Starting intern year, Surviving the ICU...

[Molecule]

So does anyone have any pointers on how to survive ICU months? I actually never sub-I'd in an ICU or CCU in medical school--largely because, as a future psychiatrist, it didn't seem to make much sense to me to invest the time. --Where I will be going for residency, the Internal Medicine requirement is only 4 months--and only half of these months are inpatient. But during those 2 months, I will have some ICU patients under my care (in addition to my floor patients).

It's a little too late for me to tinker with my 4th year schedule, so I was wondering if there were any books or survival guides any of you could recommend.

(Granted, I probably won't be able to avoid my imminent baptism by fire...)

Thanks!

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[kungfufishing]

So does anyone have any pointers on how to survive ICU months?
Thanks!

pay attention, work hard, and make friends with the nurses.

 

[doc05]

your time will be split between the icu and the floor?? I don't quite understand your explanation.

and p.s. no intern is solely responsible for anything, especially in the icu.

 

[carol ann]

your time will be split between the icu and the floor?? I don't quite understand your explanation.

and p.s. no intern is solely responsible for anything, especially in the icu.

I'm not sure if this is what he means...but some hospitals have open ICUs where you have pts on floor and in the unit at the same time -- you follow them into the unit, hover while they are in the unit,and (hopefully) keep'em when they graduate to the floor again. Personally I find open ICUs to be a major energy drain...but that's just me.

 

[Molecule]

I'm not sure if this is what he means...but some hospitals have open ICUs where you have pts on floor and in the unit at the same time -- you follow them into the unit, hover while they are in the unit,and (hopefully) keep'em when they graduate to the floor again. Personally I find open ICUs to be a major energy drain...but that's just me.

Yes, that's correct.

"Open" ICU--co-management of both floor patients and ICU patients.


Are there any reasonable-length references that you can recommend for me to read? Just so I can at least familiarize myself with some basic ICU treatment principles. Things like ventilator settings (and the like), too?


Thanks!

 

[MAC10]

Nothing in intern year is anything that the Washington Manual cant guide you through. Keep it close my friend...keep it close

 

[MAC10]

Utilize Up to Date also

 

[MAC10]

If all else fails ask someone for help..I never hesitate to ask if Im not sure. Ive found that residents would much rather help now rather than clean up a disaster

 

[carol ann]

There's a great book, "The ICU book" I think the authors last name is Stone. I enjoyed it for my ICU month, but I think it probably is a little more than you'd need for the bits of ICU that you will get. I'd get a good intern survival book that tells you what to do when the **** hits the fan until someone else can come down to help.

 

[anonymousEM]

Marino is the author of "The ICU Book" Very readable, worth having a copy around.

 

[carol ann]

Marino is the author of "The ICU Book" Very readable, worth having a copy around.

thanks for the correction - I was alittle to lazy to run up to my bookshelf last night.

 

[GMO2003]

I'm not sure if this is what he means...but some hospitals have open ICUs where you have pts on floor and in the unit at the same time -- you follow them into the unit, hover while they are in the unit,and (hopefully) keep'em when they graduate to the floor again. Personally I find open ICUs to be a major energy drain...but that's just me.

that sucks...during my internship if a patient was crashing, they were transferred to the MICU team...that is until they improved and they were transferred straight back to the floor gawd I am thankful internship year is over...what a EXTREMELY PAINFUL AND EMOTIONALLY DRAINING/AT TIMES HUMILIATING/HUMBLING experience it was...then again maybe it was just me

 

[JR]

I am an intern working at a open ICU hospital and to be honest things are not that bad. Transfering pts between the floor and an ICU is as easy as giving one telephone order and printing out a med summary sheet. No transfer notes, no headaches. If pt crashes on the floor and needs to go back up, same situation. This does, however, make our ward months harder (because we take care of both floor and ICU pts at the same time). On the other hand, we have no usual ICU rotations (our dedicated ICU rotation is 1 month of 8-4 with no weekends). Not too bad.

 

[roja]

I had not done an ICU rotation either. However, I had done CCU. I was nervous as hell about being in the ICU.

The best book and I still utilize it is Marino's ICU Handbook. Good luck

 

[djipopo]

sorry i'm only MSIII, but i have to ask - why is the ICU rotation so painful? what makes it worse than regular ward months?

