What is an ICU rotation like?

[axeon123]

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Hi, just wanted to ask what an ICU rotation is like. I'll be starting in about two weeks. I initially thought it would be similar to internal medicine, but just in a more "ICU-like" setting. But after talking with a first year resident in a different field, it sounds like it involves less of the internal medicine-aspect, but more focused on ventilation, ventilation settings, ventilation weaning? I'd appreciate it if someone can enlighten me on what to expect on an ICU rotation, what you do on call days, etc. On internal medicine, we would admit patients on call and the other times we would round and determine the diagnosis and do all necessary to manage the patient well enough to be discharged, eg pneumonia some x-ray and antibiotics and discharge after criteria met. I'll be picking up the ICU book soon to read sections I feel are important to know what is going on with the patient. Thanks.

 

[deleted263296]

You and the residents will likely work in shifts. The fellow and attending will be present during the day for procedures (intubations, bronchoscopies, thoracenteses, line placements). The fellow takes call from home overnight and directs admissions to the ICU but will come in if necessary. Taking call as a student/resident is no different than working two shifts in a row, it just depends on how your ICU schedules the residents hours. You admit new patients all day everyday. Your residents will be expected to be present in the ICU at all times during their shift. Patients will come from outside hospitals, the ED, other inpatient units, or overflow from other ICUs. You may also be required to attend all STATs.

The goals of patient care are different than on internal medicine wards. You need to maintain the stabilization that was begun in the ED and manage them until they no longer require ventilatory or pressor support for at least 24 hours. Once they meet this criteria, you will transfer them to the "floor" for completion of antibiotics and placement. You will simultaneously be managing mostly the same issues as you did on your medicine rotation, except you generally don't deal with placement. As far as adjusting the ventilator and pressors, your hospital will have protocols in place to wean patients off the ventilator and nurses wean the pressors to BP goals you set.

The most common admission will be septic shock. Other conditions you will likely see in the MICU include overdoses, CHF exacerbations, COPD exacerbations, DKA, cardiogenic shock, GI bleeds. You will look at a lot of CXRs and ECGs so you better learn to read them well.

The best example of the difference between the MICU and the general medicine rotation is this. An ICU doctor will always be more concerned with the treatment rather than belaboring the diagnosis. A lot of times you will not know what the underlying cause of the critical condition was but at least you saved that patient's life.

 

[DrDrToBe]

Hi, just wanted to ask what an ICU rotation is like. I'll be starting in about two weeks. I initially thought it would be similar to internal medicine, but just in a more "ICU-like" setting. But after talking with a first year resident in a different field, it sounds like it involves less of the internal medicine-aspect, but more focused on ventilation, ventilation settings, ventilation weaning? I'd appreciate it if someone can enlighten me on what to expect on an ICU rotation, what you do on call days, etc. On internal medicine, we would admit patients on call and the other times we would round and determine the diagnosis and do all necessary to manage the patient well enough to be discharged, eg pneumonia some x-ray and antibiotics and discharge after criteria met. I'll be picking up the ICU book soon to read sections I feel are important to know what is going on with the patient. Thanks.

I have an ICU rotation coming up soon, what is the "ICU book" that you're referring to?

 

[axeon123]

Right here: http://www.amazon.com/ICU-Book-3rd-Paul-Marino/dp/078174802X/ref=dp_ob_title_bk

I'd read a few articles: ARDSNet study, albumin vs saline NEJM 2004, NICE Sugar study, rbc transfusion and clinical outcomes JAMA 2004, antibiotics for VAP JAMA 2003, one of the papers on early goal-directed treatment of sepsis.

 

[turkeyjerky]

Right here: http://www.amazon.com/ICU-Book-3rd-Paul-Marino/dp/078174802X/ref=dp_ob_title_bk

I'd read a few articles: ARDSNet study, albumin vs saline NEJM 2004, NICE Sugar study, rbc transfusion and clinical outcomes JAMA 2004, antibiotics for VAP JAMA 2003, one of the papers on early goal-directed treatment of sepsis.

I don't really get the fixation people have w/ telling students to read seminal articles. It's really not an efficient way to study, and you run the risk of reading only a single article and missing the broader context and the impact of more recent studies. So, yeah, you could read all those articles, but a better approach would be to read recent review articles on those subjects. IMHO, you'll get a lot more out of reading the surviving sepsis guidelines than you will from reading the Rivers article.

 

[DrDrToBe]

I don't really get the fixation people have w/ telling students to read seminal articles. It's really not an efficient way to study, and you run the risk of reading only a single article and missing the broader context and the impact of more recent studies. So, yeah, you could read all those articles, but a better approach would be to read recent review articles on those subjects. IMHO, you'll get a lot more out of reading the surviving sepsis guidelines than you will from reading the Rivers article.

I actually love reading seminal articles. I usually rely on books, uptodate, classes etc to get the big picture, but when you read the actual article the info tends to stick better. Plus coming from a research background, it's nice to assess the methodology and see how appplicable the data is to specific patient populations.

 

[bleeker10]

If you are planning on going into IM, then buying the ICU book is a good idea. If you aren't, then I wouldn't buy it now. It's a very big book and more than you need for a 4 week rotation. Maybe the hospital library has a copy you can read.

I did an ICU rotation and did fine with U2D, Step Up, and asking questions/listening to lectures from the residents and attendings.

I didn't have a great understanding of fluids (I/O, which to use, etc) until I did the ICU rotation. I learned a lot about shock, vents, overdoses, pressors, antibiotics from the rotation.

 

[Depakote]

If you have the time to read, The ICU book is a really good text and I highly recommend it. It has great discussions about the pathophysiology of many conditions you'll see, it talks about the the treatments you'll be performing and the complications you'll need to watch for. It's a thick and intimidating looking text, but it's very approachable and easy to read if you manage to sit down and attack it. As a student, if you can get through this during your ICU month (doable), you'll really take a lot out of the experience.

 

[jdh71]

The ICU book is old. Generally ok for explaining pathophys, but some of the specific recommendations aren't so great anymore.

I wouldn't recommend reading the whole thing as I think it'd be generally a waste of time.

The best thing a medical student can do in my opinion is 1) show up, 2) be interested, and 3) ask questions (lots of questions).

When I'm in the unit not only do I, but my attendings run into situations ALL the time where we simply aren't exactly sure what is going on. As such I don't expect residents to know everything, and therefore definitely not the students. It's not like the wards in what we expect medical students to know.

 

[axeon123]

I actually love reading seminal articles. I usually rely on books, uptodate, classes etc to get the big picture, but when you read the actual article the info tends to stick better. Plus coming from a research background, it's nice to assess the methodology and see how appplicable the data is to specific patient populations.

Agreed. I do read review articles, but I end up reading some of the papers they reference. I feel I get a deeper understanding of the why, instead of memorizing a list of "guidelines," which I will never remember.

The ICU book is old. Generally ok for explaining pathophys, but some of the specific recommendations aren't so great anymore.

I wouldn't recommend reading the whole thing as I think it'd be generally a waste of time.

The best thing a medical student can do in my opinion is 1) show up, 2) be interested, and 3) ask questions (lots of questions).

I can't recall now, but I did not read the entire book, instead focus on specific sections that would be useful (respiratory, fluid management, transfusion). Some attendings love getting into the technical stuff, like how do you calculate oxygen content in the blood.