The Fellowship in Trauma and Critical Care is based in the Department of Surgery. The Division of Trauma/Critical Care is organized to provide continuity of care throughout the course of the acutely injured or critically ill surgical patient. The fellowship is an integral part of this organization and the candidate will be involved with all aspects of the patient's care. The fellowship is one year for Surgical Critical Care and two years when combined with Trauma. The fellow must be board certified or board eligible in General Surgery.
Our Facility
The fellowship centers
around the function of the Division of Trauma/Critical Care within
the Department of Surgery. The Trauma Service cared for 3,609 patients
in 2007, 38 percent of whom required a critical care admission.
The majority of the Surgical Critical Care patients are admitted
to the 32-bed Surgica Critical Caret. Critical care units which
are occasionally used include a 10-bed Cardiovascular Intensive
Care Unit, an 18-bed Medical Intensive Care Unit, and an eight-bed
Coronary Care Unit. Time may also be spent by the fellow on the
Pediatric Trauma/Critical Care Service.
Expectations
The fellow will be involved
with the Critical Care Service, which consists of six attendings
from Surgery, two residents and fourth year medical students on
elective. The critical care experience includes all aspects of surgical
critical care. The fellow is expected to participate in resident,
student, and nursing education. Conferences to be attended include
those of the Division of Trauma/Critical Care and those of the Department
of Surgery. Research is felt to play a vital role in trauma and
critical care; therefore, the fellow is expected to conduct clinical
and/or basic science research.
How skills in surgical critical care are acquired during the fellowship:
Respiratory: Airway managements, including endoscopy and management of respiratory systems:
Airway managements skills are learned under the direct guidance of critical care attendings. Techniques of intubation and upper airway endoscopy are evaluated by the anesthesiology critical care attendings.
Surgical airway management and bronchoscopy is conducted under the direction of surgical critical care attendings. Respiratory management and instruction in various modes of ventilatory support is gained through daily interactions with critical care attendings in managing acute respiratory problems.
Circulatory: Invasive and non-invasive monitoring including transesophageal and pericardial cardiac ultrasound and application of transvenous pacemakers; computations of cardiac output and systemic and pulmonary vascular resistance; monitoring and interpretation of electrocardiograms and management of cardiac assist devices.
Critical Care Fellows have completed ACLS to ensure the ability to monitor and interpret electrocardiograms. Ability to compute cardiac output and systemic and pulmonary vascular resistance is gained through core lectures and daily work rounds with critical care attendings. The techniques of invasive and non-invasive monitoring techniques including cardiac ultrasound is gained in conjunction with cardiologist who are consulted on patients on the critical care service. Management of cardiac assist devices is learned under the direction of cardiac surgeons.
Neurological: The performance of complete neurological examinations. Use of intracranial pressure monitoring techniques and of the electroencephalogram to evaluate cerebral function and application of hypothermia in the management of cerebral trauma.
Instruction and performance of complete neurologic exam is done under the direction of the critical care attendings and neurosurgical attendings. Discussion of intracranial pressure monitoring techniques is conducted by critical care attendings and the application and use of intracranial pressure monitoring techniques is performed under the supervision of neurosurgical attendings. Use of electroencephalogram is done in conjunction with neurologists. Application of hypothermia in the management of cerebral trauma is not used at this institution.
Renal: Evaluation of renal function; peritoneal dialysis and hemofiltration, and knowledge of indications and complications of hemodialysis.
The evaluation of renal function and knowledge of indications and complications of hemodialysis is gained on daily teaching rounds in discussions with critical care attendings. The techniques of peritoneal dialysis and hemofiltration as well as hemodialysis are gained under the direction of the nephrology service of the institution and critical care attendings.
Gastrointestinal: Utilization of gastrointestinal intubation and endoscopic techniques in the management of the critically ill patient, application of enteral feedings, and management of stomas, fistulas, and percutaneous catheter devices.
Skills in gastrointestinal intubation and endoscopic techniques are gained under the direction of the surgical critical care attendings, all of whom have credentials in endoscopy. Application of enteral feedings and percutaneous catheter devices are learned under the direction of the critical care attendings in conjunction with the nutritional support service. Management of stomas and fistulas is done with the enterostomal therapist and the critical care attendings.
Hematologic: Application of autotransfusion, assessment and coagulation status, and appropriate use of component therapy.
All of these techniques are gained under the direction of the surgical critical care attendings. Difficult and unusual hematologic problems are also managed in consultation with the hematology service.
Infectious Disease: Classification of infections and application of isolation techniques, pharmacokinetics, drug interactions and management of antibiotic therapy during organ failure; nosocomial infections, indications for application of hyperbaric oxygen therapy.
Teaching rounds are conducted on a weekly basis with an attending from the infectious disease service who supplements the teaching of critical care attendings specifically on difficult infections and nosocomial infections. Daily rounds are conducted with a doctor of pharmacology to provide guidance in pharmacokinetics and drug interactions and management of antibiotic therapy during organ failure. Hyperbaric oxygen therapy is an adjunct used by the critical care service. Two of the surgical critical care attendings have credentials in that therapy.
Nutritional: Application of parenteral and enteral nutrition, and the monitoring and assessment of metabolism in nutrition.
Skills in the use and assessment of parenteral and enteral nutrition and metabolism are gained on daily teaching rounds with the critical care attendings which are conducted jointly with the metabolic support service, consisting of a pharmacologist, nurse, and dietitian. Use of the metabolic cart and other techniques of assessment are gained under the direction or the metabolic support team.
Monitoring/Bioengineering: Use of calibration of transducers, amplifiers, and recorders.
Skills in monitoring and bioengineering are gained under the direction of critical care attendings and critical care nurse specialists. The Department of Bioengineering within the University also assists in the training.
Miscellaneous: Use of special beds for specific injuries, and employment of pneumatic anti-shock garments, traction, and fixation devices.
These skills are gained in conjunction with the trauma service attendings, orthopedics attendings, and critical care attendings.
Graduate School of Medicine
The University of Tennessee Medical Center
l924 Alcoa Highway, Box U-11
Knoxville, Tennessee 37920-6999
(865) 305-9230
(800) 596-7249
FAX (865) 305-8894
