ICU Rotation

Educational Objectives (PGY 1-2)


  • Understand the physiology of pulmonary gas exchange, and describe the clinical consequences of dead space ventilation and pulmonary shunting
  • Know a working classification of respiratory failure, and be able to list common causes for each
  • Interpret arterial blood gases, including calculation of A-a gradient and identification of acid-base abnormalities (e.g. uncompensated acute metabolic acidosis)
  • Understand the pathogenesis of acute respiratory distress syndrome and its common causes
  • Understand the indications/criteria for intubation/extubation
  • Be familiar with the various types of mechanical ventilation and their indications
  • Be familiar with positive pressure ventilation and understand its interaction with the management of patients with severe closed head injuries and increased intracranial pressure
  • Interpret an electrocardiogram, including identification of common dysrhythmias (e.g. atrial fibrillation, ventricular tachycardia).
  • Identify and initiate treatment for common, acute cardiac events (e.g. myocardial infarction, defibrillation for pulseless ventricular tachycardia).
  • Know a working classification for shock and know the pathophysiology and hemodynamic abnormality for each type (e.g. hypovolemic, septic shock:) and be able to initiate treatment for each type.
  • Possess a working understanding of the commonly used inotropes, including their indications for use, and their pharmacological effects
  • Possess a working knowledge of commonly used antihypertensive agents, their indications for use, and their pharmacological effects
  • Understand the indications, benefits and risks of invasive hemodynamic monitoring.
  • Possess a working approach to acute renal failure, including classification, history, physical examination, investigations and initial treatment
  • Understand the etiology, pathophysiology, and clinical features of systemic inflammatory response syndrome and multiple organ failure
  • Be familiar with the nutritional requirements for patients with severe closed head injury
  • Manage increased intracranial pressure and understand the pathophysiological underpinnings of management strategies
  • Understand the role of invasive intracranial monitoring including risks and limitations
  • Perform the following skills:
    1. Insert an oropharyngeal/nasopharyngeal airway
    2. Perform endotracheal intubation
    3. Obtain vascular access, including peripheral venous access, central venous access (femoral, subclavian, internal jugular
    4. Insert a jugular bulb catheter
    5. Insert an arterial line (radial, femoral)


  • Establish therapeutic relationships with patients and their families
  • Communicate effectively with patients and families in order to obtain through, focused histories during patient care encounters
  • Present consultations including detailed history, physical exam and findings of investigations to fellows and attending staff.
  • Document consultations including history, physical examination, findings of investigations and outline of the management plan (both written and dictated as appropriate).
  • Update patients and/or family with relevant information regarding their condition and management plan with appropriate supervision
  • Conduct discussions regarding appropriate level of care in the context of critically ill patients and end of life situations.
  • Participate in efficient and effective team handovers


  • Work/collaborate effectively as a member of the interdisciplinary care team in the care of critically ill patients, fostering a positive team environment
  • Consult other medical and surgical specialities appropriately in the care of the patients
  • Listen and respond appropriately to concerns of other health care providers
  • Effectively share team workload with resident colleagues


  • Manage own time, education and personal life to ensure balanced lifestyle
  • Effectively utilize, allocate, and prioritize finite resources in context of managing a critically ill patient.
  • Work effectively and efficiently, to learn time management skills in the medical setting
  • Triage patients, being able to identify emergencies that require prompt and immediate management


  • Recognize and respond to determinants of health in critically ill patients
  • Facilitate improvements in the underlying determinants of health in patients in an integrated fashion during care delivery
  • Facilitate progress of patient to care environments outside the ICU in collaboration with the multidisciplinary care team
  • Consider and practice preventative measures for ICU admission though ICU consults/outreach in ill patients on the wards.


  • Actively participate in weekly rounds/educational activities (residents are expected to be fully involved in all educational activities of the ICU service)
  • Identify and seek out personal learning needs related to cases encountered in the ICU
  • Apply principles of critical appraisal to medical information, be involved in journal club and various rounds
  • Facilitate patient, student and peer learning
  • Contribute to development of new knowledge, be actively involved in research projects where appropriate in the ICU, particularly with neurosurgical critical illnesses managed in the ICU


  • Foster collegial relationships with staff, residents, nurses and other allied health professionals
  • Demonstrate a commitment to their patients, profession, and society through ethical practice
  • Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, timeliness, respect and altruism
  • Show appropriate respect for opinions of other health care providers
  • Be able to appraise and identify own limits with respect to knowledge and patient care, and when to ask for assistance and consult effectively.