (PICU). Evaluate and manage, under the supervision of an intensivist, common| |
|signs and symptoms seen in critically ill infants, children and adolescents in the intensive care setting. | |
|PL-2: Evaluate and manage moderately complex cases | K, PC |
|PL-3: Evaluate and manage moderately complex and rare cases | |
| | |
|Evaluate and manage, under supervision of an intensivist, patients with signs and symptoms that present | |
|commonly to the intensive care unit (examples below). | |
|Cardiovascular: acute life-threatening event, bradycardia, cardiopulmonary arrest, congestive heart failure, | |
|cyanosis, hypertension, hypotension, poor capillary perfusion, rhythm disturbances, tachycardia | |
|Endocrine: signs and symptoms suggestive of hypo- and hyperglycemia and adrenal insufficiency/crisis | |
|GI: abdominal distension, hematemesis and melena, icterus, peritoneal signs, vomiting | |
|Hematologic: pallor, petechiae, purpura, uncontrolled bleeding | |
|Infectious Diseases: endotoxic shock, fever , malignancy, immunodeficiency | |
|Neurologic: acute weakness, altered mental status, coma, delirium, encephalopathy, seizures, tetany, | |
|thermoregulatory abnormalities, signs of increased intracranial pressure | |
|Renal: anuria, hematuria, oliguria, polyuria, severe electrolyte disturbance | |
|Respiratory: apnea, cyanosis, dyspnea, hemoptysis, hypercarbia, hyperpnea, hypoxemia, increased or decreased | |
|respiratory effort, poor air movement, pulmonary edema, respiratory failure, stridor, tachypnea, wheezing | |
|GOAL III: Common Conditions (PICU). Recognize and manage, under the supervision of an intensivist, conditions | |
|that commonly present to the intensive care unit, using consultation when appropriate. | |
|PL-2: Evaluate and manage moderately complex cases | K, PC, IPC |
|PL-3: Evaluate and manage moderately complex and rare cases | |
| | |
|Evaluate and manage, under the supervision of an intensivist, patients with conditions that present commonly to| |
|the intensive care unit (examples below). | |
|General: burns (thermal, electrical), common intoxications, drug overdose, shock (cardiogenic, hypovolemic, | |
|distributive, toxic), inhalation injury, malignant hyperthermia, non-accidental trauma, submersion injury, | |
|toxic or caustic ingestion or inhalation injury, toxic shock syndrome | |
|Allergy Immunology: anaphylaxis, life-threatening angioedema, Stevens Johnson Syndrome, immunodeficiencies | |
|Cardiovascular: arrhythmias, cardiac tamponade, congestive heart failure, congenital heart disease, malignant | |
|hypertension, myocarditis/cardiomyopathy | |
|Endocrine: diabetes insipidus and adrenal insufficiency/crisis, diabetic ketoacidosis, hypo- and hyperglycemia,| |
|syndrome of inappropriate antidiuretic hormone (SIADH) | |
|Fluids, electrolytes, metabolic: inborn errors of metabolism, severe dehydration (hyper-, normo-, or | |
|hyponatremic), severe acid-base disturbances, severe electrolyte disturbance | |
|GI/Surgery: abdominal trauma (blunt/penetrating), acute abdomen, acute GI bleeding, fulminant hepatic | |
|dysfunction, hepatic dysfunction, pancreatitis, pre- and post-operative management, stress ulcer | |
|Hematologic: anemia (severe), disseminated intravascular coagulopathy (DIC), Deep venous thrombosis (DVT), | |
|neutropenia, sickle crisis, polycythemia, thrombocytopenia, malignancies, tumor lysis syndrome | |
|Infectious disease: encephalitis, infant botulism, meningitis, opportunistic infections, nosocomial infections,| |
|sepsis | |
|Neurologic: acute increased intracranial pressure, brain death, cerebral edema, cerebrovascular accident (CVA),| |
|coma, encephalopathy, Guillain-Barre, head injury, spinal muscle atrophy, status epilepticus | |
|Pulmonary: acute respiratory distress syndrome (ARDS), epiglottitis, pulmonary edema, pneumothorax, respiratory| |
|failure/impending respiratory failure, severe croup and bacterial tracheitis, status asthmaticus, upper airway | |
|obstruction (infectious, structural, foreign body), pneumonia, pulmonary effusion, empyema | |
|Renal: acute renal failure, hemolytic uremic syndrome | |
|GOAL IV: Diagnostic Testing (PICU). Utilize common diagnostic tests and imaging studies appropriately in the | |
|intensive care unit, obtaining consultation as indicated for interpretation of results. | |
|PL-2: Utilize the common diagnostic tests and imaging studies below, as applies to commonly seen conditions in | |
|the PICU, by being able to: | |
| | |
|PL-3: Utilize the common diagnostic tests and imaging studies below, as applies to less commonly and rarely | |
|conditions in the PICU by being able to: | |
|Explain the indications for and limitations of each study. | K, PC |
|Know or be able to locate readily age-appropriate normal ranges (lab studies). | K, PC, PBLI |
|Apply knowledge of diagnostic test properties, including the use of sensitivity, specificity, positive | K, PC, PBLI |
