The LPCHS PICU provides a full range of advanced critcal care services, including high frequency oscillatory ventilation, continuous renal replacement therapy, and ECMO. High-volume services include neurosurgery, ENT/airway reconstruction, solid-organ and stem cell transplantation, trauma and general pediatric surgery, cardiology, nephrology, pulmonary and general pediatrics. Strong collaborations exist with the Stanford Children's Heart Center particularly with our Cardiovascular ICU. The PICU supports all subspecialty services at LPCHS as a Level 1 Trauma Center, directs the 24/7 Transport and Transfer Center, the Pallative Care Program, and the REVIVE Initiative for Resuscitation Excellence.
Our PCCM fellows lead interdisciplinary teams that include nurse practitioners, hospitalists, pediatric and emergency medicine residents, medical students, nurses, respiratory therapists, pharmacists, dieticians, social networks, and case managers to provide family-centered care to all PICU patients. Critically ill or injured childen are admitted from communities throughout Northern California, with referrals from Nevada, Oregon, Washington, Hawaii, and other states, particularly for organ transplantation or advanced neursurgical services.
PCCM Rotation Descriptions
Anesthesia: Fellows experience two 2-week blocks with pediatric anesthesia at the beginning and middle of 1st year, primarily focusing on learning airway management and vascular access skills.
CVICU: PCCM fellows, along with cardiology fellows, advanced practice providers, hospitalists and 4th year CVICU fellows, work under the guidance of dedicated CVICU attendings and serve as the frontline physician for patients in our CVICU. The LPCH CVICU is a 24-bed (expanding to 36) quaternary referral center which cares for patients with complex congenital heart disease (approximately 1200 admissions/year with 50-60% postoperative). Fellows will learn the principles of pre- and post-operative management for children with the spectrum of congenital and acquired heart disease.
PICU Team Fellow: Fellows serve in the traditional PICU fellow role throughout the majority of their first year, leading a primary team and supervising residents, hospitalists, and advanced practice providers under the guidance of an attending intensivist. Fellows lead rounds, provide bedside and formal teaching, admit, stabilize and manage patients, perform required procedures and develop communication skills throughout the rotation.
PICU Buffer Fellow: Fellows transition to the Buffer Fellow role during their second year where they have primary responsibility for managing the flow of the unit. This entails providing protected rounds for primary PICU Teams, responding to codes, rapid responses and traumas, triaging and managing external transfer referrals, serving as medical control for transport teams, managing urgent or emergent issues for patients currently admitted in the PICU.
Pretending: Senior fellows will assume the attending role, leading rounds, conducting bedside and formal teaching, and supervising junior fellows, advanced practice providers, residents, and medical students. They also have the opportunity to learn about topics such as billing and documentation and assume a supervisory role in care conferences and complex discussions with consultant teams. Attending physicians generally serve only as passive observers on rounds so that they are able to give pretending fellows constructive feedback.
Night Float: Fellows work together with the on-call resident and/or advanced practice provider/hospitalist and on-call attending to care for patients in the PICU overnight. They will be responsible for progressing patient care, managing urgent issues, and admitting any new patients. They also have responsibilities for night-time resident teaching and responding to transfer requests.
Valley PICU Elective: This is an optional elective rotation at Valley Children’s Hospital in Madera, which houses a 43-bed PICU with capabilities including CRRT, HFOV, and ECMO. Here, fellows will have the opportunity to care for patients with a variety of pathologies, perform procedures, teach residents, and gain exposure to a different care model (i.e. private practice attending-only).
Elective: Elective time may be used to augment one’s education in an individualized fashion. Some possibilities include time in interventional radiology, cardiac anesthesia, vascular access, transport elective, trauma or international experiences. Fellows are encouraged to take advantage of the many different opportunities available at Stanford/LPCH or even create their own.
Research: This is dedicated call-free time to facilitate scholarly activity in the fellow’s chosen area of interest. In conjunction with the departmental Fellows’ College, there are structured didactics regarding research principles and methodology as well as regularly scheduled scholarly oversight meetings and research-in-progress presentations.
Chest Tube Insertion: http://www.nejm.org/doi/full/10.1056/NEJMvcm071974
Placement of a Femoral Venous Catheter: http://www.nejm.org/doi/full/10.1056/NEJMvcm0801006
Pulmonary Artery Catheterization Video: http://www.nejm.org/doi/full/10.1056/NEJMvcm1212416
Ultrasound-Guided Insertion of a Radial Arterial Catheter: http://www.nejm.org/doi/full/10.1056/NEJMvcm1213181
Use of Pressure Transducers: http://www.nejm.org/doi/full/10.1056/NEJMvcm1513613