Surgical Critical Care Fellowship

LEARNING OBJECTIVES: 2 WEEKS

• Develop proficiency in airway assessment: Learn to systematically assess patients' airways, identifying potential difficulties and anatomical variations. Understand the predictors of difficult intubations, such as the Mallampati score, thyromental distance, and cervical range of motion.
• Master intubation techniques : Gain expertise in performing endotracheal intubations using direct laryngoscopy, including proper blade selection, laryngeal exposure, and tube placement. Learn about alternative intubation techniques, such as video laryngoscopy and fiberoptic intubation.
• Acquire skill in Rapid Sequence Intubation: Understand the indications and contraindications for RSI. Develop proficiency in administering induction agents, neuromuscular blockers, and properly timed ventilation for optimal intubation conditions.
• Learn techniques for intubating difficult airways: Gain expertise in managing difficult airways through advanced techniques such as bougie-assisted intubation, use of supraglottic airways, and awake intubation. Understanding the principles of cricothyrotomy and surgical airway access for extreme cases.
• Understand intubation-related complications and management: Learn to recognize and manage complications that may arise during intubation, such as desaturation, aspiration, and hypotension. Understand how to troubleshoot difficult ventilation scenarios after intubation. 
• Gain exposure to special scenarios: ​​Observe and actively participate in intubations for different surgical procedures, patient populations (e.g., obese patients, trauma patients), and emergent situations. Understand the considerations for intubating patients with known difficult airways or anatomical challenges. 
• Acquire knowledge of airway anatomy and physiology: ​​​​Gain a deep understanding of airway anatomy, including the structures of the upper airway and tracheobronchial tree. Learn about the physiology of ventilation, oxygenation, and gas exchange, and how it relates to intubation and airway management. 
• Develop a systematic approach to intubation: ​​​​​​Learn a step-by-step approach to intubation, including pre-intubation assessment, preparation of equipment, patient positioning, and post-intubation care. Understand the importance of continuous monitoring and documentation during and after intubation.
• Integrate intubation skills in critical care: ​​​​​​​Recognize the significance of intubation skills in the critical care setting, particularly in cases of airway compromise or impending respiratory failure. Apply the techniques and principles learned on the anesthesiology rotation to optimize airway management of critically ill surgical patients in the ICU setting.

CLINICAL RESPONSIBILITIES
Fellows will be assigned to the OR Monday through Friday (no weekends). Special consideration will be given to select appropriate teaching cases for all trainees. The coordinator will assign fellows to a room by late afternoon the day prior to their cases (around 1500). It is the fellows' responsibility to look up their assignments at the OR front desk. After reviewing their cases and patients, fellows must call or text the attending/resident the evening prior to 1800 to discuss the anesthetic plan and the time they should arrive. If fellows are unable to reach the attending or resident, they should arrive at the OR by 0645. 

Fellows should prepare for each of their patients the night prior. They can view the OR schedule in Epic by navigating to the status board in the upper left-hand corner and selecting the "Main OR" button. Fellows should review patient medical records in Epic and consider the anesthetic implications of the patients' comorbidities. For each case, fellows should consider what type of anesthetic would be best for the type of surgery planned and the specific patient. Fellows should then form an anesthetic plan and discuss their concerns and suggestions with the attending or resident. Unless encouraged to do otherwise, fellows should stay in the OR throughout the procedure. If fellows' patients are admitted, fellows should see them post-operatively to determine any anesthesia-related complications. 

Successful completion of the two-week anesthesiology rotation requires self-motivation. As advanced GME trainees, fellows should be familiar enough with clinical medicine and the OR to be able to identify learning opportunities on their own. Fellows can make the most of the rotation by assisting in as many different kinds of cases and in as many different subspecialties as they can. 

Note: Fellows are not expected to take call during this rotation. However, no more than two absences are permitted during the two-week rotation. If fellows will miss, or miss, more than two days, the rotation will need to be rescheduled. 

CONFERENCES

• Fellows should plan to attend Grand Rounds or didactic conferences on Wednesday mornings at 0630.
• Peri-operative Echocardiography Conference: Fellows are welcome to attend peri-operative echocardiography conferences on Thursday mornings at 0630. If they wish to do so, they must coordinate this with the attending or resident since they would be late for the OR.
• Journal Club: If there is a Journal Club scheduled during the rotation, fellows are invited to attend. They will receive an email with the information, and it will also be included in fellows' calendar.