MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953

MDR-953

Cardiac Anesthesiology/Critical Care Elective

Table of Contents

1. Clerkship Welcome Letter p.2

2. Course Description (unabridged) p.3-6

1. Overview

2. Course Design

3. Goals/Objectives

4. Location

5. Participating Faculty

6. Prerequisites

7. Expectations

8. Student Evaluations/Grading

9. Educational Resources

3. Lecture Schedule p.7

4. Recommended Self-Learning Schedule/Checklist p.8

5. Competency Checklist p.9

6. Anesthesiology Library Access Card/CD-ROM Sign-out Form p.10

MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953MDR953 – Cardiac Anesthesiology/Critical Care Elective – MDR953

Welcome to the Cardiac Anesthesiology/Cardiac Surgical Intensive Care Elective!

We look forward to providing you the opportunity for a diverse and challenging learning experience.

For the next four weeks, we want you to integrate into each of your respective teams. For the first 2 weeks, you

will be in either the Cardiothoracic-Surgery-ICU (SICU-B/CSICU) or the Cardiothoracic Operating Rooms (OR’s

72,73,74). For the second 2 weeks of the rotation, you will switch locations. Please be vigilant about completing

your checklists and reviewing the learning resources provided. In addition, one time every 2 weeks you will

participate in a patient simulation session related to the management of patients in the operating room or ICU.

I will be your contact in the Cardiothoracic operating rooms and Dr. Martinez-Ruiz (martinez_ruiz@yahoo.com)

will be your contact in the SICU-B. Please contact me by email (jkatz2@med.miami.edu) the week prior to starting

the rotation to arrange assignments. Victor Chacon (Medical Student Education in Anesthesiology, Trauma 2 nd

Floor; 585-1191; vchacon@med.miami.edu) can also be contacted for further information.

You will find it helpful to review the flowing prior to the start of the rotation:

1.Cardiac Physiology 2.Respiratory Physiology 3.Airway Anatomy 4.Airway Management on the following

website: http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/home.cfm

Please check the website for the course outline, additional educational resources, lecture schedule and the contacts

list for the rotation. I will meet with you throughout the rotation to ensure that the educational objectives are being

met. Please let me know if you should have any questions or concerns.

Again, we look forward to working with you and plan to provide you with an exceptional learning experience.

Enjoy!!

Sincerely,

Jonathan Katz, M.D., D.M.D.Clerkship Director – Cardiac Anesthesiology/Critical Care ElectiveAssociate Residency Program DirectorAssistant Professor Cardiovascular and Thoracic AnesthesiologyDepartment of Anesthesiology, Perioperative Medicine and Pain MedicineUniversity of Miami / Jackson Memorial Hospital

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TITLE: Cardiac Anesthesiology/Critical Care Medical Student Elective

COURSE CODE: MDR 953CLERKSHIP DIRECTOR: Jonathan Katz, M.D., D.M.D.TELEPHONE/FAX: 305-585-6973EMAIL: jkatz2@med.miami.eduCONTACT: Victor Chacon / (vchacon@med.miami.edu 305-585-1191)LENGTH OF ELECTIVE: 4 weeks (4 Credits) - Offered all yearPREREQUISITE: 2-week Core Anesthesiology, Surgery, Internal MedicineNUMBER OF STUDENTS: 2INTERVIEWING TIME: Yes – 3 days with prior notificationTYPE:Clinical

COURSE DESCRIPTION

1. Overview: During this rotation the student will be exposed to the principles and the practice of cardiothoracic

anesthesia, applied cardiovascular physiology and pharmacology, and the management of the cardiothoracic surgical patient in the post-surgical ICU setting.

The course will provide the student exposure to and experience performing the preoperative assessment, intraoperative management and postoperative intensive care management of cardiothoracic surgical patients from the perspective of the cardiac anesthesiologist and critical care specialist. The student will work with faculty, fellows, and residents delivering anesthetic care to adult patients undergoing cardiovascular and thoracic procedures in the operating room and be responsible for direct day-to-day patient care in the ICU.

