Medical Intensive Care Unit/Coronary Care Unit - VAMC

Critical Care Medicine Overview: Critical care medicine is designed to provide systematic, comprehensive, timely and aggressive treatments and supportive care to patients with complex and life-threatening medical conditions. Care is directed and coordinated by an intensivist and delivered by a multidisciplinary care team of healthcare professionals. Patient conditions change rapidly causing clinical deterioration resulting in increased morbidity and mortality if not acted upon swiftly and aggressively by vigilant and present clinicians. Identification of risk factors for predictable complications allows application of risk mitigation interventions and heighted preparedness to address anticipated medical emergencies. Excellent communication within the care team, between consultants, and with patients and families is critical to providing the best and timely care.

Rotation Overview: Trainees, with progressive responsibility based on their degree of demonstrated ability, learn to deliver comprehensive care to a broad range of critically ill medical, cardiac, and surgical patients. The team manages patients admitted to the MICU Service and responds to medical emergencies (except emergency room) within the hospital (buildings 1, 4, 6, and 17) and the CLC, admits transfers from outlying facilities, and provides consultative critical care services. The MICU is a closed ICU, staffed by a single Medical ICU Team that is primarily responsible for all patient care on the service. MICU Fellows and Attendings are available 24 hours a day either in house or by phone for return to the hospital within 30 minutes.

Course Learning Objectives:

By the end of this course, the student should be able to:

1. Demonstrate the ability to gather information necessary to care for critically ill patients via patient and family interviews and chart review.
2. Perform both comprehensive and focused physical exams on critically ill patients.
3. Demonstrate the ability to present critically ill patients on rounds in a system-based format.
4. Practice developing an assessment and plan for critically ill patients.
5. Use information to adjust the plan as a patient's condition changes.
6. Apply appropriate treatment strategies to different sources of shock.
7. Practice developing a management plan for electrolyte derangements.
8. Interpret the need for resuscitation in patients with septic shock.
9. Apply medical standards to the selection of antibiotics for a variety of infections.
10. Practice developing a management plan for a hypertensive emergency.
11. Demonstrate the ability to work within an interdisciplinary team.
12. Practice communicating difficult information to patients and families.
13. Demonstrate empathetic patient-centered communication when discussing end of life care issues.
14. Practice organizing information for transition of patient care across different healthcare settings.