Residency Training in General Surgery

SURGICAL CRITICAL CARE: Goals and Objectives


The physician in training will be exposed to all aspects of surgical critical care, beginning with receiving information of a patient coming to the SICU, the initial evaluation and management, ongoing clinical care, and all aspects of care delivery provided by a multidisciplinary ICU model.


n To learn to work in a multidisciplinary multiprofessional ICU environment.
n To learn the art of evaluation and management of the seriously ill patient.
n Define shock, categorize it based upon type, explain the etiology and pathophysiology of each type of shock.
n Summarize the clinical presentation and hemodynamic parameters associated with each type of shock using clinical terms, such as heart rate, respiratory rate, and blood pressure and filling pressures.
n To learn ICU pharmacotherapy including inotropes, chronotropes, and other drug-drug interactions.
n To learn about the diagnosis and treatment of such entities as respiratory failure, cardiac failure, renal failure, gastrointestinal and hepatobiliary failure, coagulopathy, neurologic compromise and multiple organ failure.
n To learn about infectious issues in the SICU and methods of evaluation and treatment.
n Outline the signs and symptoms of acute airway obstruction and define the appropriate intervention.
n To learn about mechanical ventilation and various modes of respiratory support.
n Explain the physiological impact of mechanically assisted ventilation on the cardiovascular/respiratory system.
n To become proficient at performing various procedures including central line placement, pulmonary artery catheter placement, tube thorocostomy, percutaneous tracheostomy, percutaneous endoscopic gastrostomy and arterial cannula placement.
n To gain experience and insight into laboratory evaluation, including arterial blood gas analysis and radiographic evaluation, especially chest radiographs.
n Review the importance of serial physical examinations, hemodynamic monitoring, and serial laboratory evaluations, including urine output and lactic acidosis, in assessing patient response to specific resuscitation treatment.
n Outline the clinical and laboratory indications for transfusion of blood products.
n Use disposable airway equipment, (e.g., bags, gloves) as transmissible infection precautions.
n Diagnose cardiac arrest and rhythm disturbances.
n Apply closed chest cardiac massage (CPR).
n Perform closed chest defibrillation.
n Perform pulmonary artery catheterization, including determining catheter position by pressure wave recording and electrocardiogram (EKG).
n Describe prophylactic measures routinely used in critical care.
n Outline the indications and methods for providing nutritional support.
n Outline the principles of postoperative fever with respect to causes, empiric diagnostic modalities, and specific therapy.
n Identify, define, and classify the major categories of acid-base disturbance (metabolic acidosis and/or alkalosis, respiratory acidosis and/or alkalosis) in the context of the patient's altered physiology.
n Discuss the correction of complex acid-base problems such as choice of intravenous fluids for electrolyte replacement.
n Discuss specific fluid compositions and the effect of the losses of such fluids as gastric, pancreatic, biliary, and succus entericus from intestinal fistulas of various levels.

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