Critical Care Medicine Fellowship

Mercy Hospital St. Louis medical/surgical intensive care unit rotation exposes 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.

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.   

The Saint Louis University Medical Intensive Care Unit (M.I.C.U.) rotation provides comprehensive care to patients with life-threatening or potentially life-threatening medical illnesses of all major organ systems. The two fellows assigned to pulmonary disease/critical care medicine or critical care medicine are the team leaders for the monthly rotation block-assigned medical residents. In conjunction with the M.I.C.U. attending physician, fellows actively participate in patient care including performance and supervision of all I.C.U.-related invasive procedures.

The Mercy Hospital 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.

During the C.V.I.C.U. 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 (E.C.M.O.) are managed in the C.V.I.C.U. in collaboration with the E.C.M.O. team. This team includes an E.C.M.O. intensivist, cardiovascular perfusionist, cardiothoracic surgeon, specialized intensive care unit nurses and respiratory practitioners.  

This formal ultrasound course includes didactic and practical sessions presented and directed by the critical care department including Dr. Jan Kasal, who co-chaired the Society of Critical Care Medicine ultrasound course, and Dr. Chakradhar Venkata, both certified by the National Board of Echocardiography (Testamur). The course includes echocardiography, DVT assessment, lung and chest ultrasound, and abdominal FAST examination. The 3D Systems Ultrasound Mentor provides an ultrasound simulation environment for the fellows to sharpen and test their skills.

This formal airway course presented with a multidisciplinary approach including representation from critical care medicine, pulmonary medicine, emergency medicine, trauma surgery, pharmacy and anesthesia. The course provides didactics, practical sessions, and an evaluation of the latest airway equipment. The SimMan 3G used in this course provides lively interactive and educational simulation sessions.

The mechanical ventilation course is a combination of didactic lectures and a hands-on practical evaluation of mechanical ventilators with test lungs. Case scenarios are presented and discussed at several learning stations. The course focuses on applied pulmonary physiology in the setting of mechanical ventilation.

The E.C.M.O. education course provides the fellows and staff with the foundation for the clinical practice of E.C.M.O. This course includes didactic lectures and practical sessions with a functional E.C.M.O. circuit presented by cardiovascular perfusionists, E.C.M.O. intensivists and E.C.M.O. specialists.

The Emergency Neurological Life Support (E.N.L.S.) course: E.N.L.S. is designed to help health care professionals improve patient care and outcomes during the critical first hours of a patient’s neurological emergency. Now in its fourth version, E.N.L.S. demonstrates a collaborative, multi-disciplinary approach and provides a consistent set of protocols, practical checklists, decision points, and suggested communication to use during patient management.

Fellows present journal articles following the evidence-based medicine approach. The critical care faculty responsible for journal club presentations completed the E.B.M. workshop sponsored by Duke University Medical Center.

This is a combined Mercy Hospital St. Louis and Saint Louis University Hospital video ultrasound conference that provides a platform for the fellows to present and discuss ultrasound cases with the pulmonary and critical care attendings. Focused ultrasound topics are presented and reviewed.

This is a monthly meeting between the fellows and the program director to discuss any elements of the fellowship.

The Critical Care QI conference is administered by the fellows to address quality and safety issues pertaining to the I.C.U. The A.P.A.C.H.E. Outcomes database provides physiologic and outcome data on all I.C.U. admissions and is presented during this meeting for review and to assess for trends of care.

Each month, the fellows are expected to read a section of a selected critical care textbook and then answer questions that the attendings have written for that reading. The questions are presented and discussed during the conference. The goal of the review is to complete a critical care textbook every two years in preparation for the critical care A.B.I.M. certifying examination.