Clinical Experience

Pediatric Intensive Care Unit

The busy, 20-bed PICU is the primary location for the fellow's clinical education. In all, Le Bonheur boasts approximately 1,800 admissions from a catchment area that includes parts of six states. This large area covers a population of diverse ethnic backgrounds, socioeconomic statuses, types of illness, and disease severity. All ECMO, except that for congenital heart disease, is done in the PICU and averages 18 total cases per year. For all patients, the critical care fellow is considered the team leader and first contact person for all patient evaluations and clinical decisions.

Cardiovascular Intensive Care Unit

A collaboration between the divisions of critical care, cardiology, and cardiothoracic surgery, the CVICU is a 10-bed unit that averages approximately 400 cases per year. Each fellow will rotate through the CVICU for several weeks each year, receiving instruction in the post-operative management of congenital heart disease from members of each of the above divisions.

Neuro-Intensive Care Unit

The Neuro-ICU is a collaboration between the divisions of critical care, neurosurgery, and neurology. Due in part to the close proximity of the St. Jude Children's Research Hospital, Le Bonheur has a robust and renowned neurosurgery program. Critical care fellows quickly become familiar with the assessment and management of post-operative care following tumor resection, epileptic surgery, and shunt/drain placement. In addition, the Neuro-ICU is wired to provide continuous EEG monitoring for patients with status epilepticus.

Intermediate Care Unit

The IMCU, under the direction of the division of critical care, provides care to two distinct patient populations. The first is a population of patients who require frequent assessments and treatments from nurses or physicians with critical care skills, but not to the extent that is expected in the PICU. The second population consists of patients who require a longer duration of hospital stay due to their dependence on, and the management of, durable medical equipment such as home ventilators. In this unit, the fellow works alongside our critical care nurse practitioners to not only manage in-hospital medical problems, but also to arrange home-going needs and learn to identify when all home-going requirements have been met in this fragile population.

St. Jude Children's Research Hospital

St. Jude, the largest population of immune-compromised children in the world, provides critical care services to their critically ill patients in an 8-bed ICU. Staffed by board-certified pediatric intensivists, the PCCM fellow will spend one month rotating through this unit each year. During this rotation the fellow is exposed to unique Hematologic-oncologic challenges, severe sepsis and septic shock, as well as frequent cardiac and renal failure from drug toxicity. In addition to patient care, the fellow also has the opportunity to work and collaborate with renowned hematology/oncology and infectious disease clinicians and researchers.

Interventional Radiology

This one week rotation, completed at the beginning of the first year, will expose the fellow to vascular access techniques taught directly by interventional radiologists. This rotation provides multiple opportunities to practice obtaining vascular access very early in the fellowship so that the fellow feels more comfortable obtaining access on a more urgent basis in the PICU.

Anesthesia

This one week rotation, also completed at the beginning of the first year, provides the beginning fellow with instruction on airway management directly from experienced anesthesiologists and nurse anesthetists. The fellow will have the opportunity to manage many airways, thus resulting in more practice with intubation techniques and increased comfort level with airway management.