can someone give me an idea of common crit care procedures?

This is the skillset for Critical Care as per the ABIM website:

Airway management and endotracheal intubation; ventilator management and noninvasive ventilation; insertion and management of chest tubes, and thoracentesis; advanced cardiac life support (ACLS); placement of arterial, central venous, and pulmonary artery balloon flotation catheters; calibration and operation of hemodynamic recording systems; proficiency in use of ultrasound to guide central line placement and thoracentesis is strongly recommended.
Candidates should know the indications, contraindications, complications, and limitations of the following procedures: pericardiocentesis, transvenous pacemaker insertion, continuous renal replacement therapy (CRRT) and hemodialysis, and fiberoptic bronchoscopy. Practical experience is recommended

Writing notes. If you want to do procedures, don't be an internist.

I say this, wanting to be an internist myself. There are so many niches in medicine to get into if you really like doing things with your hands. Why people insist on this pursuit of procedures in medicine has always been a mystery to me.

If you like to poke, cut, nip, sew, etc. choose a field that deals with that daily. You will do procedures as an internist, but if that is really a strong selling point, why not do anesthesia? Plenty of poking, lines, and instantaneous feedback. If you like scrubbing and cutting, why not do surgery - tons of types to choose from if you don't like general?

If you really can't live with that, why not just do family? I mean, when you get down to it, if you are really stoked on procedure, being a family med doc in a small town is about as good as you can get.

Food for thought. By the way, as with all things inherently human, placing a central line n + 100 times is going to get old anyway - no matter what the procedure is.

As am IM resident I have to agree. Procedures are hard to come by in internal medicine. ...even in MICU rotations. Depending on the academic institution, intubations & chest tubes are done by anesthesia & CT surgery respectively. Our PCCM fellows only perform bronchoscopies - they never intubate, place chest tubes, lines, etc.

Where I train the housestaff do central lines, arterial lines, thoras, paras and LPs in the MICU. The fellow occasionally hops in and does things too. In addition to those procedures, critical care has a lot of opportunity for bronchoscopy, chest tubes (we have interventional pulmonary) and bedside trachs (interventional pulmonary). So, while I agree that most of internal medicine is more cerebral, there are plenty of opportunities for procedures in critical care. More and more institutions are also implementing a procedure service, which is run by a critical care attendings and helps for lines, thoras, LPs and Paras. Plenty of stuff to go around.

You will do procedures as an internist, but if that is really a strong selling point, why not do anesthesia? Plenty of poking, lines, and instantaneous feedback.

this is why i love what i do (anesthesia resident here reliving my old days as a medicine intern on a cold friday night).

when we have BP issues, we know with in minutes, frequently seconds. and we give powerful drugs that give us results in minutes, usually seconds. more often than not, i end up giving small doses of pressors during cases because the majority of people will have pretty wild swings in their blood pressure during even the most routing general anesthetic.

patient asthmatic or having bronchospasm in the OR? better do something pretty quick or you'll be a in a lot of trouble really really fast. we don't give inhaled steroids and see 'em again in a month.

uncontrolled hypertension? break out the drips--niccardipine, nitroglycerin, nitroprusside, etc. we don't give lisinopril and recheck in two weeks. personally, i find the OR environment a little more fun just because things do change so fast.

ever given 250 mcg of fentanyl or 50 mg of versed at one time and watched someone go apneic in front of you? if you like instantaneous medicine and lots of cool drugs, you'll like anesthesia.

Central lines, arterial lines, PA catheters placements, standard and fiberoptic intubations, nerve blocks in for just about every peripheral nerve you can name, spinals, and epidurals are just the standard stuff that every anesthesiologist will be an expert in. Even run of the mill things like orogastric and nasogastric tubes and IVs can be challenging...I don't know of anyone else who routinely puts IVs in the feet and legs like we do. And trust me, it takes a really good patient-doctor relationship to do all of these things on awake patients before going back to the OR even if that relationship is short (ESPECIALLY the foot IVs. that freaks people out.)

Cardiothoracic anesthesiologists are also certified to perform TEE if that interests you. The pain guys have all sorts of crazy procedures they do that I can't speak very intelligently about just yet.

If you like internal medicine and physiology but really like to use your hands, I recommend looking into anesthesiology. We are the internists in the OR.

can someone give me an idea of common crit care procedures?

Maybe there is a regional variation, but I've had a much different experience than the above posters. IM residents at my program routinely do central lines, LPs, paracentesis, thoracentesis etc.

In the ICU you will also have an opportunity to perform intubations and place chest tubes.

-The Trifling Jester