PULM/CCM rotation... tips?

[lvspro]

---

Members don't see this ad.

Hey all
I'm starting a rotation on tues in PULM/CCM, and figured I would ask a few of our seniors here about what kind of things I should read, or what procedures I should brush-up on. The place I'm at is quite liberal with what they allow students to do, and we're at that point in the yr where residents have done at least a few of each procedure, and are more willing to pass minor things on. (Just to give y'all an idea, I did an appy, and an ind hernia rpr w/mesh here as a first assist during MS3 at the tail end of my 3rd mo ).

Typically I would just search for this kind of thing on the forum, but as y'all know the fxn is disabled.

 

[AJM]

Are you doing pulmonary consults, pulmonary outpatient, or ICU? What you should brush up on and what procedures you would expect to do are dependent on which area of pulm/cc you are going to be doing.

 

[lvspro]

Are you doing pulmonary consults, pulmonary outpatient, or ICU? What you should brush up on and what procedures you would expect to do are dependent on which area of pulm/cc you are going to be doing.

Hi AJM
We get to choose, but b/c I'm close to being an intern, I'm gonna take pulm consults, and b/c of my interest in vent mgmt and ICU work, I wanted to spend time in the ICU. I don't think outpt will be very useful for me, and I hate the outpt setting so needless to say, outpt got nixed. I was going to arrange it such that I would do ICU in the day, and consults in the PM. Either that, or two weeks of each.
So, consults, and ICU are my focus.

 

[AJM]

Hi AJM
We get to choose, but b/c I'm close to being an intern, I'm gonna take pulm consults, and b/c of my interest in vent mgmt and ICU work, I wanted to spend time in the ICU. I don't think outpt will be very useful for me, and I hate the outpt setting so needless to say, outpt got nixed. I was going to arrange it such that I would do ICU in the day, and consults in the PM. Either that, or two weeks of each.
So, consults, and ICU are my focus.

Sounds good. I'll give my 2 cents on what I think most 4th years should get out of doing pulmonary/cc and what procedures you should expect to do.

Consults: the big areas you should try to learn during your rotation that will be helpful for internship are:
-the evaluation and management of PEs (especially management of submassive and massive PEs)
-evaluation and mgmt of pleural effusions
-evaluation of pulmonary infiltrates in an immunocompromised patient (especially important if you're at a place that treats a lot of oncology or HIV patients)
-preoperative pulmonary evaluation (included in this would be interpretation of PFTs, and especially how they're used in determining a pulmonary patient's operative risk).
-evaluation of a pulmonary nodule/lung mass
-workup and mgmt of a hypoxemic patient

As far as procedures while on consults, you will probably do some thoracenteses. If the hospital that you're at let you be 1st assist on a hernia repair, they will probably also let you do a bronchoscopy or two. The biggest thing to do to prepare for that is to learn airway anatomy. Netter has a good diagram of the tracheobronchial tree. You should definitely know the locations of the lobar bronchial divisions (ie RLL, RML, etc), but you will really impress your attendings if you know your anatomy through the segmental bronchi.


ICU: others will probably want to comment on this as well. Here are a few topics that are biggies in my mind:
-management of sepsis
-management of ARDS
-modes of ventilation
-principles of vent "weaning" (there's really no such thing as weaning, but everyone calls it that anyway)
-hemodynamic monitoring
-types of pressors/inotropes and indications

As far as procedures in the ICU, expect to do some central lines and arterial lines. You may also get to float a Swan or two (I definitely did a couple while I was a student).


This is definitely not a complete list, but IMO these are important topics to learn for someone who will be starting internship soon.

 

[lvspro]

Sounds good. I'll give my 2 cents on what I think most 4th years should get out of doing pulmonary/cc and what procedures you should expect to do.

Consults: the big areas you should try to learn during your rotation that will be helpful for internship are:
-the evaluation and management of PEs (especially management of submassive and massive PEs)
-evaluation and mgmt of pleural effusions
-evaluation of pulmonary infiltrates in an immunocompromised patient (especially important if you're at a place that treats a lot of oncology or HIV patients)
-preoperative pulmonary evaluation (included in this would be interpretation of PFTs, and especially how they're used in determining a pulmonary patient's operative risk).
-evaluation of a pulmonary nodule/lung mass
-workup and mgmt of a hypoxemic patient

As far as procedures while on consults, you will probably do some thoracenteses. If the hospital that you're at let you be 1st assist on a hernia repair, they will probably also let you do a bronchoscopy or two. The biggest thing to do to prepare for that is to learn airway anatomy. Netter has a good diagram of the tracheobronchial tree. You should definitely know the locations of the lobar bronchial divisions (ie RLL, RML, etc), but you will really impress your attendings if you know your anatomy through the segmental bronchi.


