Rising PGY-2. How to prepare for the PICU?

[Forven]

Hey there.

I am really looking forward to working in the PICU as a PL-2. Would like some advice on some topics to brush up on and sources for pre-reading. Not looking for anything too in-depth, just broad overview of PICU topics.

Thanks in advance.

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[Stitch]

A relatively easy read is West's Respiratory Physiology. Very relevant to the PICU. It's also probably worth going over the surviving sepsis guidelines: http://download.springer.com/static...e46aadf033343b44f0c6c5a89fc15784385d237e3c785 . More importantly, just try and break things down into simple terms. Cardiac output is just heart rate x stroke volume, so any intervention aimed at improving cardiac output must augment or optimize those things. Focus on understanding why certain things are done; that's way more important than knowing the right pressor.

 

[BigRedBeta]

Hey there.

I am really looking forward to working in the PICU as a PL-2. Would like some advice on some topics to brush up on and sources for pre-reading. Not looking for anything too in-depth, just broad overview of PICU topics.

Thanks in advance.

Topics to consider (by system - by no means comprehensive or a minimum level):

Resp:
Vent Management
Other ways to support resp distress (high flow, CPAP, BiPAP)
Status Asthmaticus
ARDS
Pulmonary compliance curves

Cardiac:
Calculations that go into cardiac output, and how kids are different than adults
Heart failure in broad sense
Vasopressors - mechanisms of action, indications

Neuro:
Refractory Status Epilepticus
Traumatic brain injury
Increased ICP
Neuroprotective measures and the reasoning behind them
Stroke
Sedation strategies and meds

FEN/GI
Acute GI Bleed
Severe hypernatremia/hyponatremia management
Organ transplants if your center does them
SIADH

Renal
Hypertensive emergency
Dialysis modes (HD, PD, CRRT)

Endo
Severe DKA and it's complications

Genetics/Metabolism
management of critical illness in patient with inborn errors of metabolism

Heme/Onc
Tumor Lysis syndrome
Acute Chest Syndrome management

ID
Identification of sepsis/severe sepsis/septic shock and proper management


Again, this is by no means comprehensive, but should be a good place to start.

 

[Forven]

This was very helpful, thanks!

Topics to consider (by system - by no means comprehensive or a minimum level):

Resp:
Vent Management
Other ways to support resp distress (high flow, CPAP, BiPAP)
Status Asthmaticus
ARDS
Pulmonary compliance curves

Cardiac:
Calculations that go into cardiac output, and how kids are different than adults
Heart failure in broad sense
Vasopressors - mechanisms of action, indications

Neuro:
Refractory Status Epilepticus
Traumatic brain injury
Increased ICP
Neuroprotective measures and the reasoning behind them
Stroke
Sedation strategies and meds

FEN/GI
Acute GI Bleed
Severe hypernatremia/hyponatremia management
Organ transplants if your center does them
SIADH

Renal
Hypertensive emergency
Dialysis modes (HD, PD, CRRT)

Endo
Severe DKA and it's complications

Genetics/Metabolism
management of critical illness in patient with inborn errors of metabolism

Heme/Onc
Tumor Lysis syndrome
Acute Chest Syndrome management

ID
Identification of sepsis/severe sepsis/septic shock and proper management


Again, this is by no means comprehensive, but should be a good place to start.

 

[bjackrian]

A relatively easy read is West's Respiratory Physiology. Very relevant to the PICU. It's also probably worth going over the surviving sepsis guidelines: http://download.springer.com/static/pdf/847/art%3A10.1007%2Fs00134-012-2769-8.pdf?originUrl=http://link.springer.com/article/10.1007/s00134-012-2769-8&token2=exp=1435234870~acl=/static/pdf/847/art%253A10.1007%252Fs00134-012-2769-8.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs00134-012-2769-8*~hmac=3b2a2e97402637ea44ce46aadf033343b44f0c6c5a89fc15784385d237e3c785 . More importantly, just try and break things down into simple terms. Cardiac output is just heart rate x stroke volume, so any intervention aimed at improving cardiac output must augment or optimize those things. Focus on understanding why certain things are done; that's way more important than knowing the right pressor.

I agree with Stitch. If I were going to pick one quick book I'd pick West Respiratory Physiology. He also has a good and short book on ventilator management that I like and many of my residents have found helpful. I'd also suggest it's a good time to review your PALS algorithms, not because you're going to be running codes (at least not at any of the hospitals where I trained), but you may be in the room doing compression or bagging a patient and it helps you keep oriented to what else is going on in the room during that time. That'll help you get more out of it than just being grunt labor! Two of the hospitals I've worked at also have PICU mini-books that give a good overview of what that PICU thinks is important and may show some of the local practice variation in your unit. If your hospital does this, it would be worth asking for in advance.

Good luck and enjoy the rotation!