Medicine/Pulmonary Intensive Care
The Medical Critical Care/Pulmonary Teaching Service (MCCTS/PTS) is a multi-disciplinary teaching service consisting of:
- Pulmonary/critical care board certified attending physicians
- Internal medicine interns
- Family medicine and surgical interns
- Medical students
- Clinical pharmacy specialist
- A respiratory therapist
The average daily patient census for the two MCCTS/PTS teams is 20-25 patients per team, with most patients receiving mechanical ventilation. Disease states range from:
- COPD exacerbations
- Community and hospital acquired pneumonias
- Drug overdoses
- Acute neurological events
- Sepsis resulting from various infections
- Pulmonary embolus
- Adult respiratory distress syndrome
- Many other disease states
Surgery/Trauma Critical Care
The Surgery/Trauma Critical Care Teaching Service (SCCTS) is a multi-disciplinary teaching service consisting of a pulmonary/critical care board certified attending physician, one upper-level and one surgical intern, a clinical pharmacy specialist and a respiratory therapist. The SCCTS team provides critical care consultative service to patients in the six intensive care units at a Level I Trauma Center including care in:
- General Surgical
The average daily census for the SCCTS ranges from 15-30 patients depending on consultations, with all patients requiring mechanical ventilation. Disease states managed included closed head injuries including SAH/SDH, acute spinal cord injuries, sepsis resulting from a multitude of causes, adult respiratory distress syndrome, acute alcohol withdrawal, blunt trauma, aortic aneurysms and many other disease states.
Cardiovascular Intensive Care
The Cardiovascular Critical Care Attending Service is multi-disciplinary service comprised of a pulmonary/critical care board certified attending physician, respiratory therapist and clinical pharmacy specialist. This team provides management for post-operative cardiovascular or thoracic surgery patients in a 25-bed CVICU.
The GHS Heart Institute provides more than 4,000 cardiovascular surgeries per year including:
- Aneurysm repairs
- Coronary artery bypass grafting
- Valve repair/replacement
- MAZE procedures
- Surgical ventricle restoration
- Carotid endarterectomies
The clinical pharmacy specialist and attending physician work collaboratively with the cardiovascular surgeons to provide the highest level of postoperative care.
Pediatric Intensive Care
The Children’s Hospital at Greenville Memorial Hospital includes a new 12 bed Level I pediatric intensive care unit (PICU). The unit’s medical staff is composed of three pediatric intensivists and pediatric medical residents. The patient population is diverse. Services not covered at Greenville Memorial Hospital PICU include cardiovascular surgery, burns and transplantation.
Other specialty areas with children requiring intensive care are covered by this service. Previous exposure to general pediatrics is necessary to best exercise judgment in developing a critical care therapeutic plan. The resident is expected to monitor, assess and contribute to the drug therapy plans. In addition, the resident will develop a base knowledge of the differences in pediatric and adult critical care therapies.
Neonatal Intensive Care
The Neonatal Intensive Care Unit (NICU) rotation takes place in a 52-bed, level III NICU on the Memorial Campus of the Greenville Health System. The resident will be a part of one of two multidisciplinary teams comprised of one attending, three neonatal nurse practitioners or three pediatric medical residents, nursing, respiratory therapists and a clinical pharmacy specialist.
Topics commonly encountered and/or discussed throughout the rotation include:
- Apnea of prematurity
- Bronchopulmonary dysplasia (BPD)
- Patent ductus arteriosus
- Congenital heart defects
- Diaphragmatic hernia
- Intraventricular hemorrhage (IVH)
- Mechanical ventilation of the premature infant
- Morbidity and mortality of premature infants
- Neonatal abstinence syndrome
- Necrotizing enterocolitis
- Neonatal sepsis
- Nutrition of the premature infant
- Respiratory distress syndrome (RDS)
- Sedation/analgesia in premature infants, among others
The Infectious Diseases Consult Service is utilized by all of the various services in Greenville Memorial Hospital to participate in the care of patients with difficult-to-manage infectious diseases. The service is a multi-disciplinary team consisting of infectious diseases attending, internal medicine interns and residents, medical students and a clinical pharmacy specialist.
Disease states commonly encountered include
- Pneumonia (community and hospital acquired)
- Urinary tract infections
- Human immunodeficiency virus
- Sexually transmitted diseases
- Opportunistic infections
- Various fungal infections
The Metabolic Support Consult Service is utilized by all of the various services in Greenville Memorial Hospital to participate in the care of patients with difficult-to-manage enteral and parenteral nutrition support. The service is a multi-disciplinary team consisting of clinical nutrition specialists and clinical pharmacy specialists. Residents will perform:
- Initial nutrition support consultations
- Recommend therapeutic goals
- Develop individualized nutritional regimens including
- Type of support
- Follow-up to optimize the patients’ nutritional care
Disease states and topics often encountered will include protein malnutrition (Kwashiorkor), protein-calorie malnutrition (marasmus), obesity, vitamin and mineral deficiencies, short bowel syndrome, acid-base and fluid-electrolyte disturbances, metabolic syndromes, enterocutaneous fistulas, pancreatitis and nutrition in critically ill patients.
GHS provides the most extensive emergency services in the Upstate, including a Level I Trauma Center, Children’s Emergency Center, Chest Pain Center, Congestive Heart Failure/Stroke Center, intermediate care and critical care emergency services.
The emergency medicine experience provides clinical services to a variety of disease states, which may include:
- Diabetic ketoacidosis
- Drug withdrawal
Residents will understand concepts surrounding medications used in a code situation, high-dose steroids, thrombolytics and antibiotics. They may deal with issues such as conscious sedation, motor vehicle accidents, trauma codes, and adherence in homeless patients, alcoholism, drug addiction, post-exposure prophylaxis and obtaining medication histories.
Longitudinal On-Call/Clinical Pharmacokinetics Consult Service
The clinical on-call/pharmacokinetics longitudinal experience provides on-call and pharmacokinetics consult services at Greenville Memorial Hospital. The on-call/pharmacokinetics consult service is designed to provide consistent clinical resources to GMH healthcare providers in a timely manner. The resident will design, monitor and evaluate evidence-based patient-specific therapies involving:
- Clinical pharmacokinetics
- Drug information questions
- Investigational drug services
- Therapeutic outcomes program
- Clinical service cross-coverage
- Additional pharmacotherapy consults
Clinical Research Month
The clinical research month allows residents the opportunity to develop skills related to scholarly activity and clinical research. Residents are encouraged to pursue clinical research projects, peer-reviewed publications, process improvement strategies and develop oral and written presentation skills. Residents will learn the aspects of:
- Research/clinical trial design
- Statistical analysis
- Internal Review Board application process
- Research ethics
- HIPAA rules and regulations
- Quality assurance
Residents are encouraged to present their clinical research at state and national meetings.