|predictive value, negative predictive value, likelihood ratios, and receiver operating characteristic curves, | |
|to assess the utility of tests in various clinical settings | |
|Discuss cost and utilization issues. | SBP |
|Interpret the results in the context of the specific patient. | K, PC |
|Discuss therapeutic options for correction of abnormalities. | K, PC |
|Use appropriately the following laboratory and imaging studies when indicated for patients in the PICU setting:| K, PC |
| | |
|CBC with differential, platelet count, RBC indices | |
|Blood chemistries: electrolytes, glucose, calcium, magnesium, phosphate | |
|Renal function tests | |
|Tests of hepatic function (PT, albumin) and damage (ammonia, bilirubin, liver enzymes) | |
|Serologic tests for infection (e.g., hepatitis, HIV) | |
|C-reactive protein, erythrocyte sedimentation rate | |
|Therapeutic drug concentrations | |
|Coagulation studies: platelets, PT/PTT, fibrinogen, FSP, D-dimers, "DIC screen" | |
|Arterial, capillary, and venous blood gases | |
|Detection of bacterial, viral, and fungal pathogens | |
|Urinalysis | |
|CSF analysis | |
|Gram stain | |
|Stool studies | |
|Toxicologic screens/drug levels | |
|Other fluid studies (e.g., pleural fluid, joint fluid) | |
|Chest X-ray | |
|Abdominal series | |
|Skeletal survey | |
|Cervical spine films | |
|CT scans of abdomen, chest and head | |
|MRI scans | |
|Basic concepts of cerebral blood flow studies | |
|GOAL V: Monitoring and Therapeutic Modalities (PICU). Understand how to use the physiologic monitoring, special| |
|technology and therapeutic modalities used commonly in the intensive care setting. | |
|PL-2 & PL-3: | K, PC |
|Demonstrate understanding of the monitoring techniques and special treatments commonly used in the PICU by | |
|being able to: | |
|Discuss the indications, contraindications and complications | |
|Have a basic understanding of the general techniques (e.g., Seldinger technique for central venous line | |
|placement) | |
|Interpret the results of monitoring | |
|PL-2: | K, PC |
|Use appropriately the following monitoring techniques in the intensive care unit under supervision of an | |
|intensivist, (for commonly seen conditions in the PICU): | |
| | |
|PL-3: | |
|Appropriately use the following monitoring techniques in the intensive care unit under supervision of an | |
|intensivist, (for less commonly or rarely seen conditions in the PICU): | |
| | |
|Central venous pressure monitoring | |
|Invasive arterial blood pressure monitoring | |
|Intracranial pressure monitoring | |
|Pulse oximetry | |
|End-tidal carbon dioxide monitoring | |
|Cardiac monitoring | |
|PL-2: | K, PC |
|Be familiar with the following treatments and techniques in the intensive care unit, including monitoring | |
|effects and anticipating potential complications specific to each therapy: | |
| | |
|PL-3: | |
|Use appropriately the following treatments and techniques in the intensive care unit, including monitoring | |
|effects and anticipating potential complications specific to each therapy: | |
|Oxygen administration by cannula, masks, hood | |
|Positive pressure ventilation, including non-invasive modalities such as nasal/mask BiPAP/CPAP, bag and mask | |
|ventilation | |
|Principles of ventilator management, intubation and extubation procedures and criteria | |
|Analgesics, sedatives, and paralytics | |
|Enteral and parenteral nutrition | |
|Blood and blood product transfusions | |
|Vasoactive drugs (pressors and inotropes) | |
|Principles of antibiotic therapy | |
|GOAL VI: Demonstrate high standards of professional competence while working with patients in the Pediatric | |
|Intensive Care Unit. | |
|PL-2 & PL-3: | |
|Use a logical and appropriate clinical approach to the care of critically ill patients, applying principles of | K, PC, PBLI |
|evidence-based decision-making and problem-solving. | |
|Provide sensitive support to patients with serious illness and to their families, and arrange for on-going | IPC, SBP, P |
|support or preventive services if needed. | |
|Demonstrate a commitment to acquiring the knowledge base expected of general pediatricians caring for seriously| K, PBLI |
|ill children under the guidance of an intensivist. | |
|Know and/or access medical information efficiently, evaluate it critically, and apply it appropriately to care | K, PC, PBLI |
|of patients in the PICU. | |
|Provide effective and sensitive communication with patients and families in the intensive care setting. | IPC, P |
|Participate effectively as part of an interdisciplinary team in the intensive care unit to create and sustain | IPC, P |
|information exchange, including communication with the primary care physician. | |
|Maintain accurate, timely and legally appropriate medical records on complex and critically ill children. | IPC, P |
