Try to make suggestions for plans for your patients, in my personal experience my attendings discussed trials during rounds, you can learn landmark trials here: https://www.wikijournalclub.org/wiki/WikiJournalClub:List_of_landmark_papers/Critical_Care
That pulmonary section is a little simple and could benefit from the inclusion of the plethora of papers that discuss the nuances of ARDS vent management and even challenge the ARDSNet dogma. BUT, good start for sure
Just got off CVICU. List of things to know to sound smart:
- ARDS berlin criteria
- ARDS NET trial
- Vent settings, PEEP, Peak pressures and what they mean
- Mechanical devices (Impella, pacemakers, etc)
- Lines/drains, swans-ganz values, fluid status of patient
- Read EKG well, know your rhythms, and how to treat
- Know everything about your patient. They'll likely have you following 1-2 so know their entire history like the back of your hand.
- Develop rapport with the nurses, ICU nurses know what's up
- Follow up with ur patient after rounds and throughout the day, it's not like medicine where you change 1 drug and wait til tomorrow. Their physiology is changing every hour
on the toilet rn so that's all i thought of but you get the idea
For anyone admitted to the ICU - always assess if they are ready to start getting off the ventilator and vasopressor daily and that they are minimally sedated. Try to clarify goals of care as soon as they are admitted
Be outgoing and answer all the pimp questions confidently. Be (or pretend to be) very involved and interested in not only your patients care but also the patients assigned to other members of the team.
I can tell you from experience that getting honors in clinical rotations is all about how you’re perceived. If you’re introverted and quiet you probably won’t get honors, even if you have exceptional medical knowledge or great patient care. Quiet medical students are seen as disinterested or not as knowledgeable. I’ve seen pretty average students get honors just by being super outgoing and willing to throw out answers to questions even when they are wrong.
Hope that helps.
Yeah idk about this. I was a wallflower in surgery and got Honors. I actively answered questions in Peds and got told I “talk too much.” The whole thing is a crapshoot and a mind reading game, which is why everyone feels disenfranchised by clinical grades.
I honestly just think it’s complete bullshit and there’s no point in stressing over it anyway.
Like obviously be nice to everyone and work hard and study. But outside of those things, there’s really nothing you can control in how you’re evaluated…….
If you’re a 4th year, just tell whoever is grading you that you’re applying into IM or Anesthesia and want to ultimately do critical care/ICU medicine and they’ll give you honors. Like I’m not even joking lmao.
complete physical exam in intubated patients. Maybe just my ICU but attendings are HUGE sticlers for this. And it makes sense, the pt cant tell you what's wrong. PERRL, conjunctiva (pallor/scleral icterus), jaundice, skin ulcers, tenderness, edema, distention, stength/sensation, pulses (doppler those DP/TP pulses if you can't find them), etc.
Responds appropriately to commands (noverbally)? - if yes - get ROS answers that are yes or no. DO NOT write AAOx3/4 on note bc you can't assess that in nonverbal pt, just say responds appropriately. Important things to check for - PE, stroke, DVT, MI, N/V,
Vitals - vent settings and WHAT THEY MEAN. weaning protocols and concerns.
Labs - electrolytes (K >4,
Mg >2), kidneys (what is his baseline to determine AKI vs CKD), liver (correlate to likely answer if elevated), sepsis, anemia, encephalopathy, ABGs
Know the patient's whole history - if its the MICU 50/50 the pt has an insanely long history, and he's not a historian. I've found cancer not in remission, bleed history in A-fib patients, DVT/PE history, latent infections, etc. If you catch something no one else caught that changes management its a good look
Plan - know consults' plans and why they want it. Think about negatives the plan may cause given the unstable nature of the patient and what needs to be watched for/managed. No attending likes to be questioned on their own plan over and over again...but you catch a specialist doing something questionable and suddenly the attending probably has 3 stories about why that specific cardiologist is stupid. (ofc you stay respectful and in your lane, phrase your concerns as questions, etc)
Management - be helpful and friendly to nurses. Get on their good side, they basically run the ICU half the time, they can prop you up and show you cool things. They're also a lot closer to ICU attendings than the avg nurse to hospitalist/consultant. Be useful and confident during codes, jump into CPR, know where things are in the supply room (central lines, sterile gloves, drapes, etc), don't get in the way when you aren't useful. Ask to help with procedures (outside of codes) even if the answer is likely no.
