FM Critical Care Fellowships?

[EdibleEgg]

Both sides in this arguement need a dose of humility. I've worked in a ten bed critical access hospital and major tertiary care center with an ICU larger than my current 88 bed hospital. Critical care has a different standard in all of them. It is arrogant to insinuate that you can define the scope of practice for someone else (and if you are basing the acuity of a DKA patient on pH alone, then you haven't managed enough DKA). I have a huge problem with anyone coming along and defining my scope, and every time I've seen anyone try, it was based on arrogance and money, not patient care. If you don't believe it, come to my hospital and just try to get an uninsured patient transferred at three in the morning.

Medicinedoc, I think I understand what you are trying to convey. I agree that FP's belong in the ICU. Closed ICU's and mandatory CC consults are crap. However, implying that CC is useless is very similar to saying that NP's can take the place of FP's. If you've never been a situation were your butt puckered enough to make you wish you had some help, then you haven't done enough CC.

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[Instatewaiter]

You haven't the foggiest idea of what would or wouldn't be sent to the ICU at other's hospitals, and what would get our heads on sticks.
What would be sent to ICU at one hospital would be sent to tele at another.

This was my entire point. Acuity of a patient is relative to where you are. It is a rare sight for RVR to go to a CCU where I am. We turn them around quickly in the ED and take them to the floor. Unless I just shocked an A-fibber multiple times, I would probably get laughed at if I tried to bring them to the unit. However where I am tends to have a reputation for being more marine-like than some other programs. Regularly we will have our A-fibbers on a dilt drip or amio drip either in a monitored bed or step down. That could be blasphemy at some institutions. We tend to do just fine.

Llike other programs around the country we don't ever send out patients to other ICUs, they get sent to us. This is not meant to be an arrogance thing (although I admit is probably is gonna come off that way) but speaks more to the fact that we are set up to only accept the very sickest into our ICUs. Everything else can be managed in a step down. When another hospital doesn't have the resources to take care of a sick patient, they send 'em to a quarternary care hospital. Those hospitals are going to be set-up very differently from a community hospital or even a smaller university hospital.

This whole thread is a complete waste of time and just represents a couple of immature residents/ barely out of residency critical care fellows who see fm in the icu as stepping on their turf.

Dude, first of all, I don't think FM is really every going to encroach on a CCM guy's turf. I think you basically proved that for us.

Second, I have no dog in this fight. I don't want to do CCM and I am about as far away from being a fellow as I could be.

Dying/coding nonstable patients don't belong in "step down units". It doesn't matter what you define as a step down unit. A septic dying patient is actually more straight forward than a patient with multiple life threatening arrhythmias and if you don't call that critical care you are just a *****.

Again the distinction here is that what one would consider a dying patient, does not get the same distinction at some other places.

If the patient has afib with rvr that patient could be on the verge of crashing.

Sure. Similarly a guy with pneumonia could also be on the verge of crashing. Neither necessitate an ICU admission just because they carry a certain diagnosis.

 

[MedicineDoc]

Okay whatever. Someone else feel free to engage our critical care and IM guests. There is sure to be more fun with them with a link from their all ICUs should be closed thread (aftermath of leapfrog) if anyone else would like to play. I have other obligations and goals that preclude my further participation even aside from the moderators warning.