|Use scientific methods and evidence to investigate, evaluate and improve one's patient care practice in PICU | PC, PBLI |
|setting. | |
|Identify personal learning needs, systematically organize relevant information resources for future reference, | K, PBLI |
|and plan for continuing acquisition of knowledge and skills. | |
|Demonstrate a commitment to carrying out professional responsibilities while providing care in the PICU | P |
|setting. | |
|Adhere to ethical and legal principles, and be sensitive to diversity in the care of critically ill children. | P |
|Identify key aspects of health care systems, cost control, and mechanisms for payment as they relate to the | SBP |
|intensive care setting. | |
|Recognize the limits of one's knowledge and expertise and take steps to avoid medical errors. | SBP |
|Procedures | |
|GOAL VII: Technical and therapeutic procedures. | |
| | |
|PL-2: Describe the following procedures; how they work and when they should be used; competently perform those| |
|commonly used by the pediatrician in practice. | |
|PL-3: Describe the following procedures; how they work and when they should be used, discuss those | |
|occasionally or rarely used by the general pediatrician in practice. | |
|Anesthesia/analgesia: conscious sedation | K, PC |
|Anesthesia/analgesia: pain management | K, PC |
|Arterial puncture | K, PC |
|Bladder: catherization | K, PC |
|Burn: acute stabilization of major burn | K, PC |
|Cardioversion/defibrillation | K, PC |
|Central line: use/care | K, PC |
|Chest physiotherapy | K, PC |
|Chest tube placement | K, PC |
|Endotracheal intubation | K, PC |
|Endotracheal intubation: rapid sequence intubation | K, PC |
|Gastric lavage | K, PC |
|Gastric tube placement (OG/NG) | K, PC |
|Gastrostomy tube replacement | K, PC |
|Intravenous line placement | K, PC |
|Intraosseous line placement | K, PC |
|Lumbar puncture | K, PC |
|Medication delivery: endotracheal | K, PC |
|Medication delivery: IM/SC/ID | K, PC |
|Medication delivery: inhaled | K, PC |
|Medication delivery: IV | K, PC |
|Medication delivery: rectal | K, PC |
|Pulmonary function tests: peak flow meter | K, PC |
|Pulse oximeter: placement | K, PC |
|Seldinger technique | K, PC |
|Sterile technique | K, PC |
|Suctioning: tracheostomy | K, PC |
|Thoracentesis | K, PC |
|Tracheostomy tube: replacement | K, PC |
|Ventilation: bag-valve-mask | K, PC |
|Ventilation support: initiation | K, PC |
|V-P shunt external taps | K, PC |
|GOAL VIII: Diagnostic and screening procedures. | |
|PL-2 & PL-3: | |
|Describe the following tests or procedures, including how they work and when they should be used; competently | |
|interpret reports of those commonly used by the pediatrician in practice. | |
|ECG: emergency interpretation | K, PC |
|ECG: perform | K, PC |
|Electroencephalogram (EEG) | K, PC |
|Monitoring interpretation: cardiac | K, PC |
|Monitoring interpretation: pulse oximetry | K, PC |
|Monitoring interpretation: respiratory | K, PC |
|Monitoring interpretation: Capnometry/end-tidal CO2 | K, PC |
|Radiologic interpretation: abdominal ultrasound | K, PC |
|Radiologic interpretation: abdominal X-ray | K, PC |
|Radiologic interpretation: cervical spine X-ray | K, PC |
|Radiologic interpretation: chest X-ray | K, PC |
|Radiologic interpretation: CT of head | K, PC |
|Radiologic interpretation: extremity X-ray | K, PC |
|Radiologic interpretation: GI contrast study | K, PC |
|Radiologic interpretation: lateral neck X-ray | K, PC |
|Radiologic interpretation: MRI of head | K, PC |
|Radiologic interpretation: renal ultrasound | K, PC |
|Radiologic interpretation: skeletal X-ray (incl. abuse) | K, PC |
|Radiologic interpretation: skull film for fracture | K, PC |
Core Competencies: K - Medical Knowledge
PC - Patient Care
IPC - Interpersonal and Communication Skills
P - Professionalism
PBLI - Practice-Based Learning and Improvement
SBP - Systems-Based Practice
Performance Expectations by Level of Training
| |Beginning |Developing |Accomplished |Competent |
| |Description of identifiable |Description of identifiable |Description of identifiable |Description of identifiable |
| |performance characteristics |performance characteristics |performance characteristics |performance characteristics |
| |reflecting a beginning level |reflecting development and |reflecting near mastery of |reflecting the highest level of |
| |of performance. |movement toward mastery of |performance. |performance. |
| | |performance. | | |
|Medical Knowledge |PL1 |PL1, PL2 |PL2, PL3 |PL3 |
|Patient Care |PL1 |PL1, PL2 |PL2, PL3 |PL3 |
|Interpersonal and |PL1 |PL1, PL2 |PL2, PL3 |PL3 |
|Communication Skills | | | | |
|Professionalism | |PL1 |PL2, PL3 |PL3 |
|Practice-Based Learning |PL1 |PL1, PL2 |PL2, PL3 |PL3 |
|and Improvement | | | | |
|Systems-Based Practice |PL1 |PL1, PL2 |PL2, PL3 |PL3 |
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