Vanderbilt Anesthesiololgy

To provide a board eligible anesthesiologist with 12 months of advanced clinical training to develop the knowledge and skill to deliver comprehensive critical care either in a primary, collaborative or consultative capacity. In addition to care of critically ill patients, fellows will be mentored to become good teachers and administrators.

Fellowship- Aims and Objectives

Vanderbilt University Medical Center has six separate intensive care units in which you may train. These include:

1. Surgical Intensive Care Unit
2. Neurological Intensive Care Unit
3. Medical Intensive Care Unit
4. Trauma Intensive Care Unit
5. Pediatric Intensive Care Unit
6. Burn Intensive Care Unit

Each of these units provides a rich environment for the training of anesthesiologists interested in the practice of critical care medicine.

A broad perspective will be provided so that the Fellow can master the skills necessary to be a consultant in critical care medicine. This will include, but is not limited to:

• Assessing, developing, and implementing a sound, organized; logical management plans for postoperative or severely injured critically ill patients.
• Learning effective triage and bed-management skills.
• Learning skills necessary to instruct junior House Staff in the basics of critical care.
• Understanding socioeconomic, ethical, and legal problems related to critical care.
• Organization and presentation of clinical conferences and journal clubs.
• Development and completion of at least one research project.

Cognitive Clinical Skill Objectives:

Be able to describe the anatomy, physiology, pathophysiology, differential diagnosis and management of problems in the following systems or disease states:

Respiratory

• adult respiratory distress syndrome
• aspiration pneumonitis
• community-acquired and nosocomial pneumonia
• chronic obstructive pulmonary disease
• respiratory failure and ventilator dependence

Cardiac

• arrhythmias
• hypertension, hypotension
• post-cardiopulmonary resuscitation
• pericardial disorders
• tamponade
• cardiac failure, congestive heart failure

Shock

• septic
• hypovolemic
• cardiogenic
• anaphylactic
• neurogenic

Gastrointestinal

• upper and lower GI bleeding
• hepatitis, cirrhosis
• vascular and ischemic abnormalities
• nutritional deficiencies, catabolic states
• liver failure

Neurologic

• metabolic, hepatic encephalopathy
• seizures, status epilepticus
• subarachnoid hemorrhage
• traumatic brain injury
• tumors, and other space occupying lesions
• stroke
• neuromuscular disorders

Metabolic

• diabetes mellitus
• acid-base disturbances
• electrolyte disturbances

Renal

• acute tubular necrosis
• pre-renal failure
• post-renal failure
• chronic renal failure

Toxic States

• drug overdose
• drug reactions

The indications, use, pharmacology, side effects and contraindications of the following drugs or drug classes:

• Antiarrhythmics
• Antihypertensives
• Inotropes
• Vasoactive Pressors
• Antimicrobials
• Antithrombotics/Anticoagulants
• Sedatives, Anesthetics, Neuromuscular Blockers

The indications, contraindications, interpretations, and/or controversies surrounding the use of:

• Tracheal intubation
• Mechanical ventilation, including basic and advanced ventilator modes and weaning techniques
• Pulmonary artery catheter placement
• Radiographic tests
• Renal replacement therapy, including techniques for dialysis
• Blood gases, electrolytes
• Hemodynamic profiles
• Bedside central pressure monitoring
• Noninvasive techniques for assessing oxygenation and gas exchange
• Enteral and parenteral nutrition
• Techniques for pain management and sedation
• Fiberoptic bronchoscopy

Integrative Cognition Objectives: The Fellow should be able to:

• Synthesize history, physical examination, hemodynamic, laboratory, and radiographic information about each critically ill patient in the ICU into an organized logical assessment and treatment plan.
• Coordinate the management of all patients in the ICU with respect to admission, discharge, triage, and intra-hospital transportation
• Communicate effectively with primary and consultant physicians especially regarding critical care issues and coordination of total patient care. Communicate effectively with patients and family members, including discussions regarding death and dying, limitations of care, and withdrawal of support. Communicate effectively with nurses, respiratory therapists, administrative staff, and other support personnel
• Engage in unit administration and quality assurance
• Instruct junior officers in the correct performance of the first four procedures.

Procedural Skill Objectives: The fellow should be able to perform the following procedures independently:

• arterial line placement (radial, brachial, femoral, axillary)
• insertion of a pulmonary artery catheter
• endotracheal intubation, including fiberoptic
• insertion of subclavian, femoral or jugular venous catheters
• therapeutic fiberoptic bronchoscopy
• chest tube insertion for hemothorax or otherwise uncomplicated chest pathology
• percutaneous tracheostomy
• therapeutic and diagnostic chest thoracentesis
• spinal tap

Research Program: The fellow is expected to participate in existing research activities with faculty and begin to develop independent research skills in either clinical of basic research interests. Goals for these research efforts are:

Clinical Research

• Submission of a clinical trial to the IRB
• Participation in one current research protocol
• Preparation of research result for submission as an Abstract to a national meeting.

Bench Research

• Rotation through the Basic Science laboratories to become familiar with content area of current research in anticipation of spending an additional year with dedicated research time.