Swedish Faculty contact:
Ben Davis, MD
Pager: 206-998-5908
Email: ben.davis@swedish.org
Intensivist Contact:
Leah Smith MD
Phone: 206-790-7268
Email: Leah.Smith@swedish.org
This elective includes one 6-day stretch of 12-hour days in the ICU, Monday-Saturday from 7AM to 7PM. This schedule allows you to be paired with one hospitalist attending for the week and to have ongoing continuity with patients over the course of their ICU stay.
There is no night call and one half day of clinic that week. The other 3 weeks of the block will be clinic-intensive. Vacation is possible during one of those weeks. The resident will not be expected to attend the regularly scheduled Family Medicine teaching conferences while in the ICU.
During the week in the ICU, residents will admit new patients and will manage existing patients through their ICU stay, under the supervision of the intensivist. They will work closely with all members of the ICU interdisciplinary team. They will participate in all interdisciplinary rounds and in family meetings. They will complete the required readings (see the reading list below) and work through the additional reading list as time allows.
Educational goals of this elective include:
· Increased comfort and skill in the diagnosis and management of patients suffering from a broad spectrum of critical illnesses including septic shock, DKA, GI bleeding, ARDS, respiratory failure, CHF, malignant hypertension, acute delirium tremens, hyperosmolarnonketotic coma, severe electrolyte disturbances, and others
· Increased skill and confidence in the initial steps for stabilizing a critically ill patient
· Increased familiarity with the priciples of ventilator management, including strategies for minimizing complications and for weaning
· Increased knowledge and comfort with appropriate selection and use of pressors
· Hands-on experience with a variety of ICU procedures (including understanding indications and contraindications) including intubation, use of CPAP and BiPAP, line placement, thoracentesis and paracentesis (types and number of procedures you may be able to participate in will vary, depending on the needs of the patients in any given week)
· Increased knowledge of and comfort with management (including prevention) of acute delirium in the critically ill patient
Cherry Hill and Surgery residents also rotate into the ICU, so schedules need to be coordinated through Dr. Leah Smith. Plan early to maximize your chance to get the week that you want. For clinic scheduling purposes, you should pick the week you want at least two months in advance, before that block’s clinic schedule has been made. Check first with your clinic chief to make sure that this week will work with the rest of the clinic’s scheduling needs.
The hospitalist schedule can be found on the Swedish intranet at http://fhamwx-vg01/webdirectory/ (look up under “Critical care/ICU”, then “FH Medical ICU” for the month you are considering; most of the hospitalists are on call from Monday-Sunday, one week at a time).
For the rest of the block, residents will have 6 half-days of clinic each week (18 clinics in total), 3 half-days of didactics, 3 half-days (one per clinic week) of clinic coordination/admin time, and 4 half-days of remaining elective time.
Required Reading List
"ICU Basics" https://chicago.medicine.uic.edu/wp-content/uploads/sites/6/2017/09/icuguidebook.pdf
Neumar RW, Otto CW, Link MS, Kronick SL et al. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American heart Association Guidelines for Cardiovascular Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S729-S767 http://circ.ahajournals.org/content/122/18_suppl_3/S729.full.pdf+html
Here is a list of additional papers, compiled by the Intensivist group, to read as time allows:
ARDS:
1. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome. NEngl J Med. 2010;363:1107-1116
2. Guérin et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome (PROSEVA).New Engl J Med 2013;epublished May 20th
3.Ferguson et al. High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome(OSCILLATE). New Engl J Med 2013;epublished January 22rd
4.Young et al. High-Frequency Oscillation for Acute Respiratory Distress Syndrome (OSCAR).New Engl J Med 2013;epublished January 22nd
5.ARDS Definition Task Force, Acute respiratory distress syndrome: the Berlin Definition. JAMA.2012; 307:2526-33.PMID:22797452http://jama.jamanetwork.com/article.aspx?articleid=1160659
6. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentrerandomised controlled trial. Lancet 2009;374:1351-63. PMID: 19762075http://www.ncbi.nlm.nih.gov/pubmed/19762075
Long term outcomes:
1. Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011 Apr 7;364(14):1293-304. PMID: 21470008http://www.ncbi.nlm.nih.gov/pubmed/21470008
2. P.P. Pandharipande. Long-Term Cognitive Impairment after Critical Illness.N Engl J Med 2013; 369:1306-1316. October 3, 2013 DOI: 10.1056/NEJMoa1301372 http://www.nejm.org/doi/full/10.1056/NEJMoa1301372
ICU nutrition:
1. Reignier et al. Effect of Not Monitoring Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding: A Randomized Controlled Trial. JAMA 2013;309(3):249
2. Davies AR, Morrison SS, Bailey MJ, et al; ENTERIC Study Investigators; ANZICS Clinical Trials Group. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med. 2012; 2342-8.PMID: 22809907http://www.ncbi.nlm.nih.gov/pubmed/22809907
3. Rice TW, Wheeler AP, Thompson BT, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 2012;307: 795-803. PMID:22307571 http://jama.jamanetwork.com/article.aspx?articleid=1355969
4. Doig et al. Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition: A Randomized Controlled Trial. JAMA 2013;epublished May 20th
Tracheostomy:
1. Young et al. Effect of Early vs Late Tracheostomy Placement on Survival in Patients Receiving Mechanical Ventilation: The TracMan Randomized Trial. JAMA 2013;309(20):2121
ICU staffing:
1. Kerlin et al. A Randomized Trial of Nighttime Physician Staffing in an Intensive Care Unit. New Engl J Med 2013;epublished May 20th
Cardiac arrest
Nielsen N. et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest.N NEnglJ Med. 2013 Dec 5;369(23):2197-206. doi: 10.1056/NEJMoa1310519. Epub 2013 Nov 17. http://www.ncbi.nlm.nih.gov/pubmed/24237006
2. Mentzelopoulos et al. Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2013;310(3):270
3. Patricia Jabre. Family Presence during Cardiopulmonary Resuscitation. N Engl J Med 2013; 368:1008-1018 March 14, 2013 DOI: 10.1056/NEJMoa1203366
Miscellaneous
1. Morelli A. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. JAMA. 2013 Oct 23;310(16):1683-91. doi: 10.1001/jama.2013.278477. PubMed PMID: 24108526.
2. Villanueva C. Transfusion strategies for acute upper gastrointestinal bleeding.
N Engl J Med. 2013 Jan 3;368(1):11-21. doi: 10.1056/NEJMoa1211801.http://www.ncbi.nlm.nih.gov/pubmed/23281973
3.Dellinger RP. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med.2013 Feb;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af.http://www.ncbi.nlm.nih.gov/pubmed/23353941
4. Weingart SD, LevitanRM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002. Epub 2011 Nov 3. http://www.ncbi.nlm.nih.gov/pubmed/22050948
Last Updated: 07/18, Ben Davis