Out of the SICU. Yay!

[psychout]

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[173291]

starting SICU on Monday for a paltry 2 wks. any advice on how to prep?

 

[Coastie]

starting SICU on Monday for a paltry 2 wks. any advice on how to prep?

Know everything about your patients.

All meds: and why.
Days of abx.
IVF
Ins and Outs
Urine outpt per hr (range)
BP, RR, ABG, HR, Tmax, Vent Settings, Imaging
Drips
Feeds
Physical exam
Write your notes in system format.
1) Neuro
2) CVS
3) Resp
4) GI
5) Renal/FEN
6) Endo
7) ID
8) Heme
9) ICU PPX
10) Social
Always know code status
Always trend labs
Always be pro-active in your patient's care
Know what lines a patient has, the days, and when to replace them
Know all the cultures a patient has had, and the sensitivities

Otherwise, read on the patients. First day, do the above, and read thereafter. You'll be ahead of all the other medical students..

 

[Frank Rizzo]

Know everything about your patients.

All meds: and why.
Days of abx.
IVF
Ins and Outs
Urine outpt per hr (range)
BP, RR, ABG, HR, Tmax, Vent Settings, Imaging
Drips
Feeds
Physical exam
Write your notes in system format.
1) Neuro
2) CVS
3) Resp
4) GI
5) Renal/FEN
6) Endo
7) ID
8) Heme
9) ICU PPX
10) Social
Always know code status
Always trend labs
Always be pro-active in your patient's care
Know what lines a patient has, the days, and when to replace them
Know all the cultures a patient has had, and the sensitivities

Otherwise, read on the patients. First day, do the above, and read thereafter. You'll be ahead of all the other medical students..

Hell, if you do this, you'll be ahead of some of the interns!

 

[jetproppilot]

Know everything about your patients.

All meds: and why.
Days of abx.
IVF
Ins and Outs
Urine outpt per hr (range)
BP, RR, ABG, HR, Tmax, Vent Settings, Imaging
Drips
Feeds
Physical exam
Write your notes in system format.
1) Neuro
2) CVS
3) Resp
4) GI
5) Renal/FEN
6) Endo
7) ID
8) Heme
9) ICU PPX
10) Social
Always know code status
Always trend labs
Always be pro-active in your patient's care
Know what lines a patient has, the days, and when to replace them
Know all the cultures a patient has had, and the sensitivities

Otherwise, read on the patients. First day, do the above, and read thereafter. You'll be ahead of all the other medical students..

WOW.

Coastie's a stud/studette.

 

[173291]

Know everything about your patients.

All meds: and why.
Days of abx.
IVF
Ins and Outs
Urine outpt per hr (range)
BP, RR, ABG, HR, Tmax, Vent Settings, Imaging
Drips
Feeds
Physical exam
Write your notes in system format.
1) Neuro
2) CVS
3) Resp
4) GI
5) Renal/FEN
6) Endo
7) ID
8) Heme
9) ICU PPX
10) Social
Always know code status
Always trend labs
Always be pro-active in your patient's care
Know what lines a patient has, the days, and when to replace them
Know all the cultures a patient has had, and the sensitivities

Otherwise, read on the patients. First day, do the above, and read thereafter. You'll be ahead of all the other medical students..

Thanks man! I really appreciate it.

 

[lord_jeebus]

Don't touch a patient or anything touching a patient (lines, bed, etc.) unless you need to, and wear gloves

Get The ICU Book

 

[Coastie]

WOW.

Coastie's a stud/studette.

Just an intern who tries to trade ward months barf for ICU months.

 

[Coastie]

Hell, if you do this, you'll be ahead of some of the interns!

Sad, but true!

 

[jetproppilot]

Just an intern who tries to trade ward months barf for ICU months.

Sorry, stud/studette.

With habits like that y'ain't just an intern.

You are a conscientious, gifted clinician that your colleagues are gonna have a hard time keeping up with.

 

[Coastie]

Sorry, stud/studette.

With habits like that y'ain't just an intern.

You are a conscientious, gifted clinician that your colleagues are gonna have a hard time keeping up with.

haha..wow, thanks man!

CA-1 in t - 5 months...

 

[OB1🤙]

Just an intern who tries to trade ward months barf for ICU months.

If I could do this, I would jump on it in a nanosecond. I've discovered this year that I really, really like the ICU. I've also discovered that I really, really hate, abhor, detest, and loathe general medicine wards. I guess I knew that as an MS3, but still. It's viscerally painful to have to put up with it. Just one more GMed month in this slog of a year...

But yeah. The ICU is awesome.

 

[Trisomy13]

WOW.

Coastie's a stud/studette.

actually that list is what is expected from us in the ICU. anything less isn't good ICU care. a stud/studette knows this list about patients that aren't his/hers too. and if those 6 cans of Pivot are reaching your dude's kcal and protetin goals
i'm in the SICU this month as well, second time around, more comfortable with the sickies. good times. and it helps to have an attending who is both smart and strict, and a healthy dark sense of humor. almost makes me consider a CCM fellowship again.

 

[SexPanther]

If I could do this, I would jump on it in a nanosecond. I've discovered this year that I really, really like the ICU. I've also discovered that I really, really hate, abhor, detest, and loathe general medicine wards. I guess I knew that as an MS3, but still. It's viscerally painful to have to put up with it. Just one more GMed month in this slog of a year...

