Critical Care

[wood]

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Does anyone know the extent to which anesthesiologists participate in intensive care at both MICU and SICU. Specifically do they handle things other than airway management?

 

[thegasman]

Does anyone know the extent to which anesthesiologists participate in intensive care at both MICU and SICU. Specifically do they handle things other than airway management?

Depending on your location yes. At my institution anesthesia and surgery co-direct the sicu. An anes attending will be on one week and a surgery the next. At some places anesthesia directs the units entirely. I think it is much more common for anesthesia to have a role in sicu vs. micu. In case you didn't know, there is a one year anesthesia critical care medicine fellowship to prepare residents for this.

 

[wood]

Depending on your location yes. At my institution anesthesia and surgery co-direct the sicu. An anes attending will be on one week and a surgery the next. At some places anesthesia directs the units entirely. I think it is much more common for anesthesia to have a role in sicu vs. micu. In case you didn't know, there is a one year anesthesia critical care medicine fellowship to prepare residents for this.

Thanks for the input. I am aware of the fellowship in CC, I just wasn't sure if even this qualified one for general medical care, such as wound and infection management, full body physical exam, etc. Also, in terms of cart calls/codes it seems that the anesthesiologist is actually best equipped to deal with these emergencies based on training. Is this true and who handles these?
Again, thanks for the info.

 

[Skip Intro]

... full body physical exam...

You better be qualified for a full-body PE!!! You are a doctor, after all. That is a core competency for any physician. Don't think you won't be doing physicals as a gas man? I've got two words for you: pre-op evaluation.

Never forget, as an anesthesiologist, you're a doctor first and foremost. A monkey can pass gas with enough training. You make the big bucks for your medical judgment and the responsibility that comes with that.

-Skip

 

[trapper john]

The ABA is going to require as of 2008, that all anesthesiology residency programs include six months of critical care in the training. That's half a fellowship! My PD being a really gung ho type is already working to implement this, and stuck me with two extra months in my senior year.

 

[nitecap]

its ashamed

 

[Tenesma]

wood.... i have a feeling you haven't worked in a hospital yet, so therefore i am going to go easy on you 🙂

anesthesia in the ICU provides ALL critical care coverage: which includes the critical management of ALL issues from Neuro (traumatic brain injury, stroke, hemorrhage, ICP probs), Cardiac (MI, CHF, cardiogenic shock, Arrhythmias), Pulmonary (PE, ARDS, BOOP, pneumonia, etc.), GI (variceal bleeds, etc...), RENAL (ARF, starting/running CVVH, etc..), Infectious (sepsis, antibiotic management, etc.), Nutrition (TPN).... managing post-operative patients, intubating, performing bronchoscopies, some depts do bedside percutaneous tracheostomies, stabilizing patients pre-op (thoraco-abd. aneurysm contained ruptures, etc.)...

so anesthesia does all surgical ICU management if necessary, and some hospital SICUs are Closed-Unit Anesthesia run (ie: MGH).

 

[wood]

Thanks you both for the great info. You are right in that I have yet to work in a hospital. I love the idea of multi-dimensional critical care. Actually, you guys told me what I wanted to hear. I just wasn't sure of where the parameters were for the care continuum.

 

[asdash]

But how many anesthesia-run SICUs are there in community hospitals? Pretty low percentage, no?

I ask because I'm wondering: if I do a critical care fellowship after an anesthesiology residency, am I going to have to stay at an academic center after completing fellowship in order to do critical care? I think a schedule of, say, three weeks in the OR and one week in the SICU or a similar mix would be great, but I don't know if it's feasible or being done outside of academia.

I guess what I'm asking here is, how employable are anesthesiologist-intensivists in the private practice world? Are new trainees just waltzing into community hospitals and taking over the reins and "closing" units? I'd hate to do a year-long fellowship and then not be able to use those skills.

This is coming from an MS3 so I apologize in advance for any extreme naivete.

wood.... i have a feeling you haven't worked in a hospital yet, so therefore i am going to go easy on you 🙂

anesthesia in the ICU provides ALL critical care coverage: which includes the critical management of ALL issues from Neuro (traumatic brain injury, stroke, hemorrhage, ICP probs), Cardiac (MI, CHF, cardiogenic shock, Arrhythmias), Pulmonary (PE, ARDS, BOOP, pneumonia, etc.), GI (variceal bleeds, etc...), RENAL (ARF, starting/running CVVH, etc..), Infectious (sepsis, antibiotic management, etc.), Nutrition (TPN).... managing post-operative patients, intubating, performing bronchoscopies, some depts do bedside percutaneous tracheostomies, stabilizing patients pre-op (thoraco-abd. aneurysm contained ruptures, etc.)...

so anesthesia does all surgical ICU management if necessary, and some hospital SICUs are Closed-Unit Anesthesia run (ie: MGH).

 

[Tenesma]

very few anesthesiologists are interested in doing full time intensive care, primarily because of the income they can make in the OR.... so in private practice most groups have a group of ICU-fellowship trained anesthesiologists provide SICU coverage 24/7. Those anesthesiologists alternate ICU responsibilites, ie: they do 1 week of ICU and 3 weeks of OR, or 2 weeks of ICU and 2 weeks of OR.

Anesthesia-Intensivists are hired to provide SICU coverage (especially since the Leapfrog study), so jobs are definitely available.... in general new grads don't walk into a hospital and transform their ICU, but rather they join the group set-up i mentioned up above....

the reason why you don't see too many anesthesia-intensivists is primarily because of the salary differential between ICU and OR (leaning heavily towards OR)....

 

[Idiopathic]

Don't think you won't be doing physicals as a gas man? I've got two words for you: pre-op evaluation.

Riiiiiigght...havent seen an anesthesia attending ever do a physical exam during pre-op eval. Asking questions, yes...taking history, yes...looking at labs, yes...physical exam, no.

 

[Tenesma]

Rigghhhhtttt.... And I am going to take an MS3s exposure to anesthesiologists doing physical exams (especially in the ICU setting) seriously.... No offense idiopathic, but you have a tendency to post (a LOT) on a variety topics where I find it hard to believe that you have any depth of knowledge.

physical exams pre-op include: airway assessment, assessment of neck mobility, lung and cardiac auscultation, more if necessary...

physical exams daily in the ICU: complete head-to-toe assessment.

physicial exams daily in the Pain clinic: complete neuro exam (at least for new patient exam)