| Rotations | Year 1 | Year 2 |
|---|---|---|
| Mercy Night Float | 2 months | 2 months |
| Elective SLU/Mercy | 3 months | 4 months |
| SLU Medical ICU | 1 month | 1 month |
| Telemedicine | 1 month | - |
| Respiratory/Nutrition | - | 1 month |
| Anesthesia | 1 month | - |
| Mercy Medical Surgical ICU | 2 months | 2 months |
| Mercy Neuro-Trauma ICU | 2 months | 2 months |
| Mercy CVICU | 1 month | 1 month |
Medical/Surgical Intensive Care Units
The Mercy Hospital medical/surgical intensive care unit rotation provides a challenging experience exposing the fellows to medical and surgical pathophysiology. The intensive care unit team includes a fellow, resident, student, and critical care faculty member responsible for the daily multidisciplinary teaching rounds. The team is responsible for the care of complex medical and surgical patients including the performance of various invasive procedures. The night coverage is provided by the night float team that includes fellows, physician extenders and back up supervision by the in-house telemedicine critical care faculty member.
Neuro-Trauma Intensive Care Unit
The Mercy Hospital St. Louis Neuro-Trauma intensive care unit provides care to patients sustaining multiple trauma, traumatic brain injury, acute stroke, subarachnoid hemorrhage, spinal cord injury, post operative brain and spine surgery and neurologic disorders requiring respiratory support. Working closely with the trauma surgeons and neurosurgeons the neurointensivists provide bedside care of these patients including placement of intra-cranial pressure monitors. Mercy Hospital St. Louis is a Comprehensive Stroke Center and a Level I Trauma Center. The majority of critical care attending faculty have completed the Neurocritical Care Subspecialty Certification from the United Council for Neurologic Subspecialties.
Medical Intensive Care Unit
The St. Louis University Medical Intensive Care Unit (MICU) rotation provides comprehensive care to patients with life-threatening or potentially life-threatening medical illnesses of all major organ systems. The two assigned MICU fellows Pulmonary Disease/Critical Care Medicine or Critical Care Medicine are the team leaders for the monthly rotation block-assigned medical residents; and in conjunction with the MICU attending physician, direct and actively participate in patient care including performance and supervision of all ICU-related invasive procedures.
Telemedicine
The Mercy St. Louis Virtual Care Center supports one of the largest telemedicine programs in the country. The critical care and pulmonary critical care fellows learn ICU telemedicine skills during this rotation, covering several intensive care units alongside the critical care attending faculty and nursing staff. The fellows develop expertise navigating electronic medical records, bedside monitoring systems and the video capabilities of virtual care. The fellows learn the advantages and limitations of critical care telemedicine.
Cardiovascular Intensive Care Unit (CVICU)
During the CVICU rotation the fellows care for patients with ischemic coronary syndromes, challenging arrhythmias, vascular surgery, cardiogenic shock and post cardiac arrest hypothermia. In addition, patients requiring extracorporeal membrane oxygenation (ECMO) are managed in the CVICU in collaboration with the ECMO team. This team includes an ECMO intensivist, cardiovascular perfusionist, cardiothoracic surgeon, specialized intensive care unit nurses and respiratory practitioners.
Physician Extender Program
The Department of Critical Care Medicine is fortunate to be supported by a talented nurse practitioner (NP) and physician assistant (PA) program. The collaborative NP and PA program is mature and supports the ICU twenty-four hours a day by covering, admitting, discharging ICU patients and performing procedures when required. The NP and PA program is responsible for the Mercy Rapid Response System.
Procedures
During the fellowship, trainees perform the following procedures: central venous catheter, renal replacement catheter, arterial catheter, intracranial pressure monitor (Camino Catheter), intubation, tube thoracostomy, percutaneous dilational tracheostomy, thoracentesis, paracentesis and lumbar puncture.
Palliative Care
This course is a combination of didactic and simulation based education for Palliative care with specific focus on end-of-life care in the ICU. Trainees are instructed one on one with the initial portion of the course focusing on communication basics, challenges and techniques. The second portion of the course is where the trainee is asked to role-play with the instructor. The instructor plays the role of a family member. Two simulated cases are used for this. The usual simulation session lasts 10 minutes. Trainees are recorded during the simulation and then the recording is played back, watched with the trainee and immediate feedback is provided to the trainee.
