The Medical Intensive Care Unit is a closed, 24 bed intensive care unit that serves as a referral center for hospitals in Eastern North Carolina. It is managed by two attending physicians, two fellows, three senior residents and 6 junior residents or interns. The fellows and the MICU attendings lead daily teaching rounds and provide education on relevant aspects of critical care medicine for the residents.
The fellow interacts closely with the residents providing supervision and guidance for patient care as well as teaching and supervising procedures for the residents. Between 3 and 5 bedside bronchoscopies are performed per week in the MICU and a variable number of percutaneous tracheostomies. Bedside ultrasonography and echocardiography are available. The MICU fellow takes an active role in airway management and chest tube placement. The MICU fellow also provides evaluations for patients who may require admission to the MICU.
Critically ill patients admitted to the Cardiology Intensive Care Unit are managed by the ECHI Intensivist Service which is staffed by faculty from our Division. The CICU also admits medical patients when the MICU is filled to capacity. The patients are managed directly by the attending staff. It is a high acuity unit where ECMO, CRRT, and other high risk procedures are provided by the intensivists. Fellows rotating on this service will gain hands on experience performing such procedures. There are no residents assigned to this service. The rotation is structured as an apprenticeship.
The fellow will be granted autonomy based on their performance during the rotation but the faculty is in the CICU providing patient care 24 hours per day. This rotation is limited to senior fellows. The faculty work 12 hour shifts. Fellows assigned to this service will shadow the attending for the entire week, working with a different attending each week. One week will be spent on the night shift. The fellow will not take regular call during this rotation.
The fellows assigned to the pulmonary consultation service are responsible for all inpatient pulmonary and critical care medicine consultations. Patient care on the pulmonary consultation service is provided by one attending, three fellows, and a variable number of internal medicine residents.
The service receives between 100 and 150 new consultation requests per 4 week rotation. The fellows are responsible for seeing and evaluating all new patients and presenting the cases to the attending during teaching rounds after formulating an assessment and plan. The fellows also teach and supervise the residents who rotate on the service.
The fellow is responsible for interpreting all pulmonary function tests under the guidance of the consult attending. The fellow also performs all inpatient bronchoscopies with the direct supervision of a faculty member. Procedures such as Thoracentesis and tube thoracostomy are performed by the fellow or the fellow supervises and teaches the resident performing the procedure. With the exception of bronchoscopy, the fellows may perform procedures independently once they have demonstrated competency to perform and teach the procedure. The fellow will learn ultrasound-guidance in the use of thoracentesis as well as other pleural treatments including chest tubes, Pleur-x catheters, pigtail catheters, and pulmonary artery catheterization.
The goal of this rotation is to acquire the knowledge and skills necessary to manage patients with problems unique to the surgical intensive care setting and to appreciate the differences in management strategies between the surgical and medical intensive care units. The fellow will accomplish this by caring for SICU patients as a member of the Surgical Critical Care/Trauma Team. Fellows will rotate on the service in all three years of training. Bedside teaching and procedure training will occur as part of the daily work rounds. Fellows should document all procedures performed in the SICU.