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Department of Pediatrics

Cardiac Intensive Care Fellowship

Pediatrics / Cardiac Intensive Care Fellowship / Clinical Experience
 

Clinical Experience

Gloved hands performing a procedure.

The fellow will acquire clinical experiences with the required evaluation and treatment skills, which includes the knowledge of severity of symptoms and functioning; and indications/contraindications and risks/benefits for the possible medical therapy, electrophysiology therapies, and surgical options. The fellow will be instructed in the sensitivity, specificity, and the positive and negative predictive accuracy of any test employed.

Rotations

Rotations will take place at UR Medicines' Golisano Children’s Hospital and Strong Memorial Hospital. Rotations will and be divided principally into time spent on inpatient management of critically ill children with cardiac disease in the Pediatric Cardiac Care Center (PCCC) on GCH 6 South. Additional time will be spent in the operating room (Peds OR 6); pediatric interventional lab cath/EP lab- (GCH 4), pediatric echo lab and pediatric cardiology clinic (SMH-AC1), and the adult cardiac ICU (SMH 7-1600) and adult advanced heart failure unit (SMH 7-3400).

Clinical Care

The fellow will be responsible for direct or consultative care of the patients managed in the PCCC and for patients managed on the Pediatric Cardiology service, which includes neonates, children and adults. Full time Pediatric Critical Care and Cardiology faculty will supervise this care. The fellow will work with the rotating PICU and cardiology fellows and have supervisory/educational responsibilities for medical residents, medical students, and advanced practice providers (APPs).

Fellows will demonstrate competence in the diagnosis, care, and treatment, evaluation and management in the following list of diagnoses:

  • Cardiomyopathies
  • Heart failure
  • Myocarditis/Endocarditis
  • Valvar disorders
  • Congenital heart disease
  • Clinical conditions such as:
  • Sepsis, SIRS, septic shock
  • Acute respiratory failure
  • Acute cardiac arrest
  • Acute cardiogenic shock
  • Acute fluid and electrolyte disturbances
  • Aborted sudden cardiac death
  • Pulmonary hypertension-idiopathic or acquired
  • Renal dysfunction/failure
  • Hepatic dysfunction/failure
  • Bleeding and/or severe anemia
  • Coagulopathy
  • Electrophysiologic diagnoses
  • Common rhythm disorders
  • Supraventricular tachyarrhythmias
  • Ventricular tachyarrhythmias
  • Heart block
  • Overdoses/Toxidromes

Clinical Competence

Demonstrate competence in clinical experiences involving:

  • Consultation to physicians in other disciplines
  • Care of patients in intensive care settings: PCCC, PICU, NICU, ED, OR, Cath/EP lab
  • Care of the patient in transfer from outside facilities; including critical care transportation via ground or air transportation
  • Care of the patient before and after cardiac cath and electrophysiology procedures (ablations, devices, etc.)
  • Care of the patient before and after cardiac surgical procedures

Inpatient duties will include rounding with the PCCC service during CICU rotations and traveling to NICU, PICU, OR, ED, Sedation suite as part of echocardiography rotations. CICU fellows will travel to adult SMH sites for their advanced HF/Tx/VAD rotation.

Procedural Skills

The program ensures that fellows have the necessary opportunities to demonstrate competence in and acquire skills including but not limited to:

  • Peripheral IV placement
  • Intra-osseous needle placement
  • Peripheral and central arterial lines
  • Central venous catheter placement
  • Peripherally inserted central venous catheters (PICCs)
  • Endotracheal intubation
  • Chest tube insertion
  • Paracentesis
  • Transthoracic temporary pacing
  • Temporary epicardial pacing
  • CPR
  • Cardioversion/Defibrillation

The program also ensures that fellows have the necessary opportunities to acquire skill in:

  • Transthoracic echocardiography
  • Cardiac catheterization and angiography
  • ECG and rhythm interpretation
  • Exercise testing
  • Pericardiocentesis
  • Transvenous pacing