Division of Respirology

Critical Care

St. Joseph's Healthcare, Henderson Hospital
A 2 month critical care rotation will provide the resident with experience in managing a busy tertiary care Intensive Care Unit. Several of the supervisory staff members at the Henderson are dual trained in both Critical Care and Respirology. Skills in managing multi-system organ failure, respiratory failure with mechanical ventilation, and knowledge in applied respiratory physiology will be enhanced.

Medical Expert

  1. To demonstrate knowledge of the assessment and management of patients with acute respiratory failure.
  2. To develop knowledge, skills, and experience in the management of airway emergencies, particularly the technique of endotracheal intubations with and without the use of the fiber-optic bronchoscope.
  3. To understand the indications, contraindications and complications of bronchoscopy in a ventilated patient and demonstrate expertise with the technique of protected brush specimen and bronchoalveolar lavage.
  4. To understand the various methods of providing supplemental oxygen and to develop an approach to the hypoxemic patient with increasing oxygen requirements.
  5. To obtain detailed knowledge of the operation of mechanical ventilators, including the various modes of ventilation, their physiologic rationale, advantages, disadvantages, indications, and contraindications.
  6. To understand the indications, contraindications and use of noninvasive ventilation in acute respiratory failure.
  7. To understand the role of newer or experimental modalities and techniques in the management of acute lung injury and ARDS.
  8. To understand and develop an approach to weaning from mechanical ventilation and be able to withdraw mechanical ventilation in a safe fashion.
  9. To be able to identify, respond to and prevent complications of mechanical ventilation, such as patient-ventilator dyssynchrony, auto PEEP, and ventilator-induced lung injury.
  10. To appropriately interpret data obtained from hemodynamic monitoring
  11. To refine technical skills in performing procedures including:
    • Arterial and central venous cannulation
    • Pulmonary artery catheterization
    • Chest tube placement

Communicator

To communicate effectively and appropriately with family members and to refine skills in discussing negative or adverse prognoses, futility of therapy, and end of life decision-making.  

Collaborator

To understand the roles of the various members of the multidisciplinary health care team in the ICU and to interact with these members appropriately in order to optimize patient care.

Manager

  1. To gain experience in supervising the management of critically ill medical and surgical patients and controlling the flow of patients into and out of the intensive care unit.
  2. To participate in quality assurance activities through the review and analysis of patient morbidity and mortality.
  3. To learn to skills of time management in order to balance the responsibilities of a busy critical care roster and one’s own personal life.

Health Advocate

To act as health advocate for patients unable to communicate their wishes regarding personal care due to critical illness and/or intubation.  

Scholar

To utilized skills of critical appraisal to make decisions about the care of the critically ill patient.

Professional

To participate actively in discussions of ethical issues surrounding patient care in the ICU.