holy crap i'm starting with SICU!

[fireflyrxn]

hi everyone

found out my intern schedule this year - starting in the SICU!!

any tips on how to survive?
any tips on good books? i know about Marino's ICU book, but he's coming out with a new one in late august (a little too late; and the amazon site has the wrong publication date on it).

many thanks!
ffrxn

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[Blade28]

Ouch! That sucks. Is that because you're homegrown (went to med school at the same program as your residency program)?

 

[Tater]

hi everyone

found out my intern schedule this year - starting in the SICU!!

any tips on how to survive?
any tips on good books? i know about Marino's ICU book, but he's coming out with a new one in late august (a little too late; and the amazon site has the wrong publication date on it).

many thanks!
ffrxn

Holy cow dude. I wish those guys would tell me anything. 🙄

I like Tarascon's (sp?) little green critical care book. Perhaps you could check out Marino from the library, just so you won't have to pay the money for the old edition. Are they setting up ACLS/ATLS for you?

I think one of the most important basic things to learn about SICU is efficient and complete gathering of information. Unfortunately, that means figuring out the "system".

 

[fireflyrxn]

Ouch! That sucks. Is that because you're homegrown (went to med school at the same program as your residency program)?

sadly, i'm anything but homegrown!

i don't even remember seeing the SICU on the tour

 

[ExtraCrispy]

Get the MGH Critical Care Handbook! It's small enough to fit in your coat pocket, and it has all the information you need. I actually think it's more user-friendly than Marino, but with just as much info.

Before you start, review vent settings and management, PA cath monitoring, acid/base disorders, fluids/electrolytes, and pressors.

Good luck!

 

[fireflyrxn]

Get the MGH Critical Care Handbook! It's small enough to fit in your coat pocket, and it has all the information you need. I actually think it's more user-friendly than Marino, but with just as much info.

Before you start, review vent settings and management, PA cath monitoring, acid/base disorders, fluids/electrolytes, and pressors.

Good luck!

Thanks! i acutally did order the MGH handbook today!

 

[ajimd]

Really....what a nightmare. It's quite the intro into a surg residency isn't it. I am dreading to find out my schedule. It'd be nice to start with a VA rotation or something less stressful...lumps & bumps...ha!

 

[Pilot Doc]

hi everyone

found out my intern schedule this year - starting in the SICU!!

any tips on how to survive?
any tips on good books? i know about Marino's ICU book, but he's coming out with a new one in late august (a little too late; and the amazon site has the wrong publication date on it).

many thanks!
ffrxn

IF your program is like mine, SICU is one of the easiest rotations to start as an intern. There is more structure, more nursing support and more attending support there than anywhere else is the hospital. The patients are sick, but the tools at your disposal more than compensate.

 

[fireflyrxn]

IF your program is like mine, SICU is one of the easiest rotations to start as an intern. There is more structure, more nursing support and more attending support there than anywhere else is the hospital. The patients are sick, but the tools at your disposal more than compensate.

I...um....don't even remember setting foot in the SICU during the tour while interviewing there!

I hope you're right 🙂

 

[Tater]

You know, I don't remember seeing it either...I'm sure I did though.

Here's a checklist I made for myself when I rotated on MICU and SICU this past year. Consider it more of a jumping off point than the final word, because it obviously has a lot of things that may not apply for every patient. It is also more for following patients over time moreso than the first admission.

I also listed the components of the weaning protocol off the top of my head, so you might want to double check those. And its missing a lot of measurements...(i.e. Swan-Ganz, ICP monitors, etc.)

Sorry about the rtf file, this computer only has WordPad.

 

[fireflyrxn]

awesome!
thanks!

 

[exlap]

More importantly than any book is knowing when to bump it up to higher levels.

As a July intern, no one expects you to know the knitty gritties of how your hospital works. Up until now, you've been learning abstract concepts and nothing about day-to-day patient management. Your seniors and your most valuable resource and would rather you ask them early on than to have to dig the patient and you out of a crisis situation.

You're very well protected in the SICU. You can try all you want to kill the patients there, but the ICU (nurses, PA's, respiratory techs, etc.) is a self-perpetuating machine. They can usually take care of the patients themselves without any physicians around. Be humble and ask them for advice and help if you need it. You're a team with them. If you're nice to them, they'll also let you sleep at night rather than wake you up for every stupid tylenol order.

 

[mysophobe]

Sucks. I don't really have any advice. I just finished the worst gallbladder of my life and needed something to ease away the suicidal thoughts.

 

[Blade28]

I don't have anything else to add either. But I just came back from doing four great breast cases at the local private hospital. Awesome!

 

[mysophobe]

Yeah, my buddy did breasts today. Bastards, both of you. I was promised a lumpectomy and a splenectomy tomorrow though.

 

[fireflyrxn]

Sucks. I don't really have any advice. I just finished the worst gallbladder of my life and needed something to ease away the suicidal thoughts.

that sucks.

even though you have no advice - you made me realize that i won't be operating at all in the first month!

 

[surg]

Starting on SICU can be great. Your seniors will often be around and available and you probably get more attending input than a lot of other services, particularly at the beginning of the year. Don't worry, your senior residents and the ICU nurses will be watching you to keep you from killing anyone actively, so long as you are willing to ask for help.

I like the handbook that the Duke residents write http://www.amazon.com/gp/product/0323011063/104-1293461-3124737?v=glance&n=283155
although I have heard good things about the MGH one too. (I have no affiliation with Amazon or get anything from that link, so once you know which book, click on the SDN referral link instead!)

