ICU presentations

[AmoryBlaine]

So I did an SICU rotation back towards the end of the year and I saw my copy of Marino sitting on my nightstand. Memories came flooding back.

Usually we presented patients like this:
24 hour events/8hr/subjective/vitals/vent/labs/radiology/exam/micro
then A/P by system

But there was a visiting IM fellow who condescendingly told me I was doing it all wrong and that a "formal" ICU presentation went like this:
Neuro: subjective pain, meds, BP/HR, plan
Pulm: RR, sats, Vent/Abg, exam, plan
CV: BP/HR, meds, H/H, exam, plan
etc etc

I'm sure that this is mostly just attending preference but for the residents/attendings in the room what do you consider to be a "formal" ICU presentation.

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[ditch doctor]

So I did an SICU rotation back towards the end of the year and I saw my copy of Marino sitting on my nightstand. Memories came flooding back.

Usually we presented patients like this:
24 hour events/8hr/subjective/vitals/vent/labs/radiology/exam/micro
then A/P by system

But there was a visiting IM fellow who condescendingly told me I was doing it all wrong and that a "formal" ICU presentation went like this:
Neuro: subjective pain, meds, BP/HR, plan
Pulm: RR, sats, Vent/Abg, exam, plan
CV: BP/HR, meds, H/H, exam, plan
etc etc

I'm sure that this is mostly just attending preference but for the residents/attendings in the room what do you consider to be a "formal" ICU presentation.

We did ours the second way; in both the SICU and MICU. If the staff was unfamiliar with the patient we would add an HPI/PMHx at the top.

 

[southerndoc]

We provided a brief history "This is the 36 year old gentleman with HIV who was admitted with respiratory failure secondary to PCP pneumonia" and then would add 24 hour events.

We then presented vital signs (and noted the use of any pressors at this point), physical exam (pertinent), laboratory data, and diagnostic imaging that was done or is still pending.

We then reviewed the current treatment and any plan changes during a lengthy systems-based approach.

The interns and residents have a template that is used for documentation and presentation. It definitely makes things easier, and you present the information that the attendings and fellows want when you use that template.

 

[zinjanthropus]

We do ours the second way with a caveat. Every system has to start with a diagnosis followed by status, followed by plan (I kinda like it actually and it's apparently easier for billing).

e.g.
Neuro: TBI with elevated ICP. Continue to monitor and consider d/c of transducer.
Resp: Respiratory Failure. Pt on SIMV + PS. Stable at this time.

etc.....

 

[overthebars]

We do ours the second way with a caveat. Every system has to start with a diagnosis followed by status, followed by plan (I kinda like it actually and it's apparently easier for billing).

e.g.
Neuro: TBI with elevated ICP. Continue to monitor and consider d/c of transducer.
Resp: Respiratory Failure. Pt on SIMV + PS. Stable at this time.

etc.....

Seen it done both ways depending on the attending. One is definitely more tolerable when rounding for >4hrs, but not as systematic.

 

[EM_Rebuilder]

Theres more than one way to skin a cat...


I prefer a slit near the neck, place a golf ball just under the skin. Tie a good rope from that to the back of the four wheeler, and a good noose around the neck to a hearty oak tree. Make sure the camera is on, then nail it... watch the skin come off all the way to the tip of the tail.

I havent tried it yet, but anxious to.

 

[roja]

What EMrebuilder said

 

[EM OR BUST]

to.

Thats just wrong very wrong!