ICU Rotation

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La Fiera

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Im starting an icu rotation on monday and am a little nervous about how to be prepared for it. Does anyone have any ideas, or can suggest any good references to take a look at?
Thanks!
 
I really liked Marino's The ICU Book. It's not something you can carry in your pocket, but has a lot of clearly written, useful information.
 
shock, inotropes, DKA, managing ICP, vents, resuscitation 👍
 
I was a bit nervous too prior to starting my ICU rotation, but after a couple days you catch on. It was a great experience. In addition to learning about mechanical ventilation, pulmonary artery catheters, CVVH, and pressors; you'll also most likely get a chance to get a lot of fresh sticks. I got to do numerous radial arterial lines, a few internal jugular catheters (including huge quinton catheters), a couple femoral sticks, numerous line changes, and an intubation for impending respiratory failure. Most ICU's here are run by both pulmonology/critical care docs and anesthesiologists. They were great about getting the students involved in learning about the indications for procedures and actually getting to do them.

Rounding is a bit different in the ICU, as are progress notes. The notes are usually done by organ system instead of the SOAP format. You can probably find some examples online, but the general subjective flow is neuro, pulm, cardio, fen, heme/id, gi/gu, icu (lines, prophylaxis, etc). Then an assessment followed by a problem list that is again systems based but more focused: i.e. AMS, ARDS, CHF, ARF, etc. A lot more data to collect when prerounding and this method really works well.

I'm not sure where you are doing you ICU rotation but here there is A LOT of talk about evidence-based medicine including ARDSnet protocol, sepsis algorhythms, transfusion requirements, insulin control, etc. If you are really itching for some good papers give me a PM and include your email address and I'll send some salient papers that are often talked about on rounds. There is also a great textbook to check out from your school library (if they carry it) and it is called Chest Medicine. The main authors are the Mathay brothers and Dr. Light (Light's Criteria). Great book that really explains a lot of the respiratory issues you are faced with in critical medicine. Don't worry too much. Most ICU doc's clearly remember that someone's first experience in the ICU can be overwhelming. I wouldn't worry about trying to look incredibly prepared. Just show up and work hard. You will learn a ton.

Have fun!
 
La Fiera said:
Im starting an icu rotation on monday and am a little nervous about how to be prepared for it. Does anyone have any ideas, or can suggest any good references to take a look at?
Thanks!

Hi there,
Pick up a copy of ICU Recall by Tribble or Critical Care Pocketbook. Both are pretty cheap and both will fit in your pocket. The Marino book is dull reading and very dated. ICU Recall can get you up to speed in a flash and is good for a quick brush-up while you are standing around.

For more detailed readings, Intensive Care Medicine by Rippe is about the best. This can be in one or two volumes complete with detailed illustrations.

njbmd 🙂
 
njbmd said:
Hi there,
Pick up a copy of ICU Recall by Tribble or Critical Care Pocketbook. Both are pretty cheap and both will fit in your pocket. The Marino book is dull reading and very dated. ICU Recall can get you up to speed in a flash and is good for a quick brush-up while you are standing around.

For more detailed readings, Intensive Care Medicine by Rippe is about the best. This can be in one or two volumes complete with detailed illustrations.

njbmd 🙂

Hey,
Agreed njbmd, and La Fierra, I saw both ICU Recall and Critical Care Pocketbook in new:

http://cgi.ebay.com/ws/eBayISAPI.dll?ViewItem&item=6988714229&rd=1&sspagename=STRK:MESE:IT&rd=1

Good luck--we are only at the beginning; we forget that we really aren't to be expected to know everything. Yet! :laugh:
 
I'd focus on vent settings, pressors, hemodialysis, ABX. You know, the multi-system organ failure stuff. 🙂
 
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