Any residents still reading textbooks?

[teacher2md]

I’ll second Marik’s Evidence-Based Critical Care. It’s a well-referenced book that challenges a lot of the dogma that you hear repeated in the ICUs and the ORs.

It’s not really a comprehensive text that I would use to look something up, but definitely a great read.

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[deleted171991]

Marino is a fantastic book with a ton of personality that I think really helps with retention. I start a CCM fellowship in August. I'd not heard of Evidence Based Critical Care before today. Is it worth the buy? Any other suggestions for reading material? A buddy of mine is a medicine CCM fellow now, and he suggested the MGH Review of Critical Care and the Washington Manual of Critical Care.

The Washingon Manual of CC is a joke (just a bunch of algorithms). Kind of makes me wonder how good your buddy is.

Marik's Evidence-Based Critical Care is fantastic (and imperfect, but still one of the best ICU books). It's Marino on steroids. It's expensive (for the size), so try to borrow it first (or download it for free, if your institution has Springerlink).

If you can get yourself a used version of the Civetta Manual (way better than the full textbook), you probably won't regret it. Shouldn't cost you more than $20. It's a slightly older big book. Use Look Inside to get an idea of its learning- and SICU-oriented contents.

 

[deleted162650]

Apology in advance for the derail, but speaking of Marik: Whatever happened to his steroid/vitamin C sepsis thing?? That ever hold up, or just end up being a bunch of voodoo?

 

[psychbender]

Marino is a fantastic book with a ton of personality that I think really helps with retention. I start a CCM fellowship in August. I'd not heard of Evidence Based Critical Care before today. Is it worth the buy? Any other suggestions for reading material? A buddy of mine is a medicine CCM fellow now, and he suggested the MGH Review of Critical Care and the Washington Manual of Critical Care.



Agreed. My residency buys all the residents Big Miller at the beginning of CA1 year. I estimate that I've read about 20% of it over the past 2.5 years similarly to how you describe. For example, I would read the chapters on obstetrics, neuraxial, and local anesthetics during an OB rotation.

Get Marik's text, and really read though it (at the very least, read his handbook). I also like Vincent's Textbook of Critical Care, but Washington manual is really meh. Additionally, I thought that listening to the SCCM board review lectures on demand during fellowship was helpful, along with Chest SEEK questions on my phone during downtime.

 

[deleted171991]

Apology in advance for the derail, but speaking of Marik: Whatever happened to his steroid/vitamin C sepsis thing?? That ever hold up, or just end up being a bunch of voodoo?

Hasn't been proven wrong yet. Neither has it been proven right.

 

[anbuitachi]

Apology in advance for the derail, but speaking of Marik: Whatever happened to his steroid/vitamin C sepsis thing?? That ever hold up, or just end up being a bunch of voodoo?

i think vitamin D is the answer to sepsis

 

[deleted171991]

i think vitamin D is the answer to sepsis

Vitamin D deficiency decreases immunity and worsens ICU infections, so you are wiser than you seem.

 

[anbuitachi]

Vitamin D deficiency decreases immunity and worsens ICU infections, so you are wiser than you seem.

yea how often do ICu patients get vitamin D supplements?? they dont get much sunshine

 

[deleted171991]

yea how often do ICu patients get vitamin D supplements?? they dont get much sunshine

They usually don't. Probably because it's not clear which vitamin D metabolite to measure, what threshold to use for treatment, and because D hypervitaminosis is a possibility. Accordingly, the studies about vitamin D supplementation have been conflicting.

 

[BLADEMDA]

Here is my 2 cents. Knowledge is extremely important. When you are a resident try to learn as much as possible. Since your experiences are limited the knowledge you acquire (or don't acquire) can make a big difference in tough clinical situations. As your experience grows with cases and complications (yours or your associates) they will make you a better practitioner. Everything that happens in your practice or practices nearby is a learning experience what NOT to do (most of the time it's what went wrong).

Safety is priority one and that is why you are head of the team when the sh.t hits the fan. This is a truly humbling specialty in that the longer you practice the more you know/have seen the things that can go very wrong/badly in the O.R. or PACU. I always cringe when the newly minted attendings dismiss the risks of the daily process of anesthetizing a dozen or more ASA 3 and ASA 4 patients. These patients are just a day, a month or a year away from perhaps the end of their life. My goal is to make sure that day isn't with me.

Knowledge is essential to the daily practice of Anesthesiology as is experience. But, it is wisdom acquired through experience and knowledge that will make you into a superstar attending.

I concur that reading review articles, basic science, etc after doing a case as a resident is great way to bolster retention.

This is a lifelong journey of reading and staying up on good practice. It only ends the day you decide to fully retire.

 

[deleted162650]

Hasn't been proven wrong yet. Neither has it been proven right.

You tried it? What are your thoughts?

 

[deleted162650]

o you are wiser than you seem.

Well that’s a relief.

 

[deleted171991]

You tried it? What are your thoughts?

No, I haven't. Septic shock is pretty rare in my SICU (and so are my SICU weeks). And I am sure I would have to educate some high-school level pharmacist first about vitamin C's lack of toxicity.

 

[Mman]

This is a truly humbling specialty in that the longer you practice the more you know/have seen the things that can go very wrong/badly in the O.R. or PACU. I always cringe when the newly minted attendings dismiss the risks of the daily process of anesthetizing a dozen or more ASA 3 and ASA 4 patients. These patients are just a day, a month or a year away from perhaps the end of their life. My goal is to make sure that day isn't with me.

100% agree.

Bad stuff happens. I don't care who you are. When patients are quoted that they are "low risk" for a procedure with maybe 1% chance of major periop morbidity/mortality or whatever, that means if you do it to 100 patients 1 of them will have a bad outcome. It doesn't matter how good you are.

 

[TXEMC344]

Apology in advance for the derail, but speaking of Marik: Whatever happened to his steroid/vitamin C sepsis thing?? That ever hold up, or just end up being a bunch of voodoo?

Was wondering this myself. Can't find much information online about how it's going.