Tips for Junior Doctors on an Intensive Care Unit (ICU) rotation

image credit:  SnaPsi Сталкер

Tips for Junior Doctors on an Intensive Care Unit (ICU) rotation

Sep 12, 2018 0
critical care,onthepods

James chats to Dr Luke Collett about how to prepare for your first ICU rotation night shift as a junior doctor. In this podcast, we’ll also talk about what to expect from a typical day when working in the ICU rotation.

Summary Writer:  Claudia Hurwitz

Script Writers: Luke Collett & Sam Orton

Editors:  Luke Collett & Sam Orton

Interviewee:  Luke Collett

About Dr Luke Collett

Dr Luke Collett is an ICU Clinical Fellow at Royal North Shore Hospital. After separate diversions into Emergency Medicine and Infectious Diseases, he completed his ICU clinical training in 2016. He has recently returned from a fellowship year in Severe Respiratory Failure and ECMO at Guy’s and St Thomas’ Hospitals in London.

Luke is a keen educator, trained simulation instructor, and faculty on a number of courses. He has previously run the MET calls workshop at the NSW Pre-Intern Conference.

Tips for Junior Medical Officers on an Intensive Care Unit (ICU) rotation

With Dr Luke Collett, Intensive Care Unit Fellow at Royal North Shore Hospital Sydney, Australia

 

Introduction

Intensive Care is a sought after and exciting rotation for junior medical staff. From varied clinical experience to unique procedures, organ supports and drugs, all junior medical staff can gain a lot from a rotation in ICU. The long hours and high acuity of care can be taxing on residents and it is important to seek assistance clinically and emotionally if required.

  • Even as a junior doctor you do bring a lot of skill and experience and you will be able to value add to the team
  • Having said that remember that you are not an expert and it will be foreign to you at the start
  • The BASIC (Basic Assessment and Support in Intensive Care) course offered throughout Australia is a good basis for an ICU rotation
  • Being up to date on Advanced Life Support is also important
  • If you have an interest in ICU then tell the team up front so they are aware(this will also help if you need a reference at the end of the term)
  • In general:
    • Be on time
    • Be energetic
    • Be enthusiastic
  • Long days and a lot of long days in a row
  • An average day begins with a very long morning ward round
    • You are expected to examine patients, present findings and voice your opinions
    • You are part of the team and your views are valued
  • After this there is usually time to do the wards jobs that are required of you
  • The more efficient you are with this the more time you will have to do things that you want to do – e.g. procedures, family conferences etc
  • There is also a quick afternoon ward round
  • The registrars are around at all times, running the pods and are available to assist you
  • A couple of days in advance get yourself organised with meal preparation, shopping, laundry and ironing otherwise your week may be pretty tough
  • The flip side is the time off which can be wonderful
  • Early in the rotation you may not know anything about some of the trouble shooting you may be asked to do which is ok and the team will know that
  • You are expected to:
    • Use your brain
    • Come up with a possible plan, you don’t often have to follow through with it yet, but have an idea of what you would like to do
    • The nurses in ICU differ from those on the ward in that they are highly specialised and sub-specialised, so you should definitely seek their advice and consult
    • Registrars are always close and available for assistance

Case

You are a first-year Resident doing an ICU rotation. It is your first week of nights on a general ward and you are asked to review a 55-year-old male admitted through the Emergency Department. He is intubated following a motor vehicle accident. He has lots of rib fractures, is intubated and difficult to ventilate. The patient starts to desaturate and the team is troubleshooting the cause of this desaturation, including cuff leaks.

  • The overwhelming thought in the first instance is to make the patient safe and seek assistance if required
    • Turn up the oxygen
    • Increase PEEP (Positive End Expiratory Pressure) if you feel comfortable to do that
    • Suction the tube
  • Then use your brain to consider if this is expected in this type of patient
    • At this point you would be expected to seek assistance from the registrar
  • A cuff leak can be a major issue
    • It may mean that the tube is not fully in the airway which is dangerous
  • Donot be afraid to ask for help
  • You will be tired following your week of shifts, especially nights – so rest is important
  • Weeks off are essentially extra weeks of annual leave, so using some of them to get away is a very good idea
  • You can also use one or two weeks to do extra courses, prepare for interviews, study, life administration, all of which are also important
  • The technical skills are what comes up first including arterial and central lines
  • Clinically assessing unwell patients
  • