Resources for the ICU

[mcloaf]

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After my first shift on an ICU rotation I'm starting to appreciate how significant the difference is between regular floor management, which I feel at least somewhat competent at, and what goes on in the ICU. No doubt I'll learn through experience and reading on my patients, but in the mean time I'm on the hunt for good resources to learn more about ICU topics (vent management, paralytics/sedation, pressors, etc) so I look a little bit less like an idiot the next time I show up to work. Would appreciate any suggestions you folks have, I didn't see any recent threads along these lines.

 

[LUCPM]

Have you checked out Marino's The ICU book? It was a good book to read for ICU rotation.

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[ProfMD]

Definitely grab a copy of The ICU Book. It is well written and covers all the things you'll need to know.

 

[lymphocyte]

After my first shift on an ICU rotation.

I'm going to push back a little on the ICU Book. It's very good, but polarising among attendings. Some think it's too dogmatic. And it is. It's also too verbose if you already have a good foundation in physiology. Definitely worth reading if you have the time and take some of the more "definitive" statements as being slightly less than definitive.

If you're in ICU currently, I actually recommend The Little ICU Book, which is very high-yield and concise. It doesn't have the MOST current guidelines, but it's got a lot packed in there in a very digestible format.

Other resources I found helpful:
1. NEJM ICU Series! A spectacular set of articles written over 2013-2014 by giants in the field.
2. Procedures: https://www.youtube.com/channel/UCy0rtIQvoWeDwJgluiceZCA/videos (his intubation and ventilation videos are gold).
3. Dominating the vent: http://emcrit.org/archive-podcasts/vent-part-1/
4. This is my bias as a neuro-nerd, but knowing a good coma assessment can be very valuable. Read the second chapter of Plum and Posner's Diagnosis of Stuper and Coma. Not hard to find online. Incredible read for now and later in EM rotations.
5. Be familiar with Surviving Sepsis Guidelines and ARDSNet and all that jazz, but these are covered pretty well in the above resources.

 

[mcloaf]

This is great, thanks so much guys.

 

[tiedyeddog]

I'm going to push back a little on the ICU Book. It's very good, but polarising among attendings. Some think it's too dogmatic. And it is. It's also too verbose if you already have a good foundation in physiology. Definitely worth reading if you have the time and take some of the more "definitive" statements as being slightly less than definitive.

If you're in ICU currently, I actually recommend The Little ICU Book, which is very high-yield and concise. It doesn't have the MOST current guidelines, but it's got a lot packed in there in a very digestible format.

Other resources I found helpful:
1. NEJM ICU Series! A spectacular set of articles written over 2013-2014 by giants in the field.
2. Procedures: https://www.youtube.com/channel/UCy0rtIQvoWeDwJgluiceZCA/videos (his intubation and ventilation videos are gold).
3. Dominating the vent: http://emcrit.org/archive-podcasts/vent-part-1/
4. This is my bias as a neuro-nerd, but knowing a good coma assessment can be very valuable. Read the second chapter of Plum and Posner's Diagnosis of Stuper and Coma. Not hard to find online. Incredible read for now and later in EM rotations.
5. Be familiar with Surviving Sepsis Guidelines and ARDSNet and all that jazz, but these are covered pretty well in the above resources.

Those are excellent resources. I second reading Marino for a primer but as said above there are plenty of areas that are hotly debated and practitioner dependent. Those podcasts are great. There is also an ICU summary site I'll try to find that has all of the key papers on big ICU topics like ARDS and steroid stress ppx, I'll try to find it and post here.


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[lymphocyte]

Those are excellent resources. I second reading Marino for a primer but as said above there are plenty of areas that are hotly debated and practitioner dependent. Those podcasts are great. There is also an ICU summary site I'll try to find that has all of the key papers on big ICU topics like ARDS and steroid stress ppx, I'll try to find it and post here.