2. Course Design: The student will initially spend 2 weeks in the OR participating in the preoperative and intraoperative care

of at least one CT surgery patient per day and the following 2 weeks in the Cardiac-Surgery-ICU assisting in the postoperative management of CT surgery patients.

Didactics :o Several Core Topics (listed below) will be covered during this rotation. These topics will be

discussed during the existing departmental lecture series, journal club sessions, departmental Grand Rounds and M&M conferences, all of which the student will be required to attend. Core Topics not covered within these sessions will be discussed with the students in small group settings by either the cardiac anesthesia fellows or attendings.

o Core Topics/Learning Seminars : 1. Pre-Op Evaluation of CT patient (OR)2. General Cardio-pulmonary Physiology (OR/ICU)3. Hemodynamics (OR/ICU)4. Cardio-pulmonary Bypass (OR)5. Invasive Monitoring/TEE (OR/ICU)6. Ventilation (OR/ICU) 7. General Support of patient in the ICU (Fluids/Hemodynamics/Electrolytes/Nutrition/etc.)8. Pharmacology (w/ focus on intra-op cardiac pharmacology) (OR)

o Anesthesiology Simulation Lab sessions once every two weeks.

Continued Departmental Sessions:

o TEE Lecture Series: Tuesday 12:00pm

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o Anesthesiology Grand Rounds/M&M: Thursday 6:45am, RMSB 5th Fl. Aud.o CVT Anesthesia Journal Club: Friday 6:30am, JMH Cafeteriao ICU Core Lecture Series: Friday 12:00pm SICU-B Conference Room

Extra-Departmental Sessions:o Cardiology Case Presentation Conference: Monday 12:00pm, JMH C-403o ECG Conference: Tuesday 12:00pm, JMH C-403o CVT Surgery Grand Rounds/M&M: Thursday 7:00am, ET 3rd Fl. Surgery Office

Recommended Text or Reading: o A list of recommended articles and selected readings will be made available during the rotation.

Students will have access to the Anesthesiology Library, which has numerous texts available for reference, in addition to an ‘Introduction to TEE’ CD-ROM. The faculty and guest lecturers will also provide handouts.

3. Goals/Objectives: The goal of this course is to educate students on the anesthetic considerations related to cardiothoracic

surgery and familiarize the students to the management of cardiothoracic surgical patients in the post-surgical ICU setting.

During the OR portion of the course, the student will participate in preoperative evaluations and be involved with the intra-operative management of the patient. It will also be important for the student to follow the post-operative course of the patients.

During the ICU portion of the course, the student will make rounds each day, perform evaluations of postoperative patients, and help in their management. Students will be expected to present at daily rounds.

After this clerkship, the student should be able to: Clinical skill/procedural goals :

On rounds, give an oral presentation of an ICU patient in a succinct, focused manner, including H&P, assessment and plan.

Write an ICU admission note/progress note which clearly summarizes the pertinent ICU problems and delineates the student’s thought process about appropriate diagnostic and therapeutic plans

Describe or demonstrate techniques for placement of monitoring lines and devices including arterial lines, central lines, and central line guidewire exchange.

Perform a literature search on an ICU patient’s diagnosis, treatment, or prognosis and describe how to use the information to care for the patient.

Write initial mechanical ventilation orders for patients with the following conditions: ARDS, respiratory failure, COPD, asthma, post-op patients and be able to explain the rationale for the settings.

