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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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