SICU Vs. Medical ICU

[RussianJoo]

So I have the option of doing a SICU or ICU rotation at my school. Both the SICU and Medical ICU are located on the same floor, and are run by the same doctors. It's just that I would be rounding on surgical patients or medicine patients if i did one vs. the other. Which do you think would be a better rotation if I eventually want to go into anesthesia? I know that anesthesiologists take care of SICU patients but do they also manage the care of medical ICU patients?


thanks for the reply.

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[coprolalia]

So I have the option of doing a SICU or ICU rotation at my school. Both the SICU and Medical ICU are located on the same floor, and are run by the same doctors. It's just that I would be rounding on surgical patients or medicine patients if i did one vs. the other. Which do you think would be a better rotation if I eventually want to go into anesthesia? I know that anesthesiologists take care of SICU patients but do they also manage the care of medical ICU patients?


thanks for the reply.

Do the SICU rotation. Most anesthesiologists manage SICU patients. You can't fix many MICU patients. It's soul defeating work.

-copro

 

[jennyboo]

I've done SICU in a closed unit and I've done MICU. There are obviously ups and downs to both, but I vote for the MICU rotation as a stronger educational experience.

SICU admissions at our institution tend to vary quite a bit in acuity. We take stupid stuff like "Patient went into rapid Afib post-op and needs to be transferred from floor to SICU." We also get vascular stuff (aortic aneurysms either before or after repair) and traumas of varying degrees of acuity. But by and large, SICU patients are there for a short time post-op (12-24 hours), often come lined up (A-line, central line, epidural, etc) if they had surgery in the OR so many of them are already tucked in and all you do is babysit them. And even in a closed unit, you have to spend forever playing tag with the surgical team to ask them "if they think it's OK" for you to stop the antibiotics or let the patient eat. Typical SICU conditions include sepsis, trauma/resuscitation, post-op respiratory failure, post-op Afib.

MICU patients are indeed sick. So you will learn to manage some seriously sick medical conditions (CHF, pneumonia, sepsis, hepatic failure, COPD exacerbation). The also don't arrived lined up, so the bumbling medicine residents poke around and struggle with every single small procedure. They stress for hours over a decision to intubate a patient and it's a big deal because they don't know how to do it and have to call someone to intubate. The patients never arrive tucked in because they've been decompensating on the floor for 12 hours until the ward team realizes it's 5pm and they want to send the patient to the MICU so they can go home. So they start out with a 22g IV that doesn't run, and medicine residents spend 2 hours intubating, starting a-line, starting central line.

Whereas in the SICU, if you think you might intubate a patient, for you it's not a big deal, just 10 minutes of your time. A-line, same thing. Central line, 20 minutes. Done.

But you learn a lot in the MICU, and I think for a medical student the opportunities for education may be better in the MICU than the SICU.

 

[fakin' the funk]

But by and large, SICU patients are there for a short time post-op (12-24 hours), often come lined up (A-line, central line, epidural, etc) if they had surgery in the OR so many of them are already tucked in and all you do is babysit them....

MICU patients are indeed sick. So you will learn to manage some seriously sick medical conditions (CHF, pneumonia, sepsis, hepatic failure, COPD exacerbation). The also don't arrived lined up, so the bumbling medicine residents poke around and struggle with every single small procedure. They stress for hours over a decision to intubate a patient and it's a big deal because they don't know how to do it and have to call someone to intubate. ...

But you learn a lot in the MICU, and I think for a medical student the opportunities for education may be better in the MICU than the SICU.

Agree 100%. Spot-on post. Most MICU patients are complete bombs so there is a ton to learn from. Plus, all those things your anesthesiology attendings and residents taught you about bag-masking, intubation, drugs, etc.? You get to see why they were so emphatic about doing those things a certain way.

 

[cchoukal]

agree with above two posts AND Copro's post about it being soul-defeating. Ah, the paradox...

 

[White Coat HTN]

There is always the option I was suprised with. I signed up for Pulm disease and discovered that the catholic hospital has Pulm run the SICU and MICU, so I did that for a month. Then came to the trauma hospital here for SICU and discovered they combine SICU, MICU, and PICU!

