ICU advice for interns
Started by om207
I'd review some about management of hypotension, surviving sepsis, tachycardia, fever, hemodynamic monitoring, fluid management, basic vent management, pressors, and anti-hypertensives for some basics.
I wouldn't worry too much, attending and senior residents should know you are a newbie in the ICU. Nobody should leave you alone without help, especially if it's your first rotation. Don't be afraid to ask questions and also get ICU nurse input as they can be a great resource most of the time.
As far as books and other resources, I like the ICU Book for general overview. I also used Handbook of IM and critical care, your favorite PDA software (epocrates, etc), and online review source (pubmed, MD Consult, UpToDate). Online practice guidelines from specialty societies are also very good. Work hard and read about your patients and the rest of the year will be a piece of cake.
thanks so much! 👍
I found the ICU Book (by Paul Marino) online, but can you give me more details about Handbook of IM and critical care?
Is it this book? Pocket Medicine: The Massachusetts's General Hospital Handbook of Internal Medicine by Marc S. Sabatine
thanks again for your advice!
I found the ICU Book (by Paul Marino) online, but can you give me more details about Handbook of IM and critical care?
Is it this book? Pocket Medicine: The Massachusetts's General Hospital Handbook of Internal Medicine by Marc S. Sabatine
thanks again for your advice!
Here's the link on amazon.com:
http://www.amazon.com/Tarascon-Inte...=sr_1_1?ie=UTF8&s=books&qid=1212023020&sr=8-1
It's the Tarascon Internal Medicine & Critical Care Pocketbook. It's small and cheap, but doesn't go into great detail, but I liked it. Ask around, others might have different recommendations.
Towards the back of this book is a page titled ICU medications or something close. Worth copying and putting in your front coat pocket.
If your ICU uses standing order sheets (ex; glycemic control, sepsis protocol, vent management etc...) it would be worth while copying them and "studying" them before you start.
When things get hairy/weird have a low threshold to involve seniors. Spread around the knowledge (and risk).
Show up extra early on your first day. There's a lot to get familiar with.
You'll be replacing a lot of electrolytes: replace Ca++ based off of the ionized Ca not total.
Review blood gas calculations & differentials.
Can rarely go wrong with: Vt 500cc; freq 14; Fio2 100% and PEEP 5cmH20; ABG in 1hr.
be prepared for a higher mortality rate than other services you may have been on in the past. know that unfortunately for some patients, despite your best efforts, they still won't make it. as long as you come in every day and give your best effort, you shouldn't go home disappointed. all it takes is all you got.
Don't beat yourself up about people dying. To be honest in a lot of situations you begin to feel that these patients might be better passing. there will be sad cases but much of the ICU has patients who really would be better off dead.
Have your fellow or respiratory therapist go over vent's and all the settings, have them go over why they made certain changes according to the ABG.
Remember that when you leave the ICU you will never again see nursing care as good, ie your trust level won't be as high and just because you order it doesn't mean it'll get done like it does in the unit.
Try to be aggressive with procedures, lines, intubations, etc because this is where you'll get most of them.
Ask for help always, you always have your resident, fellow, and even staff (at least at my program they were available mostly). Like someone said misery loves company.
Remember that when you leave the ICU you will never again see nursing care as good, ie your trust level won't be as high and just because you order it doesn't mean it'll get done like it does in the unit.
Try to be aggressive with procedures, lines, intubations, etc because this is where you'll get most of them.
Ask for help always, you always have your resident, fellow, and even staff (at least at my program they were available mostly). Like someone said misery loves company.
