Subspecialty Goals & Objectives

1. Understand basic cardiovascular, pulmonary, and renal physiology.
2. Be familiar with the terminology and calculations used in cardiac profile analysis such as PCWP, SVR, CI, LVSWI, 02 availability, 02 consumption, 02 extraction ratio.
3. Begin developing a knowledge of the various groups of pharmacologic drips such as vasopressors, vasodilators, and inotropic agents.
4. Be familiar with the basics of ventilation including vital capacity, tidal volume, FI02, and mode (IMV, AC).
5. Define PEEP and know its indications and side effects.
6. Define and diagnose the various types of acute renal failure such as nonoliguric, oliguric, and anuric renal failure.
7. Define and diagnose hemorrhagic, oliguric, and anuric renal failure.
8. Define and diagnose hemorrhagic, septic, and cardiogenic shock.
9. Define and diagnose ARDS.
10. Be familiar with the various groups of antibiotics including aminoglycosides, penicillins, cephalosporins.
11. Be able to calculate a patient's basal energy expenditure and stress level and to formulate a nutrition program based on these.
12. Be familiar with the indicators of nutritional efficacy including UUN, catabolic index, prealbumin, retinol binding protein, transferrin.
13. Understand the basic advantages of parenteral and enteral nutritional support.
14. Be familiar with the formulas used in enteral nutrition.
15. Become comfortable with the techniques of PA catheter insertion, CVP line insertion, arterial cannulation, intubation, and flexible bronchoscopy.
16. Be familiar with the principles of transfusion therapy including indications, complications, and risks.
17. Be able to present critical care patient data in an organized fashion both on rounds and in the medical record.

1. Understand advanced cardiovascular, pulmonary, renal, cerebral, and hepatic physiology and apply this knowledge to patient care.
2. Interpret data from cardiac profile analysis such as PCWP, SVO2, SVR, CI, LVSWI, 02 availability, 02 consumption, 02 extrication ratio and make management these interpretations.
3. pharmacologic drips such as Dopamine, Epinephrine, Levophed, Neosynephrine, Nipride including dosages and effects.
4. Understand current modes of ventilation including IMV, SIMV, AC pressure control with inverse ratio, Pressure support, high frequency jet ventilation.
5. Understand the physiology of PEEP, its indications for use and its side effects.
6. Define, diagnose, and manage nonoliguric, oliguric, and anuric renal failure.
7. Understand the principles of hemodialysis and continuous arteriovenous ultrafiltration and their application to patient care.
8. Define, diagnose, and manage hemorrhagic, septic, and cardiogenic shock.
9. Define, diagnose, and manage ARDS.
10. Be familiar with the various groups of antibiotics including Aminoglycosides, Penicillins, Cephalosporins; know their indications, dosages, and side effects.
11. Be able to construct a nutritional program consisting of appropriate percentages of carbohydrate, protein, and lipid for a critically injured patient based on BEE and stress level.
12. Be able to constantly evaluate the efficacy of this program based on changes in UUN, catabolic, index, and levels of prealbumin, retinol binding protein, and transferrin.
13. Understand the importance of carbohydrate, protein including high branched chain amino acids, and lipid to the nutrition program.
14. Understand the advantages and disadvantages of parenteral and enteral nutrition.
15. Understand the composition of the most frequently used formulas in enteral nutrition.
16. Supervise the junior residents in the techniques of PA catheter insertion, CVP line insertion, arterial cannulation, intubation, and flexible bronchoscopy.
17. Understand the principles of transfusion therapy including the indications for transfusion, the complications, and the risks including AIDS and hepatitis.
18. Be familiar with the criteria for brain death and the criteria for organ procurement.
19. Be able to present critical care patient data in an organized fashion both on rounds and in the medical record.

1. Obtain an adequate urologic history.
2. Perform an adequate physical examination upon the genitourinary system - i.e. abdomen, pelvic exam in females, male external genitalia and prostate.
3. Recognize common significant abnormalities in IV urogram, renal sonogram and abdominal CT Scan.
4. Diagnose and manage renal colic, cystitis, prostatitis, epididymitis.
5. Perform minor urologic surgery such as circumcisions, remove condylomata biopsies.
6. Know the steps necessary to evaluate patients with UTI, hematuria and calculi.
7. Perform routine catheterizations and urethral dilations.

This rotation is two months in duration in the CT/SICU. At the PGY-2 level, residents are expected to have evolved their clinical abilities beyond the requirements of entry level resident in his program. In addition they are given graded responsibility for the surgical management of uncomplicated conditions such as pulmonary nodules. At this level the residents are introduced to surgical principles and technique in performing thoracotomies. They also learn the basics of pulmonary resection, vascular surgery and esophageal surgery.