MetroHealthAnesthesiaCritical Care Anesthesiology, MHMC
Case Western Reserve University, MetroHealth Campus
Anesthesiology Resident Education/Training Objectives

Syllabus for CA-1/CA-2 Anesthesia Rotation in the Surgical Intensive Care Unit

Airway Management

  • Indications for an endotracheal tube
  • The compromised airway
  • Intrathoracic vs extrathoracic airway obstruction
  • Evaluation for airway protection and edema
  • Management of post-extubation stridor
  • Intubation techniques in unstable patients
  • Medicating the hemodynamically unstable patient
  • Intubating the patient with closed head or cervical spine injury
  • Cuff leaks - evaluation and management
  • Timing of tracheostomy

Respiratory Management

Respiratory physiology
  • Ventilation perfusion relationships
  • Causes of hypoxemia
  • Postoperative changes in respiratory function
  • PaO2/FIO2 relationships
  • Oxygen delivery and consumption
Mechanical ventilation
  • Modes of mechanical ventilation - volume vs pressure
  • PEEP - indications, systemic effects, contraindications
  • Non-invasive mechanical ventilation
Weaning from mechanical ventilation
  • Determining patients who are candidates for ventilator weaning
  • Use of weaning parameters
  • Controversies in weaning modes - AC/SIMV, T-piece trials
Respiratory issues in trauma
  • Pulmonary contusion - physiology, management
  • Flail chest
  • Fat embolism
  • Diagnostic criteria
  • Management - fluid balance, ventilator strategies, steroids
  • Oxygen toxicity
  • Barotrauma

Fluid Balance in the Surgical Patient

Perioperative fluid management
  • Intraoperative fluid balance
  • Sources of intraoperative fluid loss
  • Postoperative fluid balance � patterns of third spacing and mobilization
  • Crystalloid vs colloids
Transfusion therapy
  • Optimal hematocrit
  • Indications for blood products
  • Albumin controversies

Electrolyte and Acid-base disorders

  • Acid base balance, compensatory mechanisms
  • Renal failure- diagnostic criteria, management, indications for dialysis, renal replacement techniques

Hemodynamic monitoring

Pulmonary artery catheters
  • Use of hemodynamic monitoring data, limitations of data, waveform recognition
  • Complications of catheters
Hemodynamic mangement
  • Management of hypertension
  • Management of tachyarrhythmias
  • Inotropic agents
  • Vasopressor agents
  • Recognition and management of shock states

Infectious diseases

  • Sources of infection in the ICU patient
  • Management of fever in the ICU
  • Sinusitis
  • Preventive measures
  • Antibiotic management, empiric coverage, rotation of antibiotics
  • Management of central lines in the ICU patient

Nutritional support

  • Enteral vs parenteral nutrition
  • Uses of indirect calorimetry

Neurosurgical concepts

Closed head injury, intracranial pressure
  • Basic concepts of cerebral hemodynamics
  • Management of elevated intracranial pressure
  • Concepts of cerebral perfusion pressure
Cerebral aneurysms
  • Complications of aneurysmal rupture
  • Management of cerebral vasospasm
  • Timing of aneurysmal clipping
Cervical spine injuries
  • Respiratory pathophysiology
  • Hemodynamic management
  • Steroids in spinal cord injury
  • Timing of spine stabilization

Radiology in the ICU

  • Limitations of plain films
  • Proper placement of tubes, central lines
  • Recognition of pulmonary collapse
  • Use of CT scans in the ICU patient

Recommended reading:
  • Anesthesiology Resident�s Guide to Learning in the Intensive Care Unit, 1999 ASCCA
  • The ICU Book, Marino, 1998

Send Comments to Greg Gordon MD, [email protected]
Department of Anesthesiology
The MetroHealth System
2500 MetroHealth Drive
Cleveland, Ohio 44109-1998
Phone: (216) 778-4801
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