Critical Care Core Clerkship

VISITING: Closed to visitors. TYPE OF CLERKSHIP: Required. DESCRIPTION: During this rotation, students provide care for critically ill children at Packard Children's Hospital. The rotation consists of a 4-week block in the NICU or the PICU. The Pediatric Intensive Care Unit (PICU) is a busy 36-bed academic unit that teaches students to recognize and care for critically ill children. The patients are comprised of medical, surgical, and trauma patients from within LPCH or by referral from other hospitals throughout Northern California. The medical admissions cover a broad range of disease processes and the surgical patients represent diverse pathologies from general and sub-specialty focused procedures. Students will learn the pathophysiology of critical illness in children, understand the many monitoring devices used in the ICU, and become familiar with the various treatment modalities available for organ failure ranging from mechanical ventilation to ECMO. The basic differences in both pathophysiology and management of critically ill children as compared to adults should also become apparent. The Neonatal Intensive Care Unit (NICU) offers an intensive experience in the management of premature and acutely ill term neonates admitted from the delivery room, community physicians' offices, and an active referral service that draws from throughout Northern and mid-coastal California. The rotation emphasizes delivery room experience and newborn resuscitation skills, daily management of common newborn problems, and the special follow-up needs of NICU graduates. Exposure to advanced therapies including mechanical ventilation, extracorporeal membrane oxygenation, nitric oxide therapy, and hypothermia occurs routinely. An active maternal-fetal medicine service, pediatric surgery, and various pediatric subspecialty services support the NICU. Education in both units will occur via daily morning rounds, caring for patients, scheduled didactic sessions, and interactions with ICU attendings, fellows, and residents. Absences during the 306P clerkship: Students must contact the 306P Clerkship Director to obtain explicit advance approval for any planned absence from the clerkship. Students who anticipate missing a week (i.e., 5 weekdays) or more of the 306P Clerkship are encouraged to reschedule this clerkship during a different period. Unanticipated absences for illness or emergency must be communicated to the Clerkship Director as promptly as possible. Students with more than 2 days of unexcused absences (i.e., 3-5 days) will be required to make up one week at a later date. If the absence is longer, the time will be proportionately increased. Taking extra night or weekend call may not be considered a suitable substitute for missing weekdays during the clerkship. Arrangements to make up missed time must be made by the student with the 306P Clerkship Director. Students who miss either of the half-day-long ICU Medical Student Simulator courses will need to make these experiences up at a later date in order to receive a passing grade for this clerkship. Students who are absent from the Death-and-Debriefing required didactic will need to make up this aspect of the curriculum in order to receive a passing grade for this clerkship. PREREQUISITES: Peds 300A and Surg 300A. PERIODS AVAILABLE: 1-12, full-time for 4 weeks. Maximum 3 students per period (2 PICU, 1 NICU). CLERKSHIP DIRECTOR: NICU-Christine Johnson, M.D., clcjohns@stanford.edu; PICU-Saraswati Kache, M.D., skache@stanford.edu. CLERKSHIP COORDINATOR: Bernadette F. Carvalho, berniec@stanford.edu. REPORTING INSTRUCTIONS: Where: PICU: If assigned to Team-A, report to on service Attending physician / PICU fellow in PICU, LPCH Main 420 Team room 4th floor; If assigned to Team-B, report to on service Attending physician / PICU fellow in PICU, LPCH Main 320 Team room 3rd floor, NICU: Report to on service Attending physician / NICU fellow in NICU, LPCH West 2nd floor; Time: TBA. CALL CODE: 4. OTHER FACULTY: Staff. LOCATION: LPCH.