Orientation to the ICUOrientation to the ICUCritical Care Lecture Series

ICUWelcome

ICU is one of the most demanding rotations you will do

Also is very rewarding educationally Expect to be tired

You will deal with life and death everyday You will be on the steep side of the learning

curve You will survive…..

ICUThe nuts and bolts

Morning rounds Teaching sessions Afternoon rounds Call Procedures Evaluations Journal club Grand rounds www.dalccm.com

ICUMorning Rounds

Start at 9 a.m.

You will subdivide patients, review them and have a plan ready by that time.

If you are post call you will inform your colleagues of major changes in patient status and new admissions

You will present your assessment and plan to the team

Xrays will be reviewed at completion of rounds

A “to do” list will be generated and delegated at completion of rounds

ICUMorning Rounds

If you have academic half day do not round on patient We cannot just read your note If you review a patient you must be present to present them.

You may be asked to not simply read your note, but to present your patient without notes.

Report should start with a general overview on the patient’s diagnosis and status.

Assessments and therapeutic plans should be system by system, head to toe.

A summary statement should conclude your presentation.

ICUTeaching Sessions

If the unit isn’t crazy goal is to teach at least 1 hour/day.

Usually will occur sometime between 11 and 1.

It is strongly encouraged that you attend the teaching session if you are post call.

The teaching schedule is circulated prior to your rotation.

It is expected that you have done some reading to prepare for the session.

If a session cannot be done, it will be rescheduled.

ICUTeaching Sessions

Simulator sessions every Tuesday afternoon. You will have the opportunity to learn

crisis management skills You will have the opportunity to deal with

uncommon, life threatening conditions

ICUDischarges

Prior to leaving the ICU a patient must have:

Transfer orders Written, signed and dated the day of

discharge ICU summary note Dictated note (priority dictation)

ICUAfternoon Rounds

At 4 pm the night shift attending will do rounds with the team and the day time attending

You will present the major issues that need ongoing management over the night and indicate possible pit falls

The team then leaves except for the on call resident

ICUCall

You will manage the unit independently (except for PGY1)

Do not hesitate to call your staff

You will see consults on the floor and the emerg but…..

Your responsibility is to the patients in the unit. You are not responsible for prolonged resuscitations on the floor or the emergency department.

You are not the code team at the HI but you are at the VG

ICUProcedures

You will be exposed to: Central line insertion Arterial line insertion Intubation Chest tube insertion LP Thoracentesis Paracentesis Tracheostomy US guidance Feeding tube insertion

ICUProcedures

You must learn during your rotation: Central line insertion Arterial line insertion Emergency airway management

Residents who have proficiency in these skills may teach other residents

If you are not expert in a skill ask for assistance from your staff. Remember do no harm.

All procedures are to be recorded in your log book. Indicate failed attempts and complications

The log book is a formative record of your experience

Failed attempts/complications will not be held against you.

ICUEvaluations

Every Friday afternoon you receive formal feedback on the week’s performance.

This evaluation is forwarded to the education office which creates a final evaluation for your rotation based on each of the evaluations.

The night time staff also submit evaluations

ICUEvaluations

At the completion of the rotation you will have the opportunity to provide feedback to the staff and evaluate the rotation in general.

ICUJournal Club

Held on a monthly basis

Discuss articles chosen by the attending staff

You may be chosen (lucky you!) to present an article and evaluate it’s quality based on the JAMA guidelines

Attendance is mandatory

ICUGrand Rounds

First Tuesday of every month 378 Bethune building 12 pm Attendance is mandatory Often comes with food….mmmm

foooood!

ICUwww.dalccm.com

Website for the critical care program at Dalhousie

Excellent resource of talks and seminars You get access by paying the price of

performing a formative MCQ test.

ICUTips for Survival

Ask for guidance/tips from the old guard already here

Listen to the nurses Call your attending Devil is in the details Think before you speak Assume everyone else is an idiot:

Do not take information at face value Make sure that errors are not propogated

ICUSummary

This will be a rotation you will never forget.

Hard work pays off in developing skills you need to save lives.

It will be scary but you have lots of backup.

Any concerns call Karen Berry on 3608