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Just want to plug my two favourite sites for the latest and greatest:

PulmCCM -- http://pulmccm.org/main/
Rob's Weekly Newsletters -- http://www.criticalcarereviews.com/

Rob's website is outstanding. Worth subscribing even for IM, EM, trauma, SICU, neuro-intensive, whatever. The website has a lot of the "classics" too, neatly organised. Phenomenal resource (though probably for Sub-I and beyond).

 

[cbrons]

Have you checked out Marino's The ICU book? It was a good book to read for ICU rotation.

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Definitely grab a copy of The ICU Book. It is well written and covers all the things you'll need to know.

Sorry I thought the ICU Book sucked. The book seemed a little too superficial and simplistic, based on a few minutes with it before I returned it to amazon. If you read the reviews on Amazon, half of the reviews are, "Great book for an Acute care nurse practitioner student!"

 

[cbrons]

Those are excellent resources. I second reading Marino for a primer but as said above there are plenty of areas that are hotly debated and practitioner dependent. Those podcasts are great. There is also an ICU summary site I'll try to find that has all of the key papers on big ICU topics like ARDS and steroid stress ppx, I'll try to find it and post here.


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What is a "practitioner"?

 

[lymphocyte]

Sorry I thought the ICU Book sucked. The book seemed a little too superficial and simplistic, based on a few minutes with it before I returned it to amazon. If you read the reviews on Amazon, half of the reviews are, "Great book for an Acute care nurse practitioner student!"

Get outta here with your blasphemy. It's perfect for a MS3. Little ICU Book is better for down time on the wards. Not all medical students can leisure through Irwin and Rippe...

 

[cbrons]

Get outta here with your blasphemy. It's perfect for a MS3. Little ICU Book is better for down time on the wards. Not all medical students can leisure through Irwin and Rippe...

This one is far better - http://www.springer.com/gb/book/9783319110196

There is this as well - http://www.springer.com/us/book/9783642549700

The ICU book doesn't really seem to be written for physicians, it looks like a book for nurses and mid-levels who don't have the requisite physio, pathophysio, and biochem backgrounds to really understand how things work on a more than metaphorical level. But to be fair, I did not really read much of it.

 

[lymphocyte]

.

 

[lymphocyte]

This one is far better - http://www.springer.com/gb/book/9783319110196

There is this as well - http://www.springer.com/us/book/9783642549700

The ICU book doesn't really seem to be written for physicians, it looks like a book for nurses and mid-levels who don't have the requisite physio, pathophysio, and biochem backgrounds to really understand how things work on a more than metaphorical level. But to be fair, I did not really read much of it.

Nice. I didn't know Marik wrote a textbook. I'm expecting it to be hilariously contrarian and awesome.

Edit: Just read a few chapters. It is hilariously contrarian and awesome. I also burst out laughing when I read this (from the free preview). I love the way he put studies in quotes. Bought a copy. Thanks for the suggestion.

 

[tiedyeddog]

What is a "practitioner"?

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[VisionaryTics]

Nice. I didn't know Marik wrote a textbook. I'm expecting it to be hilariously contrarian and awesome.

Edit: Just read a few chapters. It is hilariously contrarian and awesome. I also burst out laughing when I read this (from the free preview). I love the way he put studies in quotes. Bought a copy. Thanks for the suggestion.

View attachment 206386

Marik's textbook is outstanding. I like the ICU Book, too, but Marik stuck in my brain better.

Other good resources are "ICU Rounds" podcast by Jeffrey Guy (a burn surgeon). Maybe a little dated now. I also recommend the app "Journal Club" for Android or iOS. It's like $1 and it has tons and tons of high impact papers sorted by field/disease with short "what you need to know" summaries. I think it updates pretty frequently too.

 

[TypeADissection]

Marik's textbook is outstanding. I like the ICU Book, too, but Marik stuck in my brain better.

Other good resources are "ICU Rounds" podcast by Jeffrey Guy (a burn surgeon). Maybe a little dated now. I also recommend the app "Journal Club" for Android or iOS. It's like $1 and it has tons and tons of high impact papers sorted by field/disease with short "what you need to know" summaries. I think it updates pretty frequently too.