ICU: others will probably want to comment on this as well. Here are a few topics that are biggies in my mind:
-management of sepsis
-management of ARDS
-modes of ventilation
-principles of vent "weaning" (there's really no such thing as weaning, but everyone calls it that anyway)
-hemodynamic monitoring
-types of pressors/inotropes and indications

As far as procedures in the ICU, expect to do some central lines and arterial lines. You may also get to float a Swan or two (I definitely did a couple while I was a student).


This is definitely not a complete list, but IMO these are important topics to learn for someone who will be starting internship soon.

AJM you da man... or woman. Whatever you are, thanks for the input. I love the procedures you listed above, and if I get to bronch someone, I'll be ecstatic. Furthermore, I'm really interested in said pathologies, so this should make for a really cool rotation.
Thanks again
Later

 

[AJM]

AJM you da man... or woman. Whatever you are, thanks for the input. I love the procedures you listed above, and if I get to bronch someone, I'll be ecstatic. Furthermore, I'm really interested in said pathologies, so this should make for a really cool rotation.
Thanks again
Later

Hey, no problem. But I don't want to get your hopes up - you would be pretty lucky to do a bronch -- and it would probably only be part of one (which is still pretty cool, anyway!). When I was a student doing a pulm consult elective, I got to do a couple of bronchs, but the patients were basically handpicked for me as the "easy" ones to do... one was on an intubated patient, and the other was on a s/p double-lung transplant patient. On the second one, the fellow got past the cords, did the BAL and bx, and then handed it over for me to look around. They let me drive the scope on that patient because the post-transplant patients have denervated lungs, so they don't cough when the scope hits the bronchial walls! (and I was hitting a lot of walls!) 🙂

 

[lvspro]

Hey, no problem. But I don't want to get your hopes up - you would be pretty lucky to do a bronch -- and it would probably only be part of one (which is still pretty cool, anyway!). When I was a student doing a pulm consult elective, I got to do a couple of bronchs, but the patients were basically handpicked for me as the "easy" ones to do... one was on an intubated patient, and the other was on a s/p double-lung transplant patient. On the second one, the fellow got past the cords, did the BAL and bx, and then handed it over for me to look around. They let me drive the scope on that patient because the post-transplant patients have denervated lungs, so they don't cough when the scope hits the bronchial walls! (and I was hitting a lot of walls!) 🙂

Sounds like you had some pretty cool attendings/residents on your rotation. Anyhow, I'll just keep my fingers crossed, and my eyes peeled for any opportunities. Thanks again.

 

[Trisomy13]

Hey all
I'm starting a rotation on tues in PULM/CCM, and figured I would ask a few of our seniors here about what kind of things I should read....

The ICU Book by Marino


somebody's going to talk you into buying it sooner or later. might as well get it now while you are doing ICU. 🙂

 

[bullard]

But there's a new edition coming out in a few months so maybe hitting the library is in order.

uptodate is money when it comes to mechanical ventilation, ARDS, and sepsis.

The ICU Book by Marino


somebody's going to talk you into buying it sooner or later. might as well get it now while you are doing ICU. 🙂

 

[aredoubleyou]

Not trying to state the obvious, but make sure you know the basic stuff for your icu rotation like blood gas, vent settings (very basics), what one would expect cvp/wedge p/ etc in different types of shock, general electrolyte stuff, and things like that cause those are the things that a lot of students get caught on. No ones gunna ask you about lobar bronch divisions if you continually get caught up on the basics.

I borrowed ICU recall for my icu rotation and thought it was relativeley close to worthless. All the interns had the ICU book. Also, I thought the procedures that you may get a chance to do were conceptually relatively staight foward (a-lines, intubations, central lines (which I did not get to do - damn medicine interns are so greedy 😉 , etc) - and do not really require you buting a book primarily for that purpose.

 

[lvspro]

Trisomy, bullard, and are... thanks y'all. 👍