Anesthesia Critical Care Fellowship Clinical Topics
- Cardio-respiratory resuscitation: The fellow leads the Anesthesia Consult team, which is called to all hospital cardiopulmonary resuscitations to provide airway management, as well as any other assistance that may be required. Each critical care Fellow completes ACLS and ATLS provider courses. Instructor certification is available to interested fellows. Elective experience in transesophageal echocardiography is available.
- Respiratory: A full spectrum of respiratory disease is seen among the Mass General ICUs. Bedside flexible bronchoscopy is common in the ICUs and the fellow has ample opportunity to become facile with this procedure. The Mass General maintains worldwide renown as a center for tracheobronchial resection and reconstructive surgery.
- Trauma, thermal, electrical and radiation injury: The Mass General is home to the only program in the United States that is verified at the highest level by the American College of Surgeons as an adult and pediatric trauma center and as an adult and pediatric burn center. The Mass General is verified as a Level I Trauma Center, and annually admits 1800 major trauma patients; critically ill trauma patients are admitted to the SICU. The Mass General Burn Unit is the primary referral center for all of New England. A hyperbaric center at the Massachusetts Eye and Ear Infirmary is immediately available to Mass General patients.
- Neurological: Patients with neurologic complications, neurologic trauma, and following complex neurosurgery are cared for in the SICU. Additional experience is offered in the Neurosurgical Intensive Care Units. Additional topics and patient issues are discussed in a biweekly Neuro-Critical Care conference.
- Infectious diseases: Areas of interest include classification of infections and application of isolation techniques, pharmacokinetics, drug interactions, and management of antibiotic therapy during organ failure; nosocomial infections; and indications for applications of hyperbaric therapy. The fellows, in conjunction with the residents, routinely manage antibiotic therapy in the ICU patients, paying careful attention to all the above issues.
- Pharmacokinetics and dynamics of drug metabolism and excretion in critical illness: Pharmacists regularly attend rounds in the ICUs and are provide continuous and timely expert assistance.
- Ethical and legal aspects of critical care: As the nexus of communication in the ICUs, the fellows are intimately involved in all the ethical and legal issues that commonly arise. There are biweekly ethics conferences that specifically discuss ethical issues that have recently arisen.
- Renal: The evaluation of renal function, peritoneal dialysis and hemofiltration, and knowledge of the indications and complications of hemodialysis. The fellows have ample opportunity to learn about renal dysfunction and dialysis in the ICUs. Continuous venovenous hemofiltration is commonly employed.
- Gastrointestinal/nutritional: An active gastrointestinal surgery program provides opportunities to gain experience with gastrointestinal intubation and endoscopic techniques, enteral and intravenous nutrition, and management of stomas, fistulas and percutaneous catheter devices.
- Hematologic and coagulation disorders: Massive transfusion, coagulopathy and hypercoagulable states are seen frequently because of the number of trauma patients and the large numbers of patients. Blood Bank personnel and hematologists are readily available for consultation.
- Critical obstetric and gynecologic disorders: The Mass General high-risk pregnancy unit is undergoing rapid expansion. Critically ill gynecologic and obstetric patients are admitted to the intensive care units as necessary.
- Monitoring and medical instrumentation: The ICUs enjoy state-of-the-art monitoring capabilities. Most patients have indwelling arterial lines, and at any one time approximately one-third have pulmonary artery catheters.
- Principles and techniques of administration and management: Fellows are intimately involved in all daily administrative decisions. Among the various ICUs, they have the opportunity to work closely with different ICU Attendings and experience varying styles of management.
- Biostatistics and experimental design: In-depth analysis of one or two key studies in the current literature is presented at weekly fellows’ conferences. Statistical consultation and teaching is available within the department.
Department of Anesthesia,
Critical Care and Pain Medicine
55 Fruit Street
Boston, MA 02114
Public Transportation Access: Yes
Disabled Access: Yes