Orientation To The Icu


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Orientation To The Icu

  1. 1. Orientation to the ICU Critical Care Lecture Series
  2. 2. Welcome <ul><li>ICU is one of the most demanding rotations you will do </li></ul><ul><li>Also is very rewarding educationally </li></ul><ul><li>Expect to be tired </li></ul><ul><ul><li>You will deal with life and death everyday </li></ul></ul><ul><ul><li>You will be on the steep side of the learning curve </li></ul></ul><ul><li>You will survive….. </li></ul>
  3. 3. The nuts and bolts <ul><li>Morning rounds </li></ul><ul><li>Teaching sessions </li></ul><ul><li>Afternoon rounds </li></ul><ul><li>Call </li></ul><ul><li>Procedures </li></ul><ul><li>Evaluations </li></ul><ul><li>Journal club </li></ul><ul><li>Grand rounds </li></ul><ul><li>www.dalccm.com </li></ul>
  4. 4. Morning Rounds <ul><li>Start at 9 a.m. </li></ul><ul><li>You will subdivide patients, review them and have a plan ready by that time. </li></ul><ul><li>If you are post call you will inform your colleagues of major changes in patient status and new admissions </li></ul><ul><li>You will present your assessment and plan to the team </li></ul><ul><li>Xrays will be reviewed at completion of rounds </li></ul><ul><li>A “to do” list will be generated and delegated at completion of rounds </li></ul>
  5. 5. Morning Rounds <ul><li>If you have academic half day do not round on patient </li></ul><ul><ul><li>We cannot just read your note </li></ul></ul><ul><ul><li>If you review a patient you must be present to present them . </li></ul></ul><ul><li>You may be asked to not simply read your note, but to present your patient without notes. </li></ul><ul><li>Report should start with a general overview on the patient’s diagnosis and status. </li></ul><ul><li>Assessments and therapeutic plans should be system by system, head to toe. </li></ul><ul><li>A summary statement should conclude your presentation. </li></ul>
  6. 6. Teaching Sessions <ul><li>If the unit isn’t crazy goal is to teach at least 1 hour/day. </li></ul><ul><li>Usually will occur sometime between 11 and 1. </li></ul><ul><li>It is strongly encouraged that you attend the teaching session if you are post call. </li></ul><ul><li>The teaching schedule is circulated prior to your rotation. </li></ul><ul><li>It is expected that you have done some reading to prepare for the session. </li></ul><ul><li>If a session cannot be done, it will be rescheduled. </li></ul>
  7. 7. Teaching Sessions <ul><li>Simulator sessions every Tuesday afternoon. </li></ul><ul><li>You will have the opportunity to learn </li></ul><ul><ul><li>crisis management skills </li></ul></ul><ul><li>You will have the opportunity to deal with </li></ul><ul><ul><li>uncommon, life threatening conditions </li></ul></ul>
  8. 8. Discharges <ul><li>Prior to leaving the ICU a patient must have: </li></ul><ul><ul><li>Transfer orders </li></ul></ul><ul><ul><ul><li>Written, signed and dated the day of discharge </li></ul></ul></ul><ul><ul><li>ICU summary note </li></ul></ul><ul><ul><li>Dictated note (priority dictation) </li></ul></ul>
  9. 9. Afternoon Rounds <ul><li>At 4 pm the night shift attending will do rounds with the team and the day time attending </li></ul><ul><li>You will present the major issues that need ongoing management over the night and indicate possible pit falls </li></ul><ul><li>The team then leaves except for the on call resident </li></ul>
  10. 10. Call <ul><li>You will manage the unit independently (except for PGY1) </li></ul><ul><li>Do not hesitate to call your staff </li></ul><ul><li>You will see consults on the floor and the emerg but….. </li></ul><ul><li>Your responsibility is to the patients in the unit. You are not responsible for prolonged resuscitations on the floor or the emergency department. </li></ul><ul><li>You are not the code team at the HI but you are at the VG </li></ul>
  11. 11. Procedures <ul><li>You will be exposed to: </li></ul><ul><ul><li>Central line insertion </li></ul></ul><ul><ul><li>Arterial line insertion </li></ul></ul><ul><ul><li>Intubation </li></ul></ul><ul><ul><li>Chest tube insertion </li></ul></ul><ul><ul><li>LP </li></ul></ul><ul><ul><li>Thoracentesis </li></ul></ul><ul><ul><li>Paracentesis </li></ul></ul><ul><ul><li>Tracheostomy </li></ul></ul><ul><ul><li>US guidance </li></ul></ul><ul><ul><li>Feeding tube insertion </li></ul></ul>
  12. 12. Procedures <ul><li>You must learn during your rotation: </li></ul><ul><ul><li>Central line insertion </li></ul></ul><ul><ul><li>Arterial line insertion </li></ul></ul><ul><ul><li>Emergency airway management </li></ul></ul><ul><li>Residents who have proficiency in these skills may teach other residents </li></ul><ul><li>If you are not expert in a skill ask for assistance from your staff. Remember do no harm . </li></ul><ul><li>All procedures are to be recorded in your log book. Indicate failed attempts and complications </li></ul><ul><li>The log book is a formative record of your experience </li></ul><ul><li>Failed attempts/complications will not be held against you. </li></ul>
  13. 13. Evaluations <ul><li>Every Friday afternoon you receive formal feedback on the week’s performance. </li></ul><ul><li>This evaluation is forwarded to the education office which creates a final evaluation for your rotation based on each of the evaluations. </li></ul><ul><li>The night time staff also submit evaluations </li></ul>
  14. 14. Evaluations <ul><li>At the completion of the rotation you will have the opportunity to provide feedback to the staff and evaluate the rotation in general. </li></ul>
  15. 15. Journal Club <ul><li>Held on a monthly basis </li></ul><ul><li>Discuss articles chosen by the attending staff </li></ul><ul><li>You may be chosen (lucky you!) to present an article and evaluate it’s quality based on the JAMA guidelines </li></ul><ul><li>Attendance is mandatory </li></ul>
  16. 16. Grand Rounds <ul><li>First Tuesday of every month </li></ul><ul><li>378 Bethune building </li></ul><ul><li>12 pm </li></ul><ul><li>Attendance is mandatory </li></ul><ul><li>Often comes with food….mmmm foooood! </li></ul>
  17. 17. www.dalccm.com <ul><li>Website for the critical care program at Dalhousie </li></ul><ul><li>Excellent resource of talks and seminars </li></ul><ul><li>You get access by paying the price of performing a formative MCQ test. </li></ul>
  18. 18. Tips for Survival <ul><li>Ask for guidance/tips from the old guard already here </li></ul><ul><li>Listen to the nurses </li></ul><ul><li>Call your attending </li></ul><ul><li>Devil is in the details </li></ul><ul><li>Think before you speak </li></ul><ul><li>Assume everyone else is an idiot: </li></ul><ul><ul><li>Do not take information at face value </li></ul></ul><ul><ul><li>Make sure that errors are not propogated </li></ul></ul>
  19. 19. Summary <ul><li>This will be a rotation you will never forget. </li></ul><ul><li>Hard work pays off in developing skills you need to save lives. </li></ul><ul><li>It will be scary but you have lots of backup. </li></ul><ul><li>Any concerns call Karen Berry on 3608 </li></ul>