The pediatric cardiothoracic intensive care rotation introduces the fellow to the care of pediatric cardiac patients postoperatively as well as to the role of the pediatric cardiologist intra-operatively. The chief purpose of these rotations is to develop expertise in caring for infants and children who are postcardiac procedures. Fellows will develop familiarity with the clinical algorithms used in caring for these critically ill patients as well as developing expertise in assessing the hemodynamics of the postoperative patients. While superficially similar to pediatric critical care in general, a variety of issues specific to this patient population are emphasized, such as control of pulmonary blood flow, right heart failure, and postoperative arrhythmia recognition and treatment.
The fellow spends the rotation in the PCICU, a six-bed unit dedicated to specialized care for infants and children who have undergone cardiac operations. The fellow works closely with the faculty member as well as the physician assistants, who are present in the unit 24 hours, and the specialized nursing staff.
The fellow is assigned patients of increasing complexity for clinical management. The fellows, under careful supervision, progress from caring for children who have undergone simple corrective procedures (e.g., secundum atrial septal defect closure) and palliative procedures (e.g., placement of a systemic-pulmonary shunt) to the most complex (e.g., newborns who have undergone Stage I Norwood palliation for hypoplastic left heart syndrome). The fellow learns the pathophysiology of the cardiac lesions as well as the potential complications of the various surgical procedures. During twice-daily bedside rounds (approximately two hours per day), the differential diagnoses of various clinical problems are discussed in a system-based approach. The interpretation of hemodynamic monitoring (e.g., intracardiac pressure and arterial-mixed venous saturation monitoring) is stressed and integrated with the other clinical data to develop therapeutic interventions. The fellows learn about postoperative arrhythmias and the use of temporary pacing. In addition, the faculty, fellows, and physician assistants make daily rounds with the cardiothoracic surgeons (approximately one-half hour per day). Through these interactions, the fellows learn about the collaborative approach to the management of pediatric cardiac patients postoperatively and the role of the surgeons in this phase of care.
In addition to the daily rounds, the pediatric cardiology faculty, fellow, and physician assistant attend to a wide variety of issues that arise acutely in the PCICU. Issues include care of patients who have just returned from the operating room, postoperative hemorrhaging, management of low cardiac output, and acute recognition, and management of arrhythmias.
In addition to evaluating and caring for patients, the fellows have opportunities to perform certain subspecialty procedures during this rotation. These procedures include placement of central venous and arterial lines percutaneously, placement of chest tubes, and cardioversion with adenosine, overdrive pacing, and direct current. The fellows also learn about cardiopulmonary resuscitation of postoperative patients.
The fellows spend a portion of the PCICU rotation in the operating suites, observing pediatric cardiothoracic surgical procedures. In addition to seeing congenital heart defects in vivo, the fellows learn about anesthetic approaches to cardiac surgery in patients with congenital heart disease and various aspects of cardiopulmonary bypass. The fellows, who typically enter the operating rooms with their PCICU faculty member, learn the role of the pediatric cardiologist in interacting with the cardiothoracic surgeons during and immediately after surgical procedures. This interaction fosters an understanding of the data that surgeons might require during procedures, as well as the information that cardiologists need to garner in order to provide appropriate care for the patient immediately after surgery.
Icahn School of Medicine
One Gustave L. Levy Place
New York, NY 10029
Application Review Deadline:
January 15, 2014
Advanced Imaging Deadline:
September 1, 2013
September 1 - November 12, 2013