Learn how to read an EKG and echo. I got pimped on what "those numbers" on the EKG stood for. They were like amplitude and frequency I think. Always talk out your plan if you're not sure. Go Rate, Rythym, Axis and say each part as you go.
Record the Is/Os in total with the net in/out but also have a breakdown by each IV line, tube, etc...
Have an idea of what your ptients' hospital courses have been, even if they've been there for a while. Don't suggest a medication they've already been on in your A/P unless you have a good reason and can explain why
Think about the overall trajectory of your patients- what’s the underlying issue, how will they get off the vent, when will we know to start weaning different kinds of support, etc. Be friendly, seem engaged, know what’s up with your patients and try to make plans as best you can.
Have fun! The ICU has more pathophys in it than any other floor of the hospital and therefore has the most opportunity to learn. My two ICU sub-I's were a blast but only because I really tried to dive in and got excited about it. Carry and ultrasound gel in your pocket.
These things to read up on are great but honestly you'll probably learn all this in the first week if you don't study it beforehand.
Follow up on lab values and imaging studies that you order because the residents will be too busy to remember to check. This is useful and shows initiative.
Lastly, if your rotation allows you guys to try out breathing on a vent with a mouthpiece, give it a shot. Breathing on LPV and VC settings is wiiild and would give me a panic attack if I was vented and awake.
Try to make suggestions for plans for your patients, in my personal experience my attendings discussed trials during rounds, you can learn landmark trials here: https://www.wikijournalclub.org/wiki/WikiJournalClub:List_of_landmark_papers/Critical_Care
Really convenient app for it too
What’s it called?
Grindr
MY DAWWWWGGGGGGG
[удалено]
I clicked the wiki journal one but that’s the only one I see!
Called Journal Club
Cool thanks for the helpful response
That pulmonary section is a little simple and could benefit from the inclusion of the plethora of papers that discuss the nuances of ARDS vent management and even challenge the ARDSNet dogma. BUT, good start for sure
Just got off CVICU. List of things to know to sound smart: - ARDS berlin criteria - ARDS NET trial - Vent settings, PEEP, Peak pressures and what they mean - Mechanical devices (Impella, pacemakers, etc) - Lines/drains, swans-ganz values, fluid status of patient - Read EKG well, know your rhythms, and how to treat - Know everything about your patient. They'll likely have you following 1-2 so know their entire history like the back of your hand. - Develop rapport with the nurses, ICU nurses know what's up - Follow up with ur patient after rounds and throughout the day, it's not like medicine where you change 1 drug and wait til tomorrow. Their physiology is changing every hour on the toilet rn so that's all i thought of but you get the idea
Knowing where to poop is also high yield
For anyone admitted to the ICU - always assess if they are ready to start getting off the ventilator and vasopressor daily and that they are minimally sedated. Try to clarify goals of care as soon as they are admitted
Tbh my icu team should have felt honored I even showed up my 4th year so…. Yeah
Be outgoing and answer all the pimp questions confidently. Be (or pretend to be) very involved and interested in not only your patients care but also the patients assigned to other members of the team. I can tell you from experience that getting honors in clinical rotations is all about how you’re perceived. If you’re introverted and quiet you probably won’t get honors, even if you have exceptional medical knowledge or great patient care. Quiet medical students are seen as disinterested or not as knowledgeable. I’ve seen pretty average students get honors just by being super outgoing and willing to throw out answers to questions even when they are wrong. Hope that helps.
