SICU w no prep

[IgM]

Hi all,

MS4 starting a SICU rotation this month with pretty much no prior training in SICU or MICU, but all 3rd year rotations done. To add insult to injury, I've been out of the hospital for almost a year doing research. Don't ask me how this happened; it's one of those awful scheduling things. The scheduling is not fixable and I need a letter from this rotation. I go to a good school and am terrified of 1) looking really stupid compared to other med students at my level and 2) actually being really stupid. I bought Marino and the Critical Care clinical companion to read, but not sure where to start.

Looking for any ideas from residents or MS4s who know the system. If you were in my situation, what would your plan be?

Thanks in advance.
IgM

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[countingdays]

Hi all,

MS4 starting a SICU rotation this month with pretty much no prior training in SICU or MICU, but all 3rd year rotations done. To add insult to injury, I've been out of the hospital for almost a year doing research. Don't ask me how this happened; it's one of those awful scheduling things. The scheduling is not fixable and I need a letter from this rotation. I go to a good school and am terrified of 1) looking really stupid compared to other med students at my level and 2) actually being really stupid. I bought Marino and the Critical Care clinical companion to read, but not sure where to start.

Looking for any ideas from residents or MS4s who know the system. If you were in my situation, what would your plan be?

Thanks in advance.
IgM

I wouldn't worry about reading the book cover to cover at this point.
Read about vent management and ABGs.
Read about antibiotic coverage.
Read about whatever patients you get assigned.

 

[PMPMD]

Agree w/ above. Many prior threads on this, but bottom line: know your pt. You will likely only be assigned one pt at least at first. Know ranges for all VS, I/O, their PMH (+ baseline BP, Cr) what surgery they had (& why they had it), what their postop course has been. Know every line and tube coming in and out of them, and how long its been there. Know what abx theyre on and for how long. If intubated, know their vent settings, why still intubated, etc. Know why theyre still in the unit. Respiratory problems are common, so be all over that area. When it comes time to present, SPEAK UP. your team has to hear you over vent alarms, IVAC alarms, every other kind of alarm. Also try to learn as much as possible about every other pt on the svc - its a team. Dont ever say "thats not my pt.".

 

[WholeLottaGame7]

Know more than you present on rounds. Talk to the residents (or the attending) to ask how they would like patients presented, then follow that format. Be concise, but know all the little details so if they ask you can tell them.

Agree with all of the above. Specifically, I'll add that you should know drug doses/frequencies/gtt settings on your patients. It may not mean much to you as you start out but the more patients you have the more familiar with it you'll be with regards to "is this patient on a lot or a little." If you have questions about "why X antibiotic or Y pressor," ask. Some stuff is evidence-based and some is personal preference. Know how much prn sedatives/narcotics patients are requiring. Be friendly with the unit pharmacist, they'll make your life much easier.

Otherwise, show up on-time (i.e., early), be interested, look things up if you don't know them. Don't make $hit up. If you're proactive and conscientious, A) the knowledge will come, and B) people will be much more likely to forgive any knowledge gaps you may have.

Good luck!