TICU and burn units

[Perrotfish]

I'm a pediatric resident possibly interested in a PICU fellowship. I was looking at possibly using some of my elective time next year to schedule Pediatric Trauma ICU and burn unit months. I just had a few questions about those months for those who have done them:

1) Who runs burn ICUs and TICUs? Surgeons with critical care fellowships or regular Peds/IM Intensivists?

2) Is there a place for a non-surgical resident in a burn ICU or a TICU? Meaning is the OR part of the daily workload, or is the actual surgical management of those ICU patients another team's responsibility? Do EM residents and Intensivist Fellows often rotate through?

3) For wards with mixed Pediatric and adult patient populations, have you guys ever seen a 'peds only' rotator? I can only find a handful of dedicated pediatric burn units and TICUs, and none of them are close to home. On the other hand I'm sure I would not trust myself to take care of an elderly burn victim. Its been a long time since I've treated a patient with longstanding heart disease or type II diabetes.

Any other guidance would also be appreciated.

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[VisionaryTics]

I'm a pediatric resident possibly interested in a PICU fellowship. I was looking at possibly using some of my elective time next year to schedule Pediatric Trauma ICU and burn unit months. I just had a few questions about those months for those who have done them:

1) Who runs burn ICUs and TICUs? Surgeons with critical care fellowships or regular Peds/IM Intensivists?

2) Is there a place for a non-surgical resident in a burn ICU or a TICU? Meaning is the OR part of the daily workload, or is the actual surgical management of those ICU patients another team's responsibility? Do EM residents and Intensivist Fellows often rotate through?

3) For wards with mixed Pediatric and adult patient populations, have you guys ever seen a 'peds only' rotator? I can only find a handful of dedicated pediatric burn units and TICUs, and none of them are close to home. On the other hand I'm sure I would not trust myself to take care of an elderly burn victim. Its been a long time since I've treated a patient with longstanding heart disease or type II diabetes.

Any other guidance would also be appreciated.

I just finished a month of burn ICU.

Burn ICU units are either staffed by trauma/critical care trained general surgeons or plastic surgeons. Surgical management of these patients was part of the daily workload (debridements, excision and grafting, trachs, PEGs, etc). The pediatric burn patients were in the PICU, but the burn surgeons were the primary team. Burns are the ultimate trauma, and general surgeons have the strongest background in trauma management.

We had EM residents rotate through, but no medical intensivists (only surgical).

 

[Perrotfish]

I just finished a month of burn ICU.

Burn ICU units are either staffed by trauma/critical care trained general surgeons or plastic surgeons. Surgical management of these patients was part of the daily workload (debridements, excision and grafting, trachs, PEGs, etc). The pediatric burn patients were in the PICU, but the burn surgeons were the primary team. Burns are the ultimate trauma, and general surgeons have the strongest background in trauma management.

We had EM residents rotate through, but no medical intensivists (only surgical).

Out of curiosity what was your role as a medical student, and how did you feel it was as a learning experience? How much time did you spend in and out of the OR? I imagine as a Peds resident my role would be very medical student-ish.

 

[Winged Scapula]

I'm a pediatric resident possibly interested in a PICU fellowship. I was looking at possibly using some of my elective time next year to schedule Pediatric Trauma ICU and burn unit months. I just had a few questions about those months for those who have done them:

1) Who runs burn ICUs and TICUs? Surgeons with critical care fellowships or regular Peds/IM Intensivists?

In my experience:

Burn units are run by general surgeons usually either with trauma/cc or burn fellowship training or plastic surgeons. The same is true whether adult or peds.

Trauma ICUs tend to be run by GS with Trauma/CC fellowship training or Anesthesia with CC .

Our PICU (which was Peds trauma/cc) was run by Ped Surgeons and Peds Intensivists. The work division was always somewhat of a mystery to me but they tended to handle FEN and vents and surgeons did the wound care/operative care.

2) Is there a place for a non-surgical resident in a burn ICU or a TICU? Meaning is the OR part of the daily workload, or is the actual surgical management of those ICU patients another team's responsibility? Do EM residents and Intensivist Fellows often rotate through?

We always had a CC fellow (surgical), anesthesia and sometimes EM in the adult units. None of them participated in operative care but would do bronchus/PEGs/trachs/central lines/Swans etc. if the surgical residents had made their quotas. It was BY FAR the least favorite rotation of the EM and Anesthesia guys (except the latter with an interest in CC). IMHO there is certainly room for a non-surgical resident in the ICU since much of ICU management, especially TICU is non-surgical.

As noted above, daily debridement or "tub scrubs" is common in a Burn unit, but not necessarily in a PICU/TICU with the exception of bedside procedures or patients with open abdomens/nec fast, etc.

Some ICUs are closed units which means that daily management is done by the ICU team; others are open with variable input from the primary service.

3) For wards with mixed Pediatric and adult patient populations, have you guys ever seen a 'peds only' rotator? I can only find a handful of dedicated pediatric burn units and TICUs, and none of them are close to home. On the other hand I'm sure I would not trust myself to take care of an elderly burn victim. Its been a long time since I've treated a patient with longstanding heart disease or type II diabetes.

Any other guidance would also be appreciated.

I've never seen a ward with "mixed pediatric and adult patient populations"; is this common in smaller hospitals or those without a Children's Hospital?

 

[VisionaryTics]

Out of curiosity what was your role as a medical student, and how did you feel it was as a learning experience? How much time did you spend in and out of the OR? I imagine as a Peds resident my role would be very medical student-ish.

My role on the burn team was prerounding on all patients, tracking lines and cultures, rounding and writing notes on non-ICU burn patients and wound consults. I helped with daily dressing changes if I had time.

OR twice per week. I scrubbed but my role was limited to lifting limbs, occasionally stapling grafts or debriding wounds.

We had a trauma/cc fellow and two PGY3 burn fellows, so they did most of the daily management of our big burns.

I had an active role in the trauma bay, and put in a couple of lines. The interns and residents put in a ton of tough central lines and a-lines, plus bronchs.

I learned a ton about wound care and critical care physiology. Burn patients are inflammation run wild. Lots of ID, nutrition, fluids, and electrolytes. These aren't SICU patients who are weathering a brief perturbation of their physiology; these guys spends months in SIRS.