{"id":846,"date":"2013-05-24T01:40:10","date_gmt":"2013-05-24T05:40:10","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=846"},"modified":"2013-05-24T01:40:10","modified_gmt":"2013-05-24T05:40:10","slug":"the-micu-rotation-oh-no","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2013\/05\/the-micu-rotation-oh-no\/","title":{"rendered":"The MICU Rotation \u2014 Oh, no!"},"content":{"rendered":"

\"ICU<\/a>After a well-received post last week that focused on a commonly asked question I have fielded this year, I thought another common question would make for an excellent topic this week.\u00a0 We\u2019ll focus on the MICU rotation from the resident (and, potentially, the medical student) perspective.<\/p>\n

The MICU\u00a0can be one of, if not the most, daunting rotations of residency.\u00a0 However, I believe that many students, interns, and residents would agree with this statement: “After\u00a0I completed that\u00a0rotation, it ended up being one of the best months in my entire residency.”\u00a0 I say this from a learning perspective, but\u00a0the MICU rotation can also be\u00a0a confidence boost.\u00a0 Realizing you can save simultaneous \u201ccrashing\u201d patients with entirely separate disease processes can be quite rewarding \u2013 even in the unfortunate situations with\u00a0poor clinical outcomes.<\/p>\n

I am of the opinion that the worst part of the MICU rotation is dealing with the unexpected.\u00a0 Not knowing how many admissions will be called during your shift, the uncertainty of just how sick these patients will be, and the insecurities you might have about your own clinical knowledge and\/or skills can make for quite an intimidating call day \u2013 and potentially an intimidating month.<\/p>\n

What can we do to calm these fears?\u00a0 Good solutions are hard to come by\u00a0(aside from simply diving in head first, and proving to yourself that you are capable).\u00a0 However, before starting your rotation, reviewing a\u00a0few clinical concepts and manuscripts will likely pay great dividends.\u00a0 Additionally, I have a few pieces of advice that will also make for a much smoother, enjoyable experience in the MICU.<\/p>\n

I had a few discussions with my colleagues to identify some of the most important manuscripts to\u00a0review while working in the intensive care unit.\u00a0 This list is by no means exhaustive, but it serves as a good starting point and a reasonable inventory to at least briefly reconsider (or sometimes consider for the first time, if this is your first\u00a0ICU experience!) before starting your rotation.\u00a0 With that caveat, here is my list of 7 landmark articles:<\/p>\n

    \n
  1. Sepsis \u2013 Early Goal Directed Therapy<\/a>\u00a0(or read the Journal Watch summary <\/a>for a capsule view of this landmark paper)<\/li>\n
  2. Therpeutic hypothermia after cardiac arrest<\/a>\u00a0and Treating Comatose Survivors of Cardiac Arrest <\/a>(read the Journal Watch summary<\/a>)<\/li>\n
  3. Transfusions in the ICU \u2013 TRICC trial<\/a>\u00a0(read the Journal Watch summary<\/a>)<\/li>\n
  4. Respiratory failure \u2013 ARDSnet and low tidal volume ventilation<\/a><\/li>\n
  5. Corticosteroids in septic shock \u2013 CORTICUS<\/a> (read the Journal Watch summary<\/a>) and a French corticosteroid trial<\/a>\u00a0(read the Journal Watch summary<\/a>)<\/li>\n
  6. Fluid management \u2013 FACTT<\/a>\u00a0(read the Journal Watch summary<\/a>)<\/li>\n
  7. Blood glucose control and insulin therapy in the critically ill \u2013 NICE-SUGAR trial<\/a>\u00a0(read the Journal Watch summary<\/a>)<\/li>\n<\/ol>\n

    Obviously many other topics and manuscripts are as important as those I’ve listed\u00a0above.\u00a0 But, I’ve found these are very commonly referenced papers, and\u00a0they’ll serve as an excellent starting point for keeping the doubts and apprehension at bay in the days leading up to the start of your MICU rotation.<\/p>\n

    How about a\u00a0few general tips for the MICU month?<\/p>\n

      \n
    • Decipher the schedule and plan for fun activities to do on your days off.\u00a0 You\u2019ll likely be working very hard while at work; recharging while away from the hospital is vital.\u00a0 Also, plan ahead\u00a0to prevent any scheduling surprises mid-month.<\/li>\n
    • Do not hesitate to seek help when you are starting to feel uncomfortable.\u00a0 Almost certainly, you will have multiple resources for help if you need it\u00a0\u2014 a co-intern or resident, the patient\u2019s nurse, the pulmonology\/critical care fellow, your attending, a pharmacist\u2026\u00a0 You simply have to ask for help!<\/li>\n
    • \u00a0Focus on\u00a0details.\u00a0You might be able to skip over some pieces of data, vital signs, parts of the physical exam, and other aspects when you are\u00a0on other rotations, but this practice is both dangerous and sloppy when you are\u00a0caring for critically ill patients.<\/li>\n<\/ul>\n

      Finally, enjoy yourself!\u00a0 Even if you hate critical care, smiling and making the best of a potentially bad situation will take you quite far.\u00a0 Who knows, maybe you\u2019ll even find a new interest you never realized you had\u00a0\u2014 only because you never gave it a chance!<\/p>\n

      I would love to hear your own ideas on important papers, topics, and general tips for the MICU.\u00a0 Post a comment below!<\/p>\n","protected":false},"excerpt":{"rendered":"

      After a well-received post last week that focused on a commonly asked question I have fielded this year, I thought another common question would make for an excellent topic this week.\u00a0 We\u2019ll focus on the MICU rotation from the resident (and, potentially, the medical student) perspective. The MICU\u00a0can be one of, if not the most, […]<\/p>\n","protected":false},"author":24,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4],"tags":[21,26,31,36,37],"class_list":["post-846","post","type-post","status-publish","format-standard","hentry","category-about-residency","category-clinical-implications-of-research","tag-critical-care","tag-evidence-based-medicine","tag-patient-care","tag-resident-blog","tag-resident-experience"],"yoast_head":"\nThe MICU Rotation \u2014 Oh, no! - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2013\/05\/the-micu-rotation-oh-no\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The MICU Rotation \u2014 Oh, no!\" \/>\n<meta property=\"og:description\" content=\"After a well-received post last week that focused on a commonly asked question I have fielded this year, I thought another common question would make for an excellent topic this week.\u00a0 We\u2019ll focus on the MICU rotation from the resident (and, potentially, the medical student) perspective. 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