s**********t
发帖数: 217 | 1 Normally, I let the residents to report the new cases to me, not the interns
. Sorry for the new interns.
So, here, I am going to focus on what do you need to know for the follow up
patient.
As an ICU intern, you will get a sign out from your night intern(s), either
oral or in written or both the first thing in the morning. So, you know what
’s going on after you leave. That is from doctor’s standpoint. Then go to
talk to the nurse. You will get information from the nurse’s standpoint.
Sometimes the nurse gives you more information than you coworkers,
especially in the first couple month of the academic year. Then, you go to
see the patient, and get the things your resident and your attending want.
When you report to your attending, there is something I want to you guys to
keep in mind.
First, I want you to give your colleagues a brief story of this patient,
what is the background, why the patient is admitted to the ICU, and what are
the current problems. Then you will tell the team what happened after
yesterday round, especially the recommendations from the consultants, and
follow-ups.
Second, I want to know the details of the patient’s medications. Any
pressers, any drips, any medication has been changed in the last 24 hours.
Any antibiotics, what’s for, and the planned duration. Any sedation, are
they being titrated or not. If not, why?
Third, the iv access: central lines, dialysis catheters, PICC line, Foley,
feeding tube, ET tube, A line, etc. When they are placed. Any plan for
changing?
Forth, patient’s diet, tube feeding. The goal rate of the tube feed. If the
patient does not reach the goal, why? What are the patient’s accu checks,
and how is the glucose being controlled.
Fifth, Ventilator plays a big role in the ICU. Read about it before you get
in the ICU. You need to know the vent settings, the weaning parameters. Does
your patient do weaning or not in the past 24 hours. If does, how long does
the patient weaned, how does he do? Why the patient is put back on the vent
, instead of continuing to wean. If does not do weaning, why? You need to
know the reason.
Sixth, your physical exams: vital, Tmax, Tc, HR, BP range, RR, the patient’
s input/output in the past 24 hours, and in the last 8 hours.
Seventh, your patient’s labs: The detail numbers, and the trend.
Eighth, the micros: Any new positive cultures or significant negative
cultures.
Ninth, imagine studies: CXR, ultrasound, CT, MRI, etc..
Tenth, your plan for today by systems, so you are not going to miss anything
. At the end, do not forget the GI and DVT prophylaxis.
The intern plays a big role in the ICU. You are the key person between your
patient, and the nurse, resident, attending, consultants. You need to know
your patient in details, and your daily plan for your patient. So, when you
talk to the consultants, you will give them what they want. You need to
follow up things what we discussed in the morning round and keep your
resident and attending updated. If there is any question about your patient,
you do not feel comfortable to handle, call your resident or attending.
The ICU nurses know a lot. But majority of them are from nurse standpoint.
They lack the whole picture of the patient as a MD does. You need to build
up good relationship with the nurses if you do want your ICU rotation go
smoothly.
Above is something I can think about for the new ICU interns. PM me if you
have any questions. | S**********e
发帖数: 1325 | 2 先发包子，再收藏，再仔细看。第三个block就是icu，到时候救命用！ | s*****1
发帖数: 273 | | m******r
发帖数: 1904 | | h**s
发帖数: 1757 | | e****0
发帖数: 678 | 6 前辈辛苦了。
准备收藏打印，和COFFEE MM 一样， ICU救命用！
谢谢
【在 m******r 的大作中提到】
: thanks for sharing!
| z****o
发帖数: 368 | 7 Thank you! very useful information | c***y
发帖数: 811 | 8 感谢前辈！收藏了！
interns
【在 s**********t 的大作中提到】
: Normally, I let the residents to report the new cases to me, not the interns
: . Sorry for the new interns.
: So, here, I am going to focus on what do you need to know for the follow up
: patient.
: As an ICU intern, you will get a sign out from your night intern(s), either
: oral or in written or both the first thing in the morning. So, you know what
: ’s going on after you leave. That is from doctor’s standpoint. Then go to
: talk to the nurse. You will get information from the nurse’s standpoint.
: Sometimes the nurse gives you more information than you coworkers,
: especially in the first couple month of the academic year. Then, you go to
| D********r
发帖数: 119 | 9 Thank you soooooo much! ;p | l*******8
发帖数: 290 | | | | b******a
发帖数: 704 | | w******y
发帖数: 4871 | 12 哈哈，俺的ICU rotation 已经全部结束了。最后一周ICU夜班，人品爆发，病人平安，
没有新病人，护士也不page我，俺天天睡到天亮:).
【在 s**********t 的大作中提到】
: Normally, I let the residents to report the new cases to me, not the interns
: . Sorry for the new interns.
: So, here, I am going to focus on what do you need to know for the follow up
: patient.
: As an ICU intern, you will get a sign out from your night intern(s), either
: oral or in written or both the first thing in the morning. So, you know what
: ’s going on after you leave. That is from doctor’s standpoint. Then go to
: talk to the nurse. You will get information from the nurse’s standpoint.
: Sometimes the nurse gives you more information than you coworkers,
: especially in the first couple month of the academic year. Then, you go to
| s**********t
发帖数: 217 | 13 What do u want to hear?
【在 l*******8 的大作中提到】
: 接着读。
: 前辈请连载。
: 谢谢！
| s**********t
发帖数: 217 | 14 Lucky you. For no reason, the senses for micu is low everywhere in my area
too. Just jenjoy it.
【在 w******y 的大作中提到】
: 哈哈，俺的ICU rotation 已经全部结束了。最后一周ICU夜班，人品爆发，病人平安，
: 没有新病人，护士也不page我，俺天天睡到天亮:).
| p*********1
发帖数: 65 | | l*******8
发帖数: 290 | 16 您写的“What do I want to know from my intern?”和这篇“What do I want to
know from my ICU intern?"非常instructive，对intern的临床工作有指导意义。
您能再通过您自己成功的经历，从宏观上讲一讲怎样充实自己做好resident，然后成长
为一位业务出色的attending吗？
我说到的话题可能有点大，毕竟没有什么临床经验，实在是需要前辈的指点。
您说的只言片语就够我消化半天的了。
多谢！
【在 s**********t 的大作中提到】
: What do u want to hear?
| c***y
发帖数: 811 | 17 每次翻出来读，都很受益。
感谢前辈。
interns
up
【在 s**********t 的大作中提到】
: Normally, I let the residents to report the new cases to me, not the interns
: . Sorry for the new interns.
: So, here, I am going to focus on what do you need to know for the follow up
: patient.
: As an ICU intern, you will get a sign out from your night intern(s), either
: oral or in written or both the first thing in the morning. So, you know what
: ’s going on after you leave. That is from doctor’s standpoint. Then go to
: talk to the nurse. You will get information from the nurse’s standpoint.
: Sometimes the nurse gives you more information than you coworkers,
: especially in the first couple month of the academic year. Then, you go to
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