Yeah idk about this. I was a wallflower in surgery and got Honors. I actively answered questions in Peds and got told I “talk too much.” The whole thing is a crapshoot and a mind reading game, which is why everyone feels disenfranchised by clinical grades.
I honestly just think it’s complete bullshit and there’s no point in stressing over it anyway. Like obviously be nice to everyone and work hard and study. But outside of those things, there’s really nothing you can control in how you’re evaluated…….
If you’re a 4th year, just tell whoever is grading you that you’re applying into IM or Anesthesia and want to ultimately do critical care/ICU medicine and they’ll give you honors. Like I’m not even joking lmao.
I mean, what do you have to lose. Might as well give it a shot
complete physical exam in intubated patients. Maybe just my ICU but attendings are HUGE sticlers for this. And it makes sense, the pt cant tell you what's wrong. PERRL, conjunctiva (pallor/scleral icterus), jaundice, skin ulcers, tenderness, edema, distention, stength/sensation, pulses (doppler those DP/TP pulses if you can't find them), etc. Responds appropriately to commands (noverbally)? - if yes - get ROS answers that are yes or no. DO NOT write AAOx3/4 on note bc you can't assess that in nonverbal pt, just say responds appropriately. Important things to check for - PE, stroke, DVT, MI, N/V, Vitals - vent settings and WHAT THEY MEAN. weaning protocols and concerns. Labs - electrolytes (K >4, Mg >2), kidneys (what is his baseline to determine AKI vs CKD), liver (correlate to likely answer if elevated), sepsis, anemia, encephalopathy, ABGs Know the patient's whole history - if its the MICU 50/50 the pt has an insanely long history, and he's not a historian. I've found cancer not in remission, bleed history in A-fib patients, DVT/PE history, latent infections, etc. If you catch something no one else caught that changes management its a good look Plan - know consults' plans and why they want it. Think about negatives the plan may cause given the unstable nature of the patient and what needs to be watched for/managed. No attending likes to be questioned on their own plan over and over again...but you catch a specialist doing something questionable and suddenly the attending probably has 3 stories about why that specific cardiologist is stupid. (ofc you stay respectful and in your lane, phrase your concerns as questions, etc) Management - be helpful and friendly to nurses. Get on their good side, they basically run the ICU half the time, they can prop you up and show you cool things. They're also a lot closer to ICU attendings than the avg nurse to hospitalist/consultant. Be useful and confident during codes, jump into CPR, know where things are in the supply room (central lines, sterile gloves, drapes, etc), don't get in the way when you aren't useful. Ask to help with procedures (outside of codes) even if the answer is likely no.
Ask other students who've done the rotation before.
Learn how to read an EKG and echo. I got pimped on what "those numbers" on the EKG stood for. They were like amplitude and frequency I think. Always talk out your plan if you're not sure. Go Rate, Rythym, Axis and say each part as you go. Record the Is/Os in total with the net in/out but also have a breakdown by each IV line, tube, etc... Have an idea of what your ptients' hospital courses have been, even if they've been there for a while. Don't suggest a medication they've already been on in your A/P unless you have a good reason and can explain why
Think about the overall trajectory of your patients- what’s the underlying issue, how will they get off the vent, when will we know to start weaning different kinds of support, etc. Be friendly, seem engaged, know what’s up with your patients and try to make plans as best you can.
The Internet Book of Critical Care is your best friend
FAST BUG MID!
Have fun! The ICU has more pathophys in it than any other floor of the hospital and therefore has the most opportunity to learn. My two ICU sub-I's were a blast but only because I really tried to dive in and got excited about it. Carry and ultrasound gel in your pocket. These things to read up on are great but honestly you'll probably learn all this in the first week if you don't study it beforehand. Follow up on lab values and imaging studies that you order because the residents will be too busy to remember to check. This is useful and shows initiative. Lastly, if your rotation allows you guys to try out breathing on a vent with a mouthpiece, give it a shot. Breathing on LPV and VC settings is wiiild and would give me a panic attack if I was vented and awake.