Starting intern year in the ICU

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chitown82

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I'm one of the lucky kiddos to land the ICU my first month. I've been doing nothing medical related since my last rotation but I feel I should do some prep work in anticipation of a difficult first month. What would you all recommend doing? I'm not going to go crazy - just an hour or two max per day during the daytime when most of my friends are at work.
 
chitown82 said:
I'm one of the lucky kiddos to land the ICU my first month. I've been doing nothing medical related since my last rotation but I feel I should do some prep work in anticipation of a difficult first month. What would you all recommend doing? I'm not going to go crazy - just an hour or two max per day during the daytime when most of my friends are at work.
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I too landed MICU my first month as an intern. I did...wait for it...bupkus. Got a great evaluation including an amazing LOR for fellowship (not in CCM) from one of my attendings.

If you really want to do something, read Marino's ICU book. Or (and this is probably a better idea) talk to one of the ICU fellows or attendings at your school and ask them for their "Top 10" reading list for new residents in the ICU. My least favorite MICU fellow (just because he was a total douchebag of a human being) was also one of the best teachers I had as a resident because he had a phenomenal literature file that he kept updated and shared with the residents.
 
chitown82 said:
I'm one of the lucky kiddos to land the ICU my first month. I've been doing nothing medical related since my last rotation but I feel I should do some prep work in anticipation of a difficult first month. What would you all recommend doing? I'm not going to go crazy - just an hour or two max per day during the daytime when most of my friends are at work.
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You're not really expected to know much when you begin. So I wouldn't worry about it too much. Marino's book isn't bad, but seems like a lot and without a certain amount of clinical context (meaning working), I'm not sure how much you'll get out of it, but it can't hurt.

I think the surviving sepsis campaign would be a good overall review for this problem.

I'm also a big nutrition in the unit kind of a guy and ASPEN put out their new guidelines for nutrition in the critically ill last summer. I'd read that too. It will probably make you stand out more as most people coming in won't be thinking about it.
 
I was hoping both of you would respond...and you did! Thanks! 🙂
 
jdh71 said:
You're not really expected to know much when you begin. So I wouldn't worry about it too much. Marino's book isn't bad, but seems like a lot and without a certain amount of clinical context (meaning working), I'm not sure how much you'll get out of it, but it can't hurt.

I think the surviving sepsis campaign would be a good overall review for this problem.

I'm also a big nutrition in the unit kind of a guy and ASPEN put out their new guidelines for nutrition in the critically ill last summer. I'd read that too. It will probably make you stand out more as most people coming in won't be thinking about it.
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Is there a place that has the "most important" articles in ICU pt care (and for that matter Internal Medicine)? I know the ATS website has a reading list but I want something a bit shorter. One option is the "Year in review" papers that are published in the AJRCCM - they were doing that a few months ago. They sum up the current trials in P/CCM that happened over the course of the year and what are the suggested changes in pt care. But besides that?
 
Would you recommend doing a MICU rotation as a 4th year elective? If so, where?

Thanks!
 
ResidentMD said:
Is there a place that has the "most important" articles in ICU pt care (and for that matter Internal Medicine)? I know the ATS website has a reading list but I want something a bit shorter. One option is the "Year in review" papers that are published in the AJRCCM - they were doing that a few months ago. They sum up the current trials in P/CCM that happened over the course of the year and what are the suggested changes in pt care. But besides that?
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That will be fine too. I probably don't get to reading them as much as I should . . . most of what you'll pick up and do in the Unit will because of being there, hands on, so the best thing you can do for your unit experience is be around and pay attention.

You guys are going to be super busy the next few years. I'm not against a little book learning if you've got some free time and motivation to do it, but I'd really much rather like to think of you guys in the free time you ahve left going out clubing, nailing hot chicks, back-packing the rockies, diving in the caribbean, seeing the symphony, eating at the best greek restarant in town, etc. than reading about the ICU.
 
jdh71 said:
That will be fine too. I probably don't get to reading them as much as I should . . . most of what you'll pick up and do in the Unit will because of being there, hands on, so the best thing you can do for your unit experience is be around and pay attention.

You guys are going to be super busy the next few years. I'm not against a little book learning if you've got some free time and motivation to do it, but I'd really much rather like to think of you guys in the free time you ahve left going out clubing, nailing hot chicks, back-packing the rockies, diving in the caribbean, seeing the symphony, eating at the best greek restarant in town, etc. than reading about the ICU.
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So it doesnt matter if you appear like a ***** and relatively incompetent on the first day of your residency as long as you have a tan? (no jokes, serious question)
 
jdh71 said:
You guys are going to be super busy the next few years. I'm not against a little book learning if you've got some free time and motivation to do it, but I'd really much rather like to think of you guys in the free time you ahve left going out clubing, nailing hot chicks, back-packing the rockies, diving in the caribbean, seeing the symphony, eating at the best greek restarant in town, etc. than reading about the ICU.
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Word!

I also agree that without clinical context, a lot of stuff (ICU in particular) is going to go right over your head, no matter how much you read.
 
You might consider focusing on some core ICU topics and read the classic journal articles, some that come to mind after having almost finished intern year are Sepsis - Early goal directed therapy paper, PROWESS paper, ARDS - ARDSnet protocol paper, Anemia - The CRIT study, Hyperglycemia - NICE sugar trial, VAP - most recent ID review article, Vent Weaning - probably read uptodate or find a review article, you could read the original article by Tobin for rapid shallow breathing index, that one gets quoted a lot.
 
