PGY-1 MICU Rotation

[migraine12]

I will be starting my MICU rotation Aug. 1st as a PGY1. Any practical advice on what I should look over and know very well before starting on this rotation. Any advice on keeping track of patients, quick guides to carry in white coat, presenting a MICU patient during rounds, etc would be greatly appreciated. Basically just need to know how to make this month go as smoothly as possible while learning the most in terms of both patient management and procedural skills. Thanks.

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[VALSALVA]

I'm an MS-IV wrapping up the MICU now. Couple things I'd look over if I were you: Acid/Base (how to diagnose mixed stuff and how to use Winter's formula, correction formulas), Compliances (like lung, chest wall calculations), and lastly, know the criteria for SIRS, sepsis, shock. How do you treat shock? How do you choose what pressor to use? Stuff like that.

 

[tupac_don]

I will be starting my MICU rotation Aug. 1st as a PGY1. Any practical advice on what I should look over and know very well before starting on this rotation. Any advice on keeping track of patients, quick guides to carry in white coat, presenting a MICU patient during rounds, etc would be greatly appreciated. Basically just need to know how to make this month go as smoothly as possible while learning the most in terms of both patient management and procedural skills. Thanks.

Hey this is what I suggest:

1) Know how to do vents, you'll be doing a lot of that FiO2, PEEP
2) Have a good pocket book, Critical Care pharmacopeia, Critical care drug book, they are good little quick references
3) Know your pressors like another person said, and how to titrate them and how to wean pts off them
4) Also know Sepsis, you will have a lot of sepsis pts

Other than that keep your eyes and ears open, and absorb as much as you can.

 

[ariwax]

Hi,

I'm a PGY-1 in the ICU. The main thing I would focus on is being aware of all your patients' issues. Make yourself a two-sided turnover sheet with spaces to fill out CC, HPI, labs, problem list, and A/P by system. Then photocopy it 30 times. Fill it out every morning with all the new labs and A/P and walk around with the day's turnover on a clipboard. When issues come up, add them to the sheet. If you try and keep everything in your head, something will slip away inevitably. What were Patient X' I's and O's again? Was that Patient Y with the s/p STEMI, HTN, CAD and DM2 or is Patient Y the one with subdural bleed, HTN, ARF and SSS? Not to be confused with Patient Z who has HTN, CAD and ARF but no DM2... history of IVDA though. And everyone's on Levaquin, Vanco, Diflucan, Lovenox and Nexium. Carry six or eight patients and you'll see what I mean.

Know your vent settings and what they mean, because pulmonologists rule the ICU. (Forget the lung compliance crap though.) Be aware of renal dosing of things and how to do it. Know how to pronounce someone dead.

Your basic goal in the ICU (and during internship as a whole) is fix it so your senior only has to do the bare minimum and every patient gets what he needs - or at least yours do.

ariwax

 

[enfuegoEP]

Here's a pretty good resource I've been reading. I have the MICU in August.

http://www.anest.ufl.edu/ccm/hbkcritcare.pdf

 

[souljah1]

I'm a soon to be PGY3 who is planning on a career in pulmonary/critical care. What you need to know depends on what the level of expectations are during your rotation. For new interns, the most important areas to feel somewhat familiar with prior to your start in the MICU are:

1. Sepsis and its resuscitation -> fluids, initial pressor choice and when to initiate a 2nd, when to consider PRBC transfusions, when to consider dobutamine, when to consider steroids, when to consider activated protein C
2. Sepsis and its source -> how to investigate for sources, what to culture, what emperic coverage should you initiate, does your hospital have an antibiotic algorhythm or not, etc
3. Hypercarbic Respiratory Failure -> what are its causes, how do you treat it, RR and Vt and how to approach a vent, non-invasive ventilation choices
4. Hypoxic Respiratory Failure -> causes, approaches, non-invasive and invasive vent, role of PEEP and FiO2
5. Sedation and Analgesia in the ICU -> get a handle on what your ICU likes to use: propofol, versed, fentanyl, ativan, etc; daily interruption of sedation for spontaneous ventilation trials
6. Mechanical Ventilation: what are plateau pressures, peak pressures, auto-Peep, bucking the vent, etc
7. Decompensated Cirrhosis: severe encephalopathy, variceal bleeding, sbp, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary HTN
8. Fulminant Hepatic Failure: what's the differential, what initial labs should you send, what to watch for clinically
8. DIC - ddx and treatment
9. Prophylaxis: DVT, GI, Catheter related infections, Delirium, myopathy, etc

there's lots more. Personally, I think the ICU is a great place to start. You'll get your jitters out early and will be more comfortable with sick patients early in your intern year. It's a great place to practice a lot of internal medicine, without the pain of working your ass of to place someone. Have a great time!

 

[DOCTORSAIB]

I'm a soon to be PGY3 who is planning on a career in pulmonary/critical care. What you need to know depends on what the level of expectations are during your rotation. For new interns, the most important areas to feel somewhat familiar with prior to your start in the MICU are:

1. Sepsis and its resuscitation -> fluids, initial pressor choice and when to initiate a 2nd, when to consider PRBC transfusions, when to consider dobutamine, when to consider steroids, when to consider activated protein C
2. Sepsis and its source -> how to investigate for sources, what to culture, what emperic coverage should you initiate, does your hospital have an antibiotic algorhythm or not, etc
3. Hypercarbic Respiratory Failure -> what are its causes, how do you treat it, RR and Vt and how to approach a vent, non-invasive ventilation choices
4. Hypoxic Respiratory Failure -> causes, approaches, non-invasive and invasive vent, role of PEEP and FiO2
5. Sedation and Analgesia in the ICU -> get a handle on what your ICU likes to use: propofol, versed, fentanyl, ativan, etc; daily interruption of sedation for spontaneous ventilation trials
6. Mechanical Ventilation: what are plateau pressures, peak pressures, auto-Peep, bucking the vent, etc
7. Decompensated Cirrhosis: severe encephalopathy, variceal bleeding, sbp, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary HTN
8. Fulminant Hepatic Failure: what's the differential, what initial labs should you send, what to watch for clinically
8. DIC - ddx and treatment
9. Prophylaxis: DVT, GI, Catheter related infections, Delirium, myopathy, etc

there's lots more. Personally, I think the ICU is a great place to start. You'll get your jitters out early and will be more comfortable with sick patients early in your intern year. It's a great place to practice a lot of internal medicine, without the pain of working your ass of to place someone. Have a great time!

Just got my PGY-1 schedule.

I'm facing my worst nightmare first -- the ICU!

And I'm on-call my first day as an intern.. (pray for me people!)

The advice on this thread so far is pure GOLD. Thanks guys..

 

[Options]

Just got my PGY-1 schedule.

I'm facing my worst nightmare first -- the ICU!

And I'm on-call my first day as an intern.. (pray for me people!)

The advice on this thread so far is pure GOLD. Thanks guys..

I'm bumping this thread because I'm in the same boat.. first rotation in July.. if there is any more advise from current residents out there.. let's have it. Funny thing is, I'm an ob/gyn pgy-1 and will never have another medicine rotation after this one..

 

[amoebatt]

Do you have a copy of this two-sided turnover sheet that I could use? If you could e-mail or fax it to me that would be very helpful. Thank you.