Identify preoperative risk factors for cardiac surgery Discuss the indications for invasive monitoring during cardiac surgery Form a preoperative plan specific to the patient for hemodynamic monitoring of cardiac

surgery Demonstrate an understanding of cardiovascular pathophysiology and the implications

for the administration of general anesthesia Be able to recognize basic cardiac anatomy and gross pathology on transesophageal

echocardiographic evaluation Knowledge/cognitive goals :

Students will be expected to demonstrate knowledge of airway management, acute cardio-respiratory failure responses, interpretation of blood gas and other monitoring data, mechanical ventilation, respiratory therapy, management of pain and sedation, emergency resuscitation, nutrition, invasive hemodynamic monitoring using arterial, central venous pressure and pulmonary artery catheters, management of major postoperative problems such as bleeding and sepsis, and an understanding of organ system failure and shock.

Continued

4. Location:

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The rotation will take place in several venues including, but not limited to, the JMH Operating Rooms designated for CT surgery, the pre-op holding area, the Simulation lab in the JMH Patient Safety Center, and the post-surgical CT-ICU. Students may also be assigned to cases in the VAMC operating rooms and VA-SICU.

5. Participating Faculty: This course will be taught by a multidisciplinary team of faculty from the Department of Anesthesiology consisting of intensivists, fellowship trained cardiac anesthesiologists, experts in medical simulation training, in addition to several additional members of the UM Department of Anesthesiology faculty including but not limited to:

Jonathan Katz , M.D., D.M.D. , Fellowship-trained Cardiac Anesthesiologist, will be the course coordinator. Ricardo Martinez-Ruiz, M.D. , Assistant Professor of Anesthesiology with Board Certification in Critical Care

Medicine will assist Dr. Katz in coordinating the Cardiac Surgical ICU portion of the elective. Frank Rosemeier, M.D. , CVT Anesthesiology and Critical Care Medicine Faculty. Daniel Castillo, M.D. , Assistant Professor of Anesthesiology with Board Certification in Critical Care Medicine

will assist Dr. Katz in coordinating the Simulation Training and Evaluation Sessions. Jay Grossman, M.D. , CVT Anesthesiology John Sciarra M.D. , CVT Anesthesiology Brantley Dollar M.D. , CVT Anesthesiology Julie Oppenheimer M.D. , Assistant Professor of Anesthesiology, VAMC, Preceptor for Medical Student Simulator

Training Sessions There will be two Cardiac Anesthesiology Fellows who will mentor one medical student during the OR portion of

the course and will also be responsible for covering core lecture topics not otherwise covered in the exiting departmental lecture series.

6. Prerequisites: See above

7. Expectations:

Upon completion of this 4 week elective, the student will be expected to have: Performed and presented a preoperative evaluation of a patient for cardiac surgery Formulate a basic anesthetic plan for the cardiac surgical patient Observed coronary artery bypass surgery Observed cardiopulmonary bypass Observed central venous cannulation (5) Observed arterial line insertion (5) Observed the use of ultrasound for venous access Observed the use of Perioperative Transesophageal Echocardiography in the management of the

cardiac surgical patient Participated in Patient Simulation (1 session every 2 weeks) in the Patient Safety Center Attended Conferences for Cardiac and CSICU residents/fellows Followed at least one patient in the CSICU daily Presented at least one patient in the CSICU daily Actively participated in daily rounds Completed daily/admission notes Demonstrated specific understanding of sterile technique with regard to invasive procedures in the

ICU setting

Continued

8. Student evaluations and grading:

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Students will be subjectively evaluated by the course coordinator and assisting faculty and fellows at the 2-week and 4-week intervals.

Students will be required to evaluate the course and participating faculty at the 2-week and 4-week intervals.