For what it's worth...I'm a 3rd year medical student and chose to do my elective in the MICU. For prep, I read the Washington Manual to Critical Care (highly recommend! Has very concise and to the point chapters with algorithm-based treatment charts for everything). I looked at the ICU book, but as was stated above, it was very physiology oriented, and probably wouldn't help as much with the day-to-day issues you'll be facing as an intern. Though I recently discovered that there is a pocket version of the ICU book that seems to be very helpful in explaining many of the things you'll come into contact with.

One thing I've discovered, is that the ICU is and intense place (no pun intended). I agree with what was said above, no amount of reading will prepare you for it. Just show up and be willing to be present and around. Things tend to happen quickly and suddenly, and it seems that the best way to learn about the ICU is just being there. I've worked with some smart interns (and they're at the end of their year) and when they first came on they struggled a little. But no worries, they've caught up to speed quickly.

Best of luck!
 
ranmyaku said:
You might consider focusing on some core ICU topics and read the classic journal articles, some that come to mind after having almost finished intern year are Sepsis - Early goal directed therapy paper, PROWESS paper, ARDS - ARDSnet protocol paper, Anemia - The CRIT study, Hyperglycemia - NICE sugar trial, VAP - most recent ID review article, Vent Weaning - probably read uptodate or find a review article, you could read the original article by Tobin for rapid shallow breathing index, that one gets quoted a lot.
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While this is good, please remember that ICU research is progressing rapidly (as in research in many other subspecialties), and the inherent heterogeneity in the study samples makes it very difficult to make generalized guidelines. Many of these studies have their inherent limitations e.g. the NICE-SUGAR study, which has also been critiqued heavily. So while it would provide you with a good starting point, you cannot use it as a blanket recommendation.

What I would really like to see are some perspective articles that tell us where we stand today, and also highlight the limitations in these "classic" papers. The ATS reading list has some of the reviews.

I would personally think of just browsing through a book that gives you the basic concepts (any one - Marino/Hall/UPenn Tutorials/whatever you feel comfortable with) or a review/perspective article published in late 2009-early 2010 (not an original article) in one of the good journals (AJRCCM/CHEST/CCM/Critical Care), and then just showing up to the ICU and being ready to learn (as is said above). Because things are changing so rapidly that unless you know how to critically evaluate the ICU literature and know what to accept and in what context to consider it, you would be quite lost.
 
disappointment_square.jpg


at least I tried . . .
 
I guess my point was that we still get pimped on rounds on the 'classic' papers... every paper i listed I was asked numerous questions about this year, at least once, if not more than once. Yeah of course you need to know where we stand now in terms of current research and the literature now....but the attendings on rounds are gonna gonna pimp your ass on stuff that happened 10 years ago.
 
ranmyaku said:
I guess my point was that we still get pimped on rounds on the 'classic' papers... every paper i listed I was asked a question about this year, at least once, if not more than once. Yeah of course you need to know where we stand now in terms of current research and the literature now....but the attendings on rounds are gonna gonna pimp your ass on stuff that happened 10 years ago.
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True..unfortunate, but true.

Gutonc's reply to chitown just made my day :laugh:
 
Here's a vote for "surviving sepsis" campaign. Also agree with checking with the pulmonary/critical care dept. at the place you are going to train and/or faculty @your med school about suggested reading list. I think the Marino ICU book lacks some clinical focus, although might be good for knowledge base.
 
Get ready to be super-nice to the ICU nurses --- if you are on their good side, then they can make the month more bearable. It's funny to think how having a goofy grin and a self-deprecating attitude really saved my rear more than once. I feel like as an intern, I was just trying to survive and learn the ropes. As a senior resident, I started consolidating data and gaining a better conceptual framework (as was true on the general wards, as well). Aside from that, I think there have been a number of great suggestions from the previous posters.
 
This week's Annals of IM has a nice review of major critical trials from 2009

Update in Pulmonary and Critical Care Medicine


  • Anthony F. Suffredini,
  • Henry Masur,
  • and Joseph P. Lynch III
Ann Intern Med May 4, 2010 152:601-608; published ahead of print April 21, 2010, doi:10.1059/0003-4819-152-9-201005040-00247


This Update in Pulmonary and Critical Care Medicine features 12 articles published in 2009. Topics include chronic obstructive pulmonary disease, asthma, pneumonia, glucose control and mortality, early physical and occupational therapy, septic shock, response to the 2009 influenza A (H1N1) outbreak, and chlorhexidine-impregnated sponges.
 
scrantones1 said:
This week's Annals of IM has a nice review of major critical trials from 2009

Update in Pulmonary and Critical Care Medicine


  • Anthony F. Suffredini,
  • Henry Masur,
  • and Joseph P. Lynch III
Ann Intern Med May 4, 2010 152:601-608; published ahead of print April 21, 2010, doi:10.1059/0003-4819-152-9-201005040-00247


This Update in Pulmonary and Critical Care Medicine features 12 articles published in 2009. Topics include chronic obstructive pulmonary disease, asthma, pneumonia, glucose control and mortality, early physical and occupational therapy, septic shock, response to the 2009 influenza A (H1N1) outbreak, and chlorhexidine-impregnated sponges.
Click to expand...

👍

Is there anything like this for other subspecialties/GIM as well?
 
aProgDirector said:
Annals publishes an update in every field, evey year. Simply search for "Update" in the title.
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True..unfortunately most updates are from the year 2007 and before. The only other recent one is in Palliative Medicine.
 
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