ICU
What Goes in Your Pockets:
same items as internal medicine, plus
Tarascon Critical Care, and a copy of the pages from
Pocket Medicine about vent settings, respiratory failure, and acid/base disturbance (you can copy these from a classmate if you have no plans to own the book)
What to Study:
- The Little ICU Book – Condensed version of the larger text. Still very detailed and good to supplement what you read in Tarascon and other sources. Some students find it a little too detailed, but it is a quality text and all-encompassing.
- Student Handbook from Society for Critical Care Medicine¬ – Comprehensive handbook for students on their ICU rotation, available for free download from the Society for Critical Care Medicine.
- Know ABGs, how to interpret them, and what to do about them.
- Know about the vent settings: mode, rate, tidal volume, FIO2, PEEP, peaks/plateaus.
Other Advice:
- If you’re auditioning for an Internal Medicine residency, be sure to communicate early and often with your upper levels about their expectations and desired presentation style. They can be an invaluable resource for you.
- Ask the overnight nurse if anything big happened overnight on his/her shift. Sometimes this isn’t yet apparent in the chart in the morning.
- Order ABG, CXR, BMP, CBC q AM.
- Take a systems based approach to your notes. Address status and plan for each system.
- Be clear in your mind and in your notes what your plan is for:
- Sedation holidays for neuro checks
- Pain control
- Insulin requirements
- Lines – where, why, how long, are they clean?
- I’s and O’s, fluids, drips and drip rates
- Tube feeds and NPO’s
- Consults – what is requested and what hasn’t been done yet
- Code status
- Other standard items of the plan
- Learn from everything: airway issues, weaning trials, procedures, codes, ethical encounters, etc.
- Be proactive in learning about and asking to do procedures. There are lots of great opportunities in this setting for you to get experience.
