Anesthesia ccm to MICU

[sluggs]

My group is planning to hire a newly minted anesthesia ccm grad into a practice that is single coverage, with about 80-90% of the work being bread and butter MICU. No question the candidate is smart and well trained, but his only MICU exposure is as an intern and as a "guest rotator" for 1-2 months in MICU as a fellow. To confound things our hospital has very weak hospitalists and very weak sub-specialty consultants (with a few exceptions). I know that "critical care is critical care" and "it depends on the individual" but can anyone weigh in on preparation for things like cold/status asthmaticus on then vent; ID issues; cirrhotics; medical esoterica... etc...
Any guesses on the "learning curve"?
I know that in my CCM fellowship, I had leeway to focus on all the stuff I had less exposure to in IM: bronchs, intubations, anesthesia, conscious sedation, CVICU, SICU, Neuro ICU
All input appreciated!

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[G-Man82]

I almost took a PP position for ACCM with an Anesthesiology group that also provided critical care services in a community setting where the majority of ICU was medical patients. The staffing was roughly 70-30 ACCM/PCCM. I was told by the director of the ICU (an Anesthesiologist) to get a basic medical review book and read it to brush up on some of the medical esoterica that we didn't see as often in an Anesthesiology residency that focused on SICU for our CCM training. But the critical care portion was essentially the same. The Anesthesiology-trained attendings all ended up doing fine in the MICU setting.

I never had to manage status asthmaticus before, but I have had really bad COPDers in my surgical and ct surgical units. Let them exhale and prevent auto-peep/ dynamic hyperinflation. For the asthmatics especially, use high flows, allow for (at times) pretty permissive hypercapnia. Of course consider all the usual things, too, but if needed, call for sevo- or isoflurane. That is of course after trying deep sedation, paralytics, and other measures like heliox. Don't forget ecmo or ecco2r. A good CCM textbook highlights this well.

Though we didn't see it as much as the PCCM folks, my attendings all made sure we knew how to manage it. I can't speak for all programs, but I think coming out of an ACCM program that's worth it's salt, we should be able to handle most if not all vent issues.

 

[jdh71]

My group is planning to hire a newly minted anesthesia ccm grad into a practice that is single coverage, with about 80-90% of the work being bread and butter MICU. No question the candidate is smart and well trained, but his only MICU exposure is as an intern and as a "guest rotator" for 1-2 months in MICU as a fellow. To confound things our hospital has very weak hospitalists and very weak sub-specialty consultants (with a few exceptions). I know that "critical care is critical care" and "it depends on the individual" but can anyone weigh in on preparation for things like cold/status asthmaticus on then vent; ID issues; cirrhotics; medical esoterica... etc...
Any guesses on the "learning curve"?
I know that in my CCM fellowship, I had leeway to focus on all the stuff I had less exposure to in IM: bronchs, intubations, anesthesia, conscious sedation, CVICU, SICU, Neuro ICU
All input appreciated!

How much "super-hospitalist" work do you do? You know, basically being a hospitalist to medicine pateints because you can't transfer out for one reason or another - politics vary from place to place, so do practice patterns. I'm sure this new guy will be fine with vents and drips and other life-support, but actually managing MICU patients?? These patients keep getting denser by the day. I'm sure anyone can get up to speed but I'd put money on the first 6 months being a bit bumpy, but after that . . . shouldn't be too big a deal but just be ready to help a brother out. After two years I bet you won't even notice a difference.

 

[sluggs]

Hope you are right JDH, but it is hard to know how much IM knowledge we take for granted...

 

[jdh71]

Hope you are right JDH, but it is hard to know how much IM knowledge we take for granted...

The MICU really is the "last house" on the block - where those patients that would never have been in a SICU or CVICU end up.

 

[tartesos]

My group is planning to hire a newly minted anesthesia ccm grad into a practice that is single coverage, with about 80-90% of the work being bread and butter MICU. No question the candidate is smart and well trained, but his only MICU exposure is as an intern and as a "guest rotator" for 1-2 months in MICU as a fellow. To confound things our hospital has very weak hospitalists and very weak sub-specialty consultants (with a few exceptions). I know that "critical care is critical care" and "it depends on the individual" but can anyone weigh in on preparation for things like cold/status asthmaticus on then vent; ID issues; cirrhotics; medical esoterica... etc...
Any guesses on the "learning curve"?
I know that in my CCM fellowship, I had leeway to focus on all the stuff I had less exposure to in IM: bronchs, intubations, anesthesia, conscious sedation, CVICU, SICU, Neuro ICU
All input appreciated!

Shouldn't be a problem after a while. Everyone else has done fine!
But it is a learning curve or getting used to it. He will be fine. I'm assuming is a small town Icu with not many complex( dumps) cases.

 

[europeman]

He will be fine.