Critical care medicine is a diverse, fast-paced and quickly evolving field. Residents who train in critical care anesthesia at Montefiore have a unique opportunity to work in a stimulating environment and learn an approach to critical care that currently serves as a national model of excellence.
Montefiore is home to the second busiest emergency department in the nation, which requires unparalleled expertise in critical care. To elevate the standards of critical care delivery, Montefiore developed its innovative "ICU Without Walls" model, which unites medical, surgical, cardiothoracic, neurosurgical, trauma and acute care ICUs under the guidance of critical care specialists. Residents are involved in the postoperative care of cardiothoracic patients and acute care surgical patients at Montefiore's Weiler Division.
Montefiore's unique "ICU Without Walls" model has received national media coverage for its effectiveness, and provides a structure allowing critical care intensivists to treat patients needing immediate attention throughout the hospital at any time, day or night. These critical care specialists come from a wide array of medical backgrounds, including subspecialties such as pulmonology, infectious diseases, surgery and anesthesiology.
The critical care anesthesia residency rotation challenges residents to adapt to the different requirements and responsibilities of the ICU. In the operating room, anesthesiologists monitor a patient's vital signs, adjust the ventilator and administer all medications and fluids. This care continues into the ICU, where anesthesia residents work with respiratory therapists who monitor patient ventilation and nurses who monitor vitals and administer fluids and medications. In emergency situations, the anesthesia residents participate in securing the patient's airway, ensuring adequate vascular access and managing the resuscitation of the patient.
At Montefiore, residents have the opportunity to train and be mentored by some of the most talented critical care physicians. As the Division of Critical Care Medicine and the Department of Anesthesiology continue to grow, there will be increasing surgical caseloads and a greater demand for comprehensive training in critical care anesthesia.
Anesthesia residents have embarked on the development of system-based projects, such as developing a protocol for treatment of hyponatremia in the ICU. In addition, the Post Anesthesia Recovery Unit is developing a similar protocol for exploring treatment of accidental intravascular injection of local anesthetic during a regional anesthesia block.
The overall goal of the critical care rotation is to introduce anesthesia residents to the challenges faced in the care of critically ill patients after acute surgical interventions have been completed. The anesthesia residents learn to function as part of the ICU team. Communication among the primary surgical team, consulting physicians, ICU nurses, respiratory therapists, dialysis nurses and other ancillary staff is paramount in the care of these critically ill patients.