Jun 13, 2017
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I'm in love with critical care.
I want to do ICU for life.

I did two pulmonary rotations so far during residency and it's really not for me except for procedures. I can't stand the clinic. I don't want to spend most of my time on floors teaching hospitalists and cardiologists alike how to diurese their patients.

If I do pure critical care fellowship (2 years),

Can I do my own diagnostic bronchoscopies in ICU (BAL and mucus suction)? (I understand biopsies and other interventions need a pulmonologist).

Can I do my own thoracentesis?

Do I need to consult pulmonary for ventilator management? (Absurd question but I've seen in it!).

What other instances I'll need to consult pulmonary?
 

chocomorsel

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I would think as an intensivists, if you have the skills and get the privileges you should do it all.
I plan on doing it all and getting privileges to do it all. What I don't know, I will pass on to the specialists.
I guess some hospitals may prevent you from doing it all though. Stay away from those hospitals.
 
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Oct 11, 2016
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Like you, I debated between doing a 2 year CCM vs a 3 year program that included pulmonary. I ended up choosing not to do pulmonary and do not regret my choice. Here is a Critical Care Medicine privilege list from my previous institution, perhaps this might help:

Performance of history and physical exam
Airway maintenance intubation, including fiberoptic bronchoscopy and laryngoscopy
Arterial puncture and cannulation
Calculation of oxygen content, intrapulmonary shunt, and alveolar arterial gradients
Cardiac output determinations by thermodilution and other techniques
Cardiopulmonary resuscitation
Temporary cardiac pacemaker insertion and application
Cardioversion and defibrillation
Echocardiography and electrocardiography interpretation
Evaluation of oliguria
Insertion of central venous, arterial, and pulmonary artery balloon flotation catheters
Insertion of hemodialysis and peritoneal dialysis catheters
Interpretation of intracranial pressure monitoring
Lumbar puncture
Management of anaphylaxis and acute allergic reactions
Management of critical illness in pregnancy
Management of life-threatening disorders in intensive care units, including but not limited to shock, coma, heart failure, trauma, respiratory arrest, drug overdoses, massive bleeding, diabetic acidosis, and kidney failure
Management of massive transfusions
Management of the immunosuppressed patient
Monitoring and assessment of metabolism and nutrition
Needle and tube thoracostomy
Paracentesis
Percutaneous needle aspiration of palpable masses
Percutaneous tracheostomy/cricothyrotomy tube placement
Pericardiocentesis
Peritoneal dialysis
Peritoneal lavage
Preliminary interpretation of imaging studies
Thoracentesis
Tracheostomy
Transtracheal catheterization
Image-guided procedures
 
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Hernandez

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I would think as an intensivists, if you have the skills and get the privileges you should do it all.
I plan on doing it all and getting privileges to do it all. What I don't know, I will pass on to the specialists.
I guess some hospitals may prevent you from doing it all though. Stay away from those hospitals.
I think your last sentence is very important. I had looked at a place for CC only and I'm pulm-cc. They were telling me that I'd be required to consult their pulm for vents and I'd have no bronch privileges. No thank you. That is likely an indication of significant hospital politics
 

TimesNewRoman

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I think your last sentence is very important. I had looked at a place for CC only and I'm pulm-cc. They were telling me that I'd be required to consult their pulm for vents and I'd have no bronch privileges. No thank you. That is likely an indication of significant hospital politics
Hahahahahagavahahahahavahahaha.
 
Jun 13, 2017
23
28
21
Status
Resident [Any Field]
Like you, I debated between doing a 2 year CCM vs a 3 year program that included pulmonary. I ended up choosing not to do pulmonary and do not regret my choice. Here is a Critical Care Medicine privilege list from my previous institution, perhaps this might help:

Performance of history and physical exam
Airway maintenance intubation, including fiberoptic bronchoscopy and laryngoscopy
Arterial puncture and cannulation
Calculation of oxygen content, intrapulmonary shunt, and alveolar arterial gradients
Cardiac output determinations by thermodilution and other techniques
Cardiopulmonary resuscitation
Temporary cardiac pacemaker insertion and application
Cardioversion and defibrillation
Echocardiography and electrocardiography interpretation
Evaluation of oliguria
Insertion of central venous, arterial, and pulmonary artery balloon flotation catheters
Insertion of hemodialysis and peritoneal dialysis catheters
Interpretation of intracranial pressure monitoring
Lumbar puncture
Management of anaphylaxis and acute allergic reactions
Management of critical illness in pregnancy
Management of life-threatening disorders in intensive care units, including but not limited to shock, coma, heart failure, trauma, respiratory arrest, drug overdoses, massive bleeding, diabetic acidosis, and kidney failure
Management of massive transfusions
Management of the immunosuppressed patient
Monitoring and assessment of metabolism and nutrition
Needle and tube thoracostomy
Paracentesis
Percutaneous needle aspiration of palpable masses
Percutaneous tracheostomy/cricothyrotomy tube placement
Pericardiocentesis
Peritoneal dialysis
Peritoneal lavage
Preliminary interpretation of imaging studies
Thoracentesis
Tracheostomy
Transtracheal catheterization
Image-guided procedures
This is amazing!

May I ask where did you do your training if you don't mind?

I have a friend who's doing her CC training in NY in a procedures heavy program and I think her procedures list is similar to yours.
 
Jun 13, 2017
23
28
21
Status
Resident [Any Field]
I think your last sentence is very important. I had looked at a place for CC only and I'm pulm-cc. They were telling me that I'd be required to consult their pulm for vents and I'd have no bronch privileges. No thank you. That is likely an indication of significant hospital politics
I train at such hospital and it's as absurd as you can imagine.
 
Oct 11, 2016
353
308
81
Status
Attending Physician
This is amazing!

May I ask where did you do your training if you don't mind?

I have a friend who's doing her CC training in NY in a procedures heavy program and I think her procedures list is similar to yours.
I did not do my fellowship in NY.

That isn't necessarily a procedure list - it is a list of basic privileges all CCM attendings were given at my previous institution. All were trained at different places so you don't necessarily have to be trained at a procedure heavy fellowship program. I shared it to give you a general idea but as mentioned, every hospital is slightly different when it comes to credentialing.

I have yet to encounter a gig that mandates a consult to pulmonary for vented patients - sounds like a good way to increase consult revenue for the local pulmonary group though. Could do it for every organ system: mandatory consult to neurology for encephalopathy, cards for A Fib, anesthesia for intubation and sedation, nephrology for AKI, GI for ileus, ID for antibiotics, endocrine for diabetes. What a joke.
 
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Jun 13, 2017
23
28
21
Status
Resident [Any Field]
I did not do my fellowship in NY.

That isn't necessarily a procedure list - it is a list of basic privileges all CCM attendings were given at my previous institution. All were trained at different places so you don't necessarily have to be trained at a procedure heavy fellowship program. I shared it to give you a general idea but as mentioned, every hospital is slightly different when it comes to credentialing.

I have yet to encounter a gig that mandates a consult to pulmonary for vented patients - sounds like a good way to increase consult revenue for the local pulmonary group though. Could do it for every organ system: mandatory consult to neurology for encephalopathy, cards for A Fib, anesthesia for intubation and sedation, nephrology for AKI, GI for ileus, ID for antibiotics, endocrine for diabetes. What a joke.
Thanks again for for the clarification.
This makes me feel much better and more confident about going to CC only.