The goal of the Pediatric Surgical Critical Care Fellowship program is to provide advanced proficiency in the care and management of critically ill surgical patients ranging in age from extreme prematurity to adolescence.
At the conclusion of the training program, the PSCCR will demonstrate:
1. Thorough understanding of the pathophysiology of critically ill or injured premature infants, neonates, toddlers, school-aged children, and adolescents with emphasis on the unique features of each age group.
2. Proficiency in pediatric cardiopulmonary resuscitation. It is expected that the resident will achieve Pediatric Advanced Life Support (PALS) certification shortly after arrival.
3. Proficiency in the resuscitation of trauma patients. It is expected that the resident will be certified in the American College of Surgeons Advanced Trauma Life Support (ATLS), and will pursue the additional qualifications to become an ATLS instructor.
4. Thorough understanding of the principles of care of the critically ill pediatric surgical patient, including, but not limited to:
- Hemodynamic monitoring, including the use of noninvasive and invasive monitoring devices.
- Hemodynamic support, including the appropriate use of fluids and pharmacologic agents.
- Recognition of patients who are suffering from shock.
- Management of the injured child from initial emergency department resuscitation to ultimate discharge, including ICU care and post-discharge planning.
- Evaluation of the airway and initiation of respiratory support, including the use of noninvasive devices (oxygen, CPAP, BIPAP) and various modes of mechanical ventilation (pressure and volume cycled, high frequency oscillatory ventilation, pressure support, etc.), as needed.
- Evaluation and management of infants and children who require extracorporeal membrane oxygenation (ECMO).
- Management of pediatric patients with elevated intracranial pressure, including those who sustain severe traumatic brain injury (TBI).
- Management of patients who have undergone major surgery, including general surgical, cardiac, thoracic, neurosurgical, head and neck, orthopedic, plastic and urologic procedures.
- Management of patients who require or who have undergone organ transplantation.
- Understanding the principles of nutritional support and becoming facile with the prescribing of total parenteral nutrition solutions and the various enteral nutritional formulas and delivery systems.
- Understanding the role of infection in critical illness as well as its diagnosis and management in both immunocompetent and immunocompromised hosts.
- Understanding the role that endocrine and metabolic abnormalities play in the host response to illness, and effective diagnosis and management of these disorders.
- Understanding the indications for transfusion of blood and blood components and application of this knowledge to effectively treat patients with primary or secondary hematologic and coagulation disorders.
- Understanding the diagnostic and therapeutic interventions used to diagnose and treat illness of multiple organ system failure or dysfunction.
5. Develop the technical skills necessary to practice pediatric surgical critical care, including, but not limited to: endotracheal intubation, establishment of central venous access, arterial access, ECMO cannulation and tube thoracostomy. The PSCCF should demonstrate proficiency in these procedures across the age spectrum encompassed by the program.