You may get to do some procedures in the ICU. Most common operation is probably tracheostomy, although I've seen a number of bigger cases done in the ICU including a pancreatic debridement I had to do with an attending when I was an intern. Lots of other stuff worth doing: bronchs, EGD, colonoscopy, chest tubes, lines, intubations. All skills that will come in handy.

 

[Blade28]

Yeah, my buddy did breasts today. Bastards, both of you. I was promised a lumpectomy and a splenectomy tomorrow though.

Sweet cases!

 

[mysophobe]

Wow. The spleen was AWESOME. It looked perfectly healthy, but I guess ITP is an internal disease, so it wouldn't look too bad in the early stages. The whole case took 35 mins skin to skin. We have another one tomorrow. Go spleens!

The lumpectomy sucked. It turned into an axillary node dissection after the FS report came back positive. 🙁

 

[Samoa]

You're very well protected in the SICU. You can try all you want to kill the patients there, but the ICU (nurses, PA's, respiratory techs, etc.) is a self-perpetuating machine. They can usually take care of the patients themselves without any physicians around. Be humble and ask them for advice and help if you need it. You're a team with them. If you're nice to them, they'll also let you sleep at night rather than wake you up for every stupid tylenol order.

Speaking as a former ancillary staff person in SICU, I can vouch for this statement. All of it. They're all looking out for you, if you'll be nice and let them. And really, if the staff don't know what needs to be done for a patient, it's time to wake up your senior.

The only thing is, if you follow their advice, you do need to understand why it's the right thing to do. Because "the nurse suggested it" isn't going to fly if your attending asks why you did something (even if it was absolutely right). I'm sure you know that already. It's just that I've seen a number of interns severely chastised for this even when what they did was appropriate, so apparently some people do need to be warned.

 

[fireflyrxn]

The only thing is, if you follow their advice, you do need to understand why it's the right thing to do. Because "the nurse suggested it" isn't going to fly if your attending asks why you did something (even if it was absolutely right). I'm sure you know that already. It's just that I've seen a number of interns severely chastised for this even when what they did was appropriate, so apparently some people do need to be warned.

that's a great tip 🙂 thank you!

 

[FliteSurgn]

Wow. The spleen was AWESOME. It looked perfectly healthy, but I guess ITP is an internal disease, so it wouldn't look too bad in the early stages. The whole case took 35 mins skin to skin. We have another one tomorrow. Go spleens!

The lumpectomy sucked. It turned into an axillary node dissection after the FS report came back positive. 🙁

I sure hope you were doing the spleen laparoscopically. I do believe that the days of elective open splenectomies for benign disease are over. Once you go scope, you never go back.

 

[mysophobe]

No, it was open. From what I gather, the one tomorrow will be too. I was curious as to why it was done that way, but I forgot to ask.

 

[Blade28]

Wow. The spleen was AWESOME. It looked perfectly healthy, but I guess ITP is an internal disease, so it wouldn't look too bad in the early stages. The whole case took 35 mins skin to skin. We have another one tomorrow. Go spleens!

The lumpectomy sucked. It turned into an axillary node dissection after the FS report came back positive. 🙁

You're doing some good cases - aren't you graduating soon too? I wasn't working that hard in May of my fourth year. 🙂

 

[mysophobe]

Ha. I figured I'd much rather enjoy experiencing my future career than doing something else. If I wasn't here, I'd be thinking about being here. 🙂

 

[Blade28]

I was taking it easy in the second half of the year...I think this time last year I was just about to graduate.

Sounds like you're rearing to go...don't worry, internship is just around the corner!

 

[mysophobe]

Don't remind me. 😉

 

[Zummy]

Hi guys,

I just found out that I'm starting with neurosurgery. I've never rotated on neurosurg elective or anything... not sure what to expect. Which resource did you guys use for this rotation? Is this going to be one of my "easier" rotations as an intern?

Thanks!

Oh, and SICU isn't even on my schedule for the year. Is it unusual for a categorical GS to not even do SICU until 2nd year??

 

[Blade28]

If it's anything like neurosurg here, it's definitely NOT going to be easy.

And we don't do SICU until second year.

 

[Zummy]

If it's anything like neurosurg here, it's definitely NOT going to be easy.

And we don't do SICU until second year.

Oh great. Thanks, Blade What would you recommend I read before starting?
Thanks!

 

[Blade28]

I have no idea, since I didn't do neurosurg this year (my intern year). I would prepare for the ICU though - either the MGH or Duke guides are good. (That, along with Marino, of course.)

 

[supercut]

Speaking as a former ancillary staff person in SICU, I can vouch for this statement. All of it. They're all looking out for you, if you'll be nice and let them. And really, if the staff don't know what needs to be done for a patient, it's time to wake up your senior.

The only thing is, if you follow their advice, you do need to understand why it's the right thing to do. Because "the nurse suggested it" isn't going to fly if your attending asks why you did something (even if it was absolutely right). I'm sure you know that already. It's just that I've seen a number of interns severely chastised for this even when what they did was appropriate, so apparently some people do need to be warned.

Q: How many ICU nurses does it take to change a light bulb?
A: It's already been done, they just need the order.

I found that often the ICU almost ran on autopilot. There gerenally are lots of protocols, and the nurses are usually pretty experienced and know the protocols well. Just make sure that you understand why the protocols exist. Soon it will become routine (eg: protonix, insulin gtt and DVT prophliaxis for everyone!)

THe advantage of doing the SICU first is that you'll have some clue what to do on a subsequent rotation when a floor patient you're covering crumps on your shift. Every year, many interns start in the SICU and not only survive, but thrive. I'm sure you'll do fine.

 

[SouthSideSteve]

Q: How many ICU nurses does it take to change a light bulb?
A: It's already been done, they just need the order.

lol, thats so true.