But yeah. The ICU is awesome.

Agree wholeheartedly. I actually tried to pawn off my VA ward month for another month in the MICU but was told I couldn't b/c the ward month is a transitional year requirement as part of my categorical residency. Give me the unit any day over the wards.

 

[smgilles]

Agree wholeheartedly. I actually tried to pawn off my VA ward month for another month in the MICU but was told I couldn't b/c the ward month is a transitional year requirement as part of my categorical residency. Give me the unit any day over the wards.

Couldn't agree more. We (prelim anesthesia) do 4 months of ICU (MICU, NICU, PICU, CCU) our intern year. It's so much better than the floors it's ridiculous. I would do 12 months of ICU versus 3 months of general medicine any day.

 

[Bobblehead]

Couldn't agree more. We (prelim anesthesia) do 4 months of ICU (MICU, NICU, PICU, CCU) our intern year. It's so much better than the floors it's ridiculous. I would do 12 months of ICU versus 3 months of general medicine any day.

There can be a large fatigue factor in critical care. One month at a time is plenty.

 

[coprolalia]

I really enjoy CCM. It is truly an opportunity to get the "big picture" on a cohort of patients you are likely to see in the OR.

Take advantage of these months. They will make you a better overall clinician.

-copro

 

[Green912]

Just finished my MICU month and really enjoyed it but as my last weekend, 80hr week, and 30hr call day was coming to a close I was ready for a restful, cush month.

 

[VentdependenT]

starting SICU on Monday for a paltry 2 wks. any advice on how to prep?

http://forums.studentdoctor.net/showthread.php?t=199197

 

[Coastie]

For the interns: How many patients did you usually manage on the ICU service months, and what was the max you had?

For the residents: How does the ICU experience as a prelim intern in medicine/surg differ from the ICU experience (and expectations) of the attendings as a CA-1? I understand as a CA-2/3, you'll be the "senior", but many CA-1's don't even have ICU experience prior to their CA years..So, are you seen as an "advanced" intern? Additionally, how many patients do you manage as a CA-1?

 

[smgilles]

For the interns: How many patients did you usually manage on the ICU service months, and what was the max you had?

For the residents: How does the ICU experience as a prelim intern in medicine/surg differ from the ICU experience (and expectations) of the attendings as a CA-1? I understand as a CA-2/3, you'll be the "senior", but many CA-1's don't even have ICU experience prior to their CA years..So, are you seen as an "advanced" intern? Additionally, how many patients do you manage as a CA-1?

Typically I "managed" 5-7 patients with most 10-12 - this was in the MICU and CCU. Less in the PICU and more in the NICU. We have 2 interns per team and we split the patients for that day so the overall census would run 10 - 24.

 

[SexPanther]

For the interns: How many patients did you usually manage on the ICU service months, and what was the max you had?

For the residents: How does the ICU experience as a prelim intern in medicine/surg differ from the ICU experience (and expectations) of the attendings as a CA-1? I understand as a CA-2/3, you'll be the "senior", but many CA-1's don't even have ICU experience prior to their CA years..So, are you seen as an "advanced" intern? Additionally, how many patients do you manage as a CA-1?

At Vanderbilt in the MICU and SICU you are on call q3, so on those call days you typically managed ~12 patients in the MICU (there are 2 teams usually each with ~12 patients) and possibly more in the SICU. Non-call days are spent assisting with procedures, transfers, lectures etc. During our rotation in the neuro ICU we would typically follow 5-7 patients daily b/c the format was different. We split the patient's up in the a.m. and had some NP assistance for the less critical players about to be transferred out.

 

[Green912]

MICU Intern: during the day when everyone was there we capped at 6. During call nights we managed 18 plus new admits. Residents were always available for questions.

 

[OB1🤙]

In our very very very cush VA MICU rotation (almost our whole intern year is done at this VA), we average maybe 3-4 pts at a time, often have only 1-2, occasionally zero out, and very rarely have more than 5. Most of these people are in the MICU only because the floor nurses would kill them, not because they need to be in the unit. You'll have maybe one or two vented sick people at most. Enough to learn the vents on, but not enough to frazzle you. This is a Q4 month, and we're out on non-call days after rounds.

Needless to say, this rotation does not suck.

Some of us have to do a month or two at our big academic center, and they get their a$$es handed to them since the pts there are legitimately extremely critically ill. I won the lucky intern lottery and don't have to do any unit months there, praise Jah.

 

[173291]

Week one in SICU down. I must say that the experience has not been the nightmare that I envisioned. It is actually really cool and a I am learning a lot from the incredibly sick pts and the cool housestaff. I am definitely glad that I didn't punk out due to senioritis.

Cheers

 

[boratgas]

Get as many lines as you can, learn vents, pressors, and cardio/pulm monitoring. it will do you good next year. get the ICU book

Week one in SICU down. I must say that the experience has not been the nightmare that I envisioned. It is actually really cool and a I am learning a lot from the incredibly sick pts and the cool housestaff. I am definitely glad that I didn't punk out due to senioritis.

Cheers

 

[173291]

Get as many lines as you can, learn vents, pressors, and cardio/pulm monitoring. it will do you good next year. get the ICU book

Thanks