5+ Year Member
Dec 15, 2012
Resident [Any Field]
I am currently doing my ICU rotation. I am only about 2 weeks in but I feel really incompetent. The ICU patients are all extremely complicated with multiple co-morbidities (divided into cardiothoracic, trauma and general medical ICU). I try to read about everything that I come across on UpToDate and in books but I don't feel confident about my knowledge base or making decisions. I don't expect to know everything about taking care of critically ill patients but just wondering do the pros have any advice about what topics I should know like the back of my hand?

Most of the consultants say I should start to get the hang of things by 6 weeks :/


10+ Year Member
15+ Year Member
Oct 15, 2001
Attending Physician
Just keep reading, showing up, and asking a good question here and there. Like all of medicine, it'll come with time and curiosity.


SDN Donor
15+ Year Member
Dec 30, 2002
Ann Arbor
Attending Physician

The ICU can be pretty overwhelming at first; take a step back and remember that they are some of the sickest patients in the hospital. Generally, if they weren't very sick and complex, they wouldn't need to be in the ICU.

To start, no one should expect you to know everything - hell, the more critical care you see, the more you'll realize how little anyone really knows critical illness. But to get things going:
1) Analyze every patient by system, everytime. You may be able to stop doing this as you get better & more experienced, but even if someone is admitted (for whatever reason) to your ICU with an issue on their little toe, you should still think about their neuro/CV/pulm/GI/renal/heme/nutrition/MSK statuses. This will help you organize your thoughts, your notes, your plans, and help cover the comorbid issues that may complicate the picture.

2) Much of ICU care is protocolized, with varying levels of benefit. But finding those protocols (which have different names in different places - where I am now calls them "bundles") will help explain a lot of what is going on.

3) Common things are common. Make a note card for each of the most frequent 5 diagnoses you see, and for each of the most frequent 5 signs/symptoms you see. Get to know those cold.

4) Be present. Easy to say, harder to do. Check


7+ Year Member
Nov 16, 2009
Attending Physician
Find a copy of the Washington manual for critical care....it helped me a lot. Covers like 80 topics