Any advice for an ICU rotation???

[esfh]

I have my first ICU rotation coming up in August. Any advice from people who have been through it? I have never had an ICU rotation so I feel as though I don't know anything! Do interns end up calling their senior for almost everything at the beginning?
Thanks!

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[joaquin13]

"The ICU Book" is supposed to be good. Im a medical student, but did ICU last month. The interns worked with the residents mostly, ICU patients are hard to handle, even for 2-3rd yr residents.

Im not sure how it will work at your place.
Be ready for lots of procedures!

 

[xcsdwe23]

pH/pCO2/PO2/%O2

left side is ventilation (pH/pCO2), right side is oxygenation

to affect left side of eqn, change respiratory rate first, then tidal volume

right side is affected by % FIO2

Important Vent Settings:
Mode: AC
RR: varies, b/n 10-20's
Tidal Volume: 400-600 (usually; bigger people higher volumes)
%FIO2: everyone starts on 100%, then adjust vaules based on first ABG after intubation.

AG= Na- (CL+HCO3)
Winter's Formula (for metabolic acidosis to see if mixed disorder)= 1.5HCO3 + 8= expected pCO2

That's a good start for ICU.

 

[Bobblehead]

Get to know the nurses, they can make your life miserable or they can make your month a decent experience. ICU nurses are in general very knowledgable about critical care issues. Learn the dynamics of your particular ICU (i.e. on admission does the stat patient bath take priority over the intern examination--and believe me if it does, do not interfere). For the most part letting the nurses fiddle with the patient's drips, etc. is probably the best than trying to micromanage things unless you feel that your direct involvement in that specific patient will imminently affect mortality. Unfortunately you'll also have to be involved in some of the micromanagement aspects (i.e. we want this patient net negative by morning so he'll need at least 3 doses of IV lasix) as it really does work more like a hierarchy in the unit. That is the attending will be concentrating on the big picture but will rely on the housestaff to tell him that the patient's sodium has dropped another 5 points, the patient weighs 0.5kg more etc. to make those overall management decisions.

As for calling for help, learn the particular flow of your institution but at most good places the senior residents should be expecting their interns to call early and call often. There's nothing worse than being surprised an hour before rounds start by changes made by the intern that could have been discussed in better detail with someone.