Gonna go ahead and second this. The Marik manual is a much better read than Marino's (just my opinion). He also throws in these one-liners here and there that'll make you laugh. Read especially the chapter on fluid management. Cheers.

 

[tiedyeddog]

Just curious, is Marik suitable for the med student (M4) or intern level? Or still better to stick with the ICU Book (which I've read parts of and like what I've read, I've never read Marik though)?

In my opinion marik is just a more in depth read. If you just want an overview go for Marino, if you have more time do marik.


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[TypeADissection]

I think Marino is still a tried and true basis for ICU care. Read a chapter in Marino first, iron out the basics and then when you want more, go to Marik. I don't think you can go wrong either way. Just think of your clinical years as a time to practice all this vocabulary you've been learning your first two years. Intern year will come soon enough and before you know it, the expectation is that there is a level of conversant-ness (I think I just made up that word) when it comes to these concepts. Always ask questions.

 

[lymphocyte]

In my opinion marik is just a more in depth read. If you just want an overview go for Marino, if you have more time do marik.


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Marik's textbook is outstanding. I like the ICU Book, too, but Marik stuck in my brain better.

I just finished reading through the book, and I want to throw my 2 cents in.

Three pluses: 1) It's a fun read. Laugh out loud funny in some parts and not even in a dorky way. It just keeps you reading and reading. 2) It's memorable. What he says simply sticks. 3) It's practical. Loooooooooots of pearls and tips. In some ways, it feels like rounding with a genius but cranky and opinionated intensivist (makes sense).

But this is not appropriate for a MS3. No way. Not everything Marik says is uncontroversial, and if you approach this book without a firm grounding in physiology and a mature clinical perspective, you'll probably come away with a lot of dogma. He writes really confidently, but I don't have the time or clinical experience to work through the references or grok where he might be fudging a little. And the very poor editorial quality and "checklist-y" nature in parts doesn't help my confidence either.

I also think Marik's book only makes sense as part of a broader conversation with the literature, and the literature changes all the time. If you're not a resident or a fellow--or a very keen medical student--you're liable to mistake "intensive care" with "intensive care according to Paul Marik in the year 2015 with no chance of any updates soon."

I'd stick with Marino who at least emphasises the physiology and first principle reasoning (which is useful for almost everything), before even considering Marik's book.

 

[SurfingDoctor]

West Physiology is what we give all the fellows. It isn't a terribly long and a pretty easy but comprehensive read.

 

[Hangry]

Any consensus on best ICU resource for someone going into general surgery? @SouthernSurgeon or anyone else with an opinion.

After looking through this thread I am wondering about the ICU book vs the little ICU book vs Marik vs no textbooks and just using the resources @lymphocyte listed above. Historically I have had some trouble reading textbooks all the way through, so I really don't want to buy multiple ones just to have them never get used. I can get access to Marik's online using my school's library, fwiw but not Marino's.

 

[LUCPM]

For m4 or even r1 on ICU rotation, I would go with the Marino's ICU book.

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[lymphocyte]

Any consensus on best ICU resource for someone going into general surgery? @SouthernSurgeon or anyone else with an opinion.

After looking through this thread I am wondering about the ICU book vs the little ICU book vs Marik vs no textbooks and just using the resources @lymphocyte listed above. Historically I have had some trouble reading textbooks all the way through, so I really don't want to buy multiple ones just to have them never get used. I can get access to Marik's online using my school's library, fwiw but not Marino's.

If you have trouble reading textbooks, and already have a good understanding of physiology, my vote is Baby Marino for revision + Marik. You could get through both in 2 weeks. Baby Marino is actually a collection of condensed essays, very high-yield, and Marik is phenomenal because it gets you conversant with the literature quickly while being highly practical.

Just FYI, Baby Marino is pretty out of a date, and the 2nd edition is coming out soon. I'd wait.

 

[WheezyBaby]

I've already read Marino. I'm debating between reading Marik and just jumping into Rogers' peds intensive care and trying to knock it out in the next year or so. How long does Marik take to get through, hours wise?