yesterdy I had one of the most difficul nights so far. stuck in the icu alone, responsible for 15 paients. I had never been in the icu before, but i was put on ICU call for the night. Did not know any of the patients before. in the morning i had a lot of info. missing and i had not managed to see all the patients.
can you please share your experiences in the icu. I feel like i am completely unorganized, but also would have appreciated some help from my seniors who smoked me in sign out. I had to take all ABGs, update all labs and info send labs to the lab, write am notes. it was crazy. I do not want to complain but i feel like should not have been left alone and i am scared for my next icu call. please share your experiences and suggestions
Hi there,
I did SICU as an intern and had one of the best experiences of my residency. I was one of three residents who did a 24-hour shift every third night. My fellow residents were both CA-2 anesthesia residents. They helped me with lines, with patient admissions and with changing and placement of lines. They were just the best.
You were always post call, on call or pre-call. After morning report, the post-call person went home, the on-call person did orders and the pre-call person helped with lines/procedures/discharges. After the administrative work was complete, the pre-call person could leave the hospital (around 10AM). The on-call person finished the day and wrote the early morning notes before rounds and morning report. We had a total of 16 patients to round and get morning notes done on before 6AM (took about 2 hours if you kept up during the previous shift). You can write your notes as you go along and fill in the AM and PM labs when they come in. I never waited until the early morning to start my notes.
One of the best things that I learned is: You receive the sign-out that you allow the person signing out to give you. If you are getting a lousy sign-out, ask the questions that you need to know. We had a great sign-out sheet that was filled in during the day and kept with the on-call resident in the sign-out book along with a H & P and lab reports. The on-call resident could consult the previous signout sheets and have a quick idea of what was going on with the patient if an attending came by to round or for report.
Don't let anyone give you a lousy sign-out. You might get labeled as a "bastard" but you will get the information that you need and the patients will do better because you are more informed. People who are signing out to you are NOT doing you a favor but providing care for their patients. Don't let them get away with poor care.
In reverse, don't give a lousy sign-out. I always try to anticipate what my patients might need and tell the on-call person. For example, "Mrs. Jones might drop her potassium because I gave lasix so I have ordered a set of lytes at 6pm. Can you check them and replace as needed?" After all, they are covering for me until I get back and I want my patients to do well. The more info the on-call person has, the better for the patients.
Covering ICU as an intern can be a great learning experience or it can be awful with the constant fear that you will miss something or "screw-up". If you are overwhelmed, ask for help and keep asking. Also, don't forget that the ICU nurses can be an invaluable resouce too. They spend more time at the bedside and can help you with the nuances of each patient. The more everyone communicates, the better for the patients.
Try to enjoy this experience and do as many procedures as possible. I always remember my first central line and my first perc trach. These are just great. Also, remember that you are an intern and your learning curve is steep. Even if you believe you might look stupid, ask questions and get the information that you need to know. Everyone of us went through the same things that you are going through. You are going to be fine.
njbmd
🙂