So much surprise ICU

 

[rsgillmd]

So I have the option of doing a SICU or ICU rotation at my school. Both the SICU and Medical ICU are located on the same floor, and are run by the same doctors. It's just that I would be rounding on surgical patients or medicine patients if i did one vs. the other. Which do you think would be a better rotation if I eventually want to go into anesthesia? I know that anesthesiologists take care of SICU patients but do they also manage the care of medical ICU patients?


thanks for the reply.

RussianJoo, are you at St. Barnabas in Livingston? If you are, I would recommend neither. Instead I would recommend a month in the burn unit. I learned a lot there and really became a part of the team. I also became comfortable doing femoral lines there. Dr. Marano is a great teacher.

If you have to pick between MICU and SICU, go with MICU. At least you'll get exposure to the sick patients and be comfortable with multiple diseases. You'll get plenty of SICU when you hit anesthesia.

Even til now I tend to view my patients as medical patients with surgical solutions.

 

[RussianJoo]

RussianJoo, are you at St. Barnabas in Livingston? If you are, I would recommend neither. Instead I would recommend a month in the burn unit. I learned a lot there and really became a part of the team. I also became comfortable doing femoral lines there. Dr. Marano is a great teacher.

If you have to pick between MICU and SICU, go with MICU. At least you'll get exposure to the sick patients and be comfortable with multiple diseases. You'll get plenty of SICU when you hit anesthesia.

Even til now I tend to view my patients as medical patients with surgical solutions.

Yes I am at St. Barnabas, one question about the burn unit. Do you wear scrubs while doing your elective there? the reason I ask is because I sweat very easily and I know most burn patients will have the room temp sky high due to lack of thermal regulation, with that said if I can wear scrubs then I wouldn't sweat as much as wearing a shirt and tie. I sweat so much that I would refuse to scrub in on pediatric cases because they would have the room temp up to keep the little guys warm.

 

[RussianJoo]

First off I just want to thank everyone who replied, it's truly appreciated.

I want to do a SICU/MICU rotation to not only learn a great deal but also to get a solid letter for when I apply to anesthesia programs. With the letter of recommendation in mind which would be a better choice? or would it not matter?


If it doesn't matter I'll either pick MICU or the burn unit, because I was talking to a friend today who's rotationg through the ICU and he told me that the SICU will have slow days where they won't get a single patient and I don't want to waste my time sitting on my butt, i'll do that at the end of my 4th year after successfully matching into an anestheisa program....

 

[jennyboo]

I want to do a SICU/MICU rotation to not only learn a great deal but also to get a solid letter for when I apply to anesthesia programs. With the letter of recommendation in mind which would be a better choice? or would it not matter?

If it doesn't matter I'll either pick MICU or the burn unit, because I was talking to a friend today who's rotationg through the ICU and he told me that the SICU will have slow days where they won't get a single patient and I don't want to waste my time sitting on my butt, i'll do that at the end of my 4th year after successfully matching into an anestheisa program....

If your SICU has a lot of big names in anesthesiology, then rotate in the SICU and work your butt off by acting like a resident and personally managing your patients with everything from notes to orders (and then you'll "earn" the right to doing procedures too).

If your SICU is mostly run by surgeons, does not have a cluster of "big shot" anesthesiologists, or does not reside in a big name hospital (which can look good behind a letter written by a non-big-shot anesthesiologist), then choose what will be the most worthwhile experience (burn or MICU).

I'm guessing that you should probably go with the latter option (burn or MICU).

 

[RussianJoo]

If your SICU has a lot of big names in anesthesiology, then rotate in the SICU and work your butt off by acting like a resident and personally managing your patients with everything from notes to orders (and then you'll "earn" the right to doing procedures too).

If your SICU is mostly run by surgeons, does not have a cluster of "big shot" anesthesiologists, or does not reside in a big name hospital (which can look good behind a letter written by a non-big-shot anesthesiologist), then choose what will be the most worthwhile experience (burn or MICU).

I'm guessing that you should probably go with the latter option (burn or MICU).

I'll ask about who runs our SICU.. but the hospital is a medium size hospital, it's a community hospital so I doubt it will have too many big shot names, nor will the name of the hospital bring a lot of weight with it. Learning is also important to me, and thus I agree with you and I'll probably end up picking Burn or MICU. I just need to have some questions answered about the burn unit first.

Thank you very much for your help!