Clinical Experience

Clinical fellowship activities include rotations at Banner – University Medical Center (UMC) Tucson and Banner – UMC South. Banner – UMC Tucson has about 60 adult critical care beds. Banner – UMC South has 13 adult critical care beds. 

The clinical activities and responsibilities of the critical care medicine (CCM) fellows focus on the development of an evaluation and management plan for critically ill patients and the supervision and teaching of residents in the intensive care unit (ICU). CCM fellows are required to see and participate in the initial assessment and management of all patients admitted to, or evaluated in consultation by, the ICU service. Progressive independence during the fellowship provides senior fellows increasing opportunity to direct patient care and teaching. Fellows will gain proficiency in the evaluation and management of critically ill and injured patients with medical, surgical, traumatic and neurologic diseases. This will include, but not be limited to, the following:

Evaluation and management of acute and chronic respiratory failure involves differential diagnoses, ventilator management and diagnostic approaches. This includes evaluation and management of patients with:

  • Acute respiratory distress syndrome
  • Acute and chronic respiratory failure in obstructive lung diseases
  • Neuromuscular respiratory drive disorders
  • Acute lung injury due to trauma
  • Invasive and non-invasive modes of ventilation

Evaluation and management of:

  • Circulatory and shock disorders including septic, cardiogenic and hypovolemic shock
  • Cardiovascular diseases including ischemic heart disease, sepsis and sepsis syndromes, hypertensive emergencies
  • Multi-organ failure
  • Acute metabolic disturbances and electrolyte and acid-base disorders
  • Inhalation or radiation induced lung injury
  • Infections in the immunosuppressed patient
  • Anaphylaxis and acute allergic reactions
  • Respiratory failure including ARDS, acute and chronic respiratory failure in patients with obstructive and restrictive lung diseases, and in those with neuromuscular respiratory drive disorders
  • Use of paralytic drugs and sedative and analgesic medications
  • Hemodynamic and ventilatory support of patients in the post-operative period
  • Overdoses and intoxication syndromes
  • Metabolic, nutritional and endocrine effects of critical illness,
  • Hematologic and coagulation disorders associated with critical illness
  • Detection and prevention of iatrogenic and nosocomial problems in critical care medicine
  • Psychosocial and emotional effects of critical illness on patients and families
  • Management of end of life issues and palliative care
  • Evaluation and management of patients with neurosurgical and trauma emergencies
  • Critical obstetric and gynecologic disorders.
  • Trauma
  • Neurosurgical emergencies
  • Obstetric and gynecologic disorders
  • Evaluation and management of patients after discharge from the ICU.
  • Evaluation and management of patients with disorders of the cardiovascular, respiratory, renal, gastrointestinal, genitourinary, neurologic, endocrine, hematologic, musculoskeletal and immune systems.
  • Evaluation and management of infectious diseases in the ICU.
  • Basic and Advanced cardiopulmonary resuscitation (CPR)
  • Procedures: Fellows have the opportunity to perform and supervise a variety of critical care procedures including arterial lines, central venous lines, pulmonary artery catheterization, endotracheal intubation, bronchoscopy, chest tube placement, thoracentesis, paracentesis, lumbar puncture, and percutaneous tracheostomy.

Elective clinical rotations for fellows include: Difficult Airway Management, Advanced Echocardiography, Thoracic Surgery and Lung Transplantation, Pulmonary Hypertension (including performing right heart catheterization), Medical Toxicology, Palliative Medicine and a variety of medical subspecialties.