Grading will be Pass/Fail and based on: Timely submission of Evaluations and Competency Checklist Attendance to all scheduled sessions Performance in simulation sessions Motivation and involvement with patient management Patient evaluation and presentation skills

9. Educational Resources:

Useful Internet Links:

Cardiac Physiology and Monitoringhttp://www.healthsystem.virginia.edu/internet/anesthesiology-elective/cardiac/home.cfm

Transesophageal Echocardiographyhttp://www.ucsf.edu/teeecho/http://www.ucsf.edu/teeecho/TEE/index.htmhttp://www.med.yale.edu/intmed/cardio/chd/contents/index.html

ECGhttp://www.ecglibrary.com/

The Pulmonary Artery Catheter Education Projecthttp://www.pacep.org/pages/start/ref.html?xin=accp

Thoracic Anesthesiologyhttp://www.thoracic-anesthesia.com

Society of Cardiovascular Anesthesiologists (SCA)http://www.scahq.org

SCA Education links: http://www.scahq.org/sca3/links.shtml

Reference Books: (Not required) Available in Anes Library

Cardiac Surgery in the Adult by Cohn and Edmunds (FREE On-line Textbook)http://cardiacsurgery.ctsnetbooks.org

Clinical Anesthesiology (Paperback) by Morgan, Mikhail, Murray Copies of CV Physiology and Anesthesia for CV/Thoracic Surgery Chapters Available in Anes Lib, additional copies may be requested from course coordinator.

Critical Care Medicine by Marini, Wheeler – Textbook generously donated by Dr. Silverman This text may be signed-out for the two week ICU segment of the course

Board Stiff TEE -- Transesophageal Echocardiography (Paperback) by Christopher J. Gallagher

Kaplan's Cardiac Anesthesia (Hardcover) by Joel A. Kaplan, David L. Reich, Carol L. Lake, Steven N. Konstadt

Additional Educational Resources:

Introduction to Trans-Esophageal Echocardiography CD-ROMo Copy available for sign-out at the beginning of the elective. - $20 replacement fee will apply if lost

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o Additional copy available in Anesthesiology Library for use on Library computers.

Anesthesiology Library Access Cardo Must be checked out and returned at the end of the electiveo $20 replacement fee will apply if lost

Lecture and Conference Schedule

Monday: (12 Noon) Cardiology Case Presentation Conference - JMH C-403

Tuesday: (12 Noon) ECG Conference - JMH C-403

Wednesday: No formally scheduled lectures

Thursday: (6:45 am) Anesthesiology Grand Rounds Rosensteil Bldg 5th Floor Auditorium

OR(7:00am) Cardiothoracic Surgery Grand RoundsEast Tower 3rd Floor Surgical Offices

*Attend one of these each week.

Friday: (6:30am) CVT Anesthesia Journal Club- Jackson Cafeteria(12 Noon) CS-ICU Noon Conference - SICU B Conference Room

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MDR-953 Recommended Self-Learning Schedule and Checklist

Name: ________________________ Rotation Month: ________________

The following is a suggested schedule of learning resources to be reviewed during this elective. It is neither a comprehensive list nor a mandatory schedule, but merely should be used as a weekly guide to cover certain integral topics relevant to this elective.

In the Anesthesiology Library, all of the following website links are saved in the ‘favorites’ section under ‘Cardiac Anes-Critical Care-MDR953’.

Ask Ms. Avilette Rodriguez in the Anesthesiology Library for the in-house copy of the TEE CD-ROM and heaphones, or use your signed-out copy.

To help us improve the educational aspect of this elective, please accurately check-off the learning resources you were able to complete and circle during which segment (OR / ICU) it was completed. Please turn this form in at the conclusion of the elective - Your progress will by no means affect your grade or evaluation.

**Prior to the start of the course, please review the following core topics available on:**http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/home.cfm

Airway Anatomy Respiratory Physiology Airway Management

Week 1Tuesday: OR / ICUInvasive Cardiac Monitoring Review http://www.healthsystem.virginia.edu/Internet/Anesthesiology-Elective/home.cfm

Invasive Cardiac Monitoring: The Physiology Behind the Practice

Invasive Cardiac Monitoring: Procedures and Complications

Thursday: OR / ICUTEE CD-ROM (20 images):

Introduction Myocardial Wall Motion Left Ventricle Mitral Valve

Week 2Tuesday: OR / ICU Pulmonary Artery Catheter Education Project http://www.pacep.org/pages/start/ref.html?xin=accpComplete Registration and Level I:

