Critical Care Selective: Patient Experience and Procedure Logs

Organization and Course Description

For this selective, medical students are expected to encounter the following types of patients and clinical conditions and have the indicated level of student responsibility.  

The standardized levels of student responsibility include:

  1. Observe and Discuss: This may include observing another member of the team interview a patient, perform a procedure or physical exam, etc. and discussion of the case, condition or other relevant components.
  2. Actively Participate in Care: This category indicates more active responsibility for the patient, such as performing a physical exam and workup, entering progress notes or H&Ps, presenting the patient on rounds, as scrubbing into a case or counseling or discussing prevention with the patient.
  3. Perform Procedure: This is defined as the student performing the procedure with supervision.  

The following steps should be taken for alternative experiences:

  1. The student will notify the selective director that an alternative experience is needed for a procedure or diagnoses one week prior to the end of the selective.
  2. An approved alternative experience/requirement is completed.
Type of Patient/Clinical Conditions Level of Student Responsibility Alternative Experience
Shock Active participation in care https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/shock/v/septic-shock-pathophysiology-and-symptoms
Management of arrhythmias Active participation in care Review >5 videos on arrhythmias on Kham Academy:
https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/dysrhythmias-and-tachycardias/v/normal-sinus-rhythm-on-ecg
Respiratory failure Active participation in care https://youtu.be/gk_Qf-JAL84

Watch all five parts of the video
Electrolyte derangements Active participation in care Review ILM by Dr. Brigham Willis (posted to course website)
Transfusion of blood products Active participation in care https://youtu.be/tLCl04RNVMQ
Sepsis Active participation in care https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/shock/v/sepsis-sirs-mods
Healthcare associated infection Active participation in care https://youtu.be/-FfMCv8FUXI
Cardiopulmonary interactions - preload limitation / augmentation by intrathoracic pressure changes Observe and discuss Read: Stigall WL, Willis BC. Mechanical Ventilation, Cardiopulmonary Interactions, and Pulmonary Issues in Children with Critical Cardiac Disease, in E.M. da Cruz e al. (Eds.), Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, Springer-Verlag London

(posted to course website)
Cardiopulmonary interactions - left ventricular afterload modulation by intrathoracic pressure changes Observe and discuss Read: Stigall WL, Willis BC. Mechanical Ventilation, Cardiopulmonary Interactions, and Pulmonary Issues in Children with Critical Cardiac Disease, in E.M. da Cruz e al. (Eds.), Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, Springer-Verlag London

(posted to course website)
Cardiopulmonary interactions - effect of intrathoracic pressure changes and ventilation on right ventricular performance and pulmonary vascular resistance Observe and discuss Read: Stigall WL, Willis BC. Mechanical Ventilation, Cardiopulmonary Interactions, and Pulmonary Issues in Children with Critical Cardiac Disease, in E.M. da Cruz e al. (Eds.), Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, Springer-Verlag London

(posted to course website)
Assessment of coagulopathy Active participation in care https://www.khanacademy.org/science/health-and-medicine/advanced-hematologic-system/bleeding-and-impaired-hemostasis/v/introduction-to-hemostasis
Management of elevated intracranial pressure Active participation in care https://youtu.be/6aqklopZheU
Acute kidney injury Active participation in care https://youtu.be/DecCzLpjAHw
Skills and Procedures Expected Level of Student Responsibility Alternative Requirements
ABG Interpretation Active participation in care ILM on ABG interpretation
Arterial line placement Observe and discuss NEJM Videos in Clinical Medicine - Arterial Line Placement
Chest X-ray interpretation Perform procedure https://internalmedicine.med.uky.edu/im-chest-x-ray-tutorial
ECG Interpretation Perform procedure https://ecg.utah.edu/
Endotracheal intubation Observe and discuss NEJM Videos in Clinical Medicine - Endotracheal Intubation
Management of mechanical ventilation Active participation in care Clinical cases in mechanical ventilation online:

https://courses.washington.edu/med610/mechanicalventilation/cases.html
Obtain informed consent Observe and discuss UpToDate: Informed Consent
Central venous line placement Observe and discuss NEJM Videos in Clinical Medicine - Central Venous Access
Thoracentesis / thoracostomy Observe and discuss NEJM Videos in Clinical Medicine - Thoracentesis 
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Source:
https://ume.ucr.edu/critical-care
Captured on May 6, 2021