 

[Blade28]

Three words: VERY sick patients.

 

[JR]

Things can go south VERY quickly

 

[roja]

multiple drips.

 

[JR]

Altered Mental Status
Code Status

Oh yea, running Codes...

JR

P.S. 3 months until the end of internship and counting...

 

[timtye78]

Alright to the OP:

Here is your suggested reading list before reporting to the ICU (j/k)
Sign here after you have completed 500 subclavian blind central lines (hehe)
Even as a psychiatrist, you must be a master of the airway-hey, you never know when you will have to perform an emergency tracheotomy with your 'phat' Lexapro pen from the hot drug reps after deftly placing a line in the depressed, maladjusted soccer mom on Serafem...

Seriously, just learn how to write a basic ICU note, and practice translating the chicken-scratch consults so you can at least say correctly on your plan:
Also, one more intern year trick, review your previous daily note so you only have to read your note to find out stuff like TLC day number, abx day number, etc.

"Continue dialysis as per renal"
"Continue TPN"
"Continue....." (You get the idea!)

 

[Gerota]

um no one will have to do an emergent tracheostomy except the trauma team/ER/possibly anesthesia. Maybe a handful of times a year is this needed, maybe your anesthesia department stinks and cant intubate people. but 99.9% of codes- the dude is tubed by the code team and no one had to think twice for emergent airway. At my hospital, the major tertiary hospital in the south west- the ENT folks take in house call for emergent trachs during a code- there has been 1 emergent trach needed. usually that will be the trauma team that has that pager.

We have an open ICU which i like since when i have a patient crashing i dont have to bargain with some stupid team regarding a transfer. The medicine services have that, but all surgical teams manage their floor and ICU patients.

the most important thing you'll have to learn is probably the Vent/Access placement/code protocol/when a drip is indicated. Most of the drip and vent stuff you cant actually just play around with, go up on someones dopamine momentarily it wont hurt the patient....watch and learn.....decrease the Fio2 and draw a gas off the aline....etc. great learning experience

Alright to the OP:

Here is your suggested reading list before reporting to the ICU (j/k)
Sign here after you have completed 500 subclavian blind central lines (hehe)
Even as a psychiatrist, you must be a master of the airway-hey, you never know when you will have to perform an emergency tracheotomy with your 'phat' Lexapro pen from the hot drug reps after deftly placing a line in the depressed, maladjusted soccer mom on Serafem...

Seriously, just learn how to write a basic ICU note, and practice translating the chicken-scratch consults so you can at least say correctly on your plan:
Also, one more intern year trick, review your previous daily note so you only have to read your note to find out stuff like TLC day number, abx day number, etc.

"Continue dialysis as per renal"
"Continue TPN"
"Continue....." (You get the idea!)

 

[DrFeelgoodDO]

So does anyone have any pointers on how to survive ICU months? I actually never sub-I'd in an ICU or CCU in medical school--largely because, as a future psychiatrist, it didn't seem to make much sense to me to invest the time. --Where I will be going for residency, the Internal Medicine requirement is only 4 months--and only half of these months are inpatient. But during those 2 months, I will have some ICU patients under my care (in addition to my floor patients).

It's a little too late for me to tinker with my 4th year schedule, so I was wondering if there were any books or survival guides any of you could recommend.

(Granted, I probably won't be able to avoid my imminent baptism by fire...)

Thanks!

To the OP....I am an IM intern at OU-Tulsa and currently I'm on my 2nd ICU month. You only have to know a few things in order to be successful; make nice with the nurses b/c ICU nurses know a HELL of a lot and it can help you tremendously; when you work up a pt, focus on the critical care issues - if a patient has a disease, who cares - just deal with the issue at hand i.e. respiratory distress; read a lot - up to date kicks some serious ass, as well as Marino's ICU book - learn the exact definition of things like ARDS - it will come in handy; do a good physical exam EVERY day on patients who are sedated or who are unresponsive - you never know when you'll pick up a CVA or some other problem that is easily diagnosed normally with a good history; finally, learn when and when not to admit/discharge a patient from the ICU - this is key and will make you look like a superstar in front of attendings;

good luck with the ICU stuff and internship in general; overall, it's not that bad!

- Feelgood