Critical Care Specialty Track

Faculty Director: Holly Thompson, MD

 

This track is made for EM residents with an interest in refining their knowledge and skills pertaining to critical care medicine, and in pursuing critical care fellowship after residency. It is continually re-evaluated and improved to provide the most beneficial and in-depth training available with the resources at TBHC.

 

LEARNING OBJECTIVES

  • Become competent in the initial evaluation and comprehensive care of critically ill patients
  • Understand indications for admission to the ICU
  • Set initial invasive and non-invasive ventilator settings for patients with acute respiratory failure
  • Function as a member of the a multidisciplinary team caring for critically ill
  • Understand the approach to fever, acid-base disorders, DKA, electrolyte disturbances, status epilepticus, CVA and alcohol withdrawal as it applies to the critically ill patient
  • Understand the diagnosis and treatment of anxiety, agitation, pain and delirium, including appropriate use of sedatives and paralytics
  • Become an effective communicator with patients, family members and the ethics committee and lead appropriate discussions regarding end-of- life care, DNR and withdrawal of care
  • Use advanced critical care knowledge to create simulations, research opportunities, and publish articles, papers, FOAM contributions, blogs
  • Become proficient with and teach procedure skills
  • Strengthen the qualifications and skills necessary to succeed in fellowship

 

RECURRENT ANNUAL OBJECTIVES

Quarterly meeting as a group that will include:

  •     Review of recent CC literature
  •     Discussion of ongoing CC-related QI and research projects
  •     Meeting with CC-trained mentor to address questions or ongoing issues
  •     Coverage of upcoming important meetings, conferences
  •     Going over fellowship and elective opportunities

Present CC-focused lectures at monthly conference

Develop CC simulation cases

Work on TBHC CC handbook and lecture series

Apply for leadership roles within EMRA or national committees

 

INTERDISCIPLINARY LECTURE SERIES / CC JOURNAL CLUB

Dr Gerolemou along with the pulmonary fellows and MICU residents will participate in the ED weekly conference once per quarter to present and discuss notable cases admitted to the ICU. We will address particular learning points for critical care in the ED, improve communication between the ED and the ICU, and foster other areas of interest between the two departments.

CC track residents will be invited to participate in the monthly pulmonary fellowship critical care journal club. New trends, modalities and medications will also be discussed. 

 

QI PROJECT

The effort should focus on sustainable improvement of ED processes as it applies to the ICU patients. These projects should be developed in conjunction with Dr Holly Thompson, Dr Louis Gerolemou, and Billy Shin. 

  • TIMELINE: The resident should begin thinking about a QI project as soon as possible. Some important time constraints to consider: (1) The IRB board at TBHC convenes monthly, and will take at least one month (usually more) to approve the project; (2) Collecting adequate data to publish results may take upwards of one year of data collection; (3) Papers and posters often take several months to work their way through editorial acceptance. It would be ideal to have the IRB approval early in your second year at the latest to have the strongest impact on fellowship
  • IRB/QI PROCEDURES: Billy Shin is the head of our research program and will guide you through the IRB process. Dr Gerolemou is heavily involved in the QI process in the hospital and can provide guidance with how best to execute your idea, as well as collecting the relevant hospital metrics and data.
  • POTENTIAL PROJECTS at TBHC

             o DKA time to anion gap closure

             o Arterial line setup in resus room

             o Zoll machine maintenance program to reduce time to CT

             o End-of- life planning in the ED

             o Improving appropriate antibiotic use

             o IVC ultrasound to guide sepsis/resuscitation decisions

             o IO availability to decrease time to IV access during resuscitations

             o Advanced vent management in the ED

 

PUBLISH

In addition to original research, which is strongly encouraged, other contributions may

  •     Critical care track blog on TBHC website
  •     Articles for EM Resident publication
  •     Pressordex and other EMRA-CC specific publications

 

MEETINGS AND WORKSHOPS

  • Attending local, state and national meetings focused on critical care concepts increases the visibility of the program, helps the future applicant build their network in the critical care and EM-CC world, and enriches the residency. Members of the CC track will be encouraged to attend critical care meetings and workshops and present what they learned at conference.
  • EMRA-CC meetings at ACEP and SAEM
  • Levitan airway course
  • Crashing Patient course at University of Maryland
  • HART Course at UPenn
  • Annual NYC resuscitation conference at Mount Sinai
  • Annual Jacobi Trauma conference

 

IMPORTANT FELLOWSHIP APPLICATION DATES

ANESTHESIA-CRITICAL CARE

  • Match registration opens in NOVEMBER OF YOUR THIRD YEAR
  • Match day is in MAY OF YOUR THIRD YEAR
  • ie. To start fellowship in July 2019, you register in November of 2017

SURGICAL CRITICAL CARE

  • Match registration opens JUNE OF YOUR THIRD YEAR
  • Match day is in OCTOBER OF YOUR FOURTH YEAR

CRITICAL CARE MEDICINE

  • Match registration opens AUGUST OF YOUR FOURTH YEAR
  • Match day is in December