Lesson A Lesson D Lesson B Lesson E Lesson C Lesson F

Thursday: OR / ICUTEE CD-ROM (14 images):

LAA, LUPV, ME Bicaval Aorta Coronary Sinus Right Ventricle Aortic Valve

Week 3Tuesday: OR / ICUPulmonary Artery Catheter Education Project http://www.pacep.org/pages/start/ref.html?xin=accpComplete Level II:

Lesson A Lesson D Lesson B Lesson E Lesson C

Thursday: OR / ICUUCSF TEE Primer:http://www.ucsf.edu/teeecho/

Introduction Valve Pathology Insertion Other Pathology Anatomy 1 Devices Anatomy 2 Masses Short Axis

Week 4Tuesday: OR / ICUSociety of Cardiovascular Anesthesiologists Intraoperative Exam: A-Jhttp://www.ucsf.edu/teeecho/TEE/index.htm

A E I B F J C G D H

Thursday: OR / ICUSociety of Cardiovascular Anesthesiologists Intraoperative Exam: K-Thttp://www.ucsf.edu/teeecho/TEE/index.htm

K O S L P T M Q N R

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Cardiac Anesthesiology/Critical Care Elective (MDR953) Competency Checklist

Name: _______________________________ Rotation Dates: _____________________

Operating Room DatePatient Initials or

Attending/Fellow Signature

Performed and Presented a Preoperative Evaluation of a Patient for Cardiac Surgery

Formulate Basic Anesthetic Plan for the Cardiac Surgical Patient

Observed Coronary Artery Bypass Surgery

Observed Cardiopulmonary Bypass

Observed Central Venous Cannulation (5) / / / /Observed Use of Ultrasound for Venous Access

Observed Arterial Line Insertion (5) / / / /Observed the use of Perioperative

Transesophageal Echocardiography

Participated in Patient Simulation (1 session during 2 weeks)

Attended Departmental Conferences

CSICU DatePatient Initials or

Attending/Fellow Signature

Followed At Least One Patient daily

Presented At Least One Patient daily

Actively Participated in Rounds daily

Completed Daily/Admission Notes

Demonstrate Specific Understanding of Sterile Technique

Participated in Patient Simulation (1 session during 2 weeks)

Student Signature: ______________________ OR Segment Faculty:________________________

ICU Segment Faculty:________________________

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Cardiac Anesthesiology/Critical Care Elective (MDR-953)

Anesthesiology Library Access Card/Intro to TEE CD-ROM/Critical Care Text

Sign-out Form

Name: ___________________________ C-number: _______________________

Phone: ___________________________ E-mail: __________________________

Access Card ID#: __________________

I, the above named student, agree to use the Anesthesiology Department provided

‘Introduction to TEE CD-ROM’ and the ‘Anesthesiology Library Access Card’ during my

scheduled 4-week Cardiac Anesthesiology/Critical Care Elective and will return the CD-ROM

and ‘Access Card’ to Brandy Bluett (office: SW-303, BBluett@med.miami.edu) on, or before,

the last day of the elective.

I understand that I will receive an incomplete for the course until both the CD-ROM and the

Access Card are returned. If either the Access Card or CD-ROM is lost, I will be responsible

for immediately notifying Brandy Bluett and reimbursing the Department a $20 fee for each.

Sign-out:Signed: ___________________________________ Date: _____________________

Returned:Signed: ___________________________________ Date: _____________________

You also have the option of signing out the ‘Critical Care Medicine: The Essentials’ text

(donated to the course by Dr. Silverman) for the 2-week ICU segment to be returned at the end

of those two weeks. If the text is lost, you will be responsible for reimbursing the Department

the $52.00 replacement fee.

Sign-out:Signed: ___________________________________ Date: _____________________

Returned:Signed: ___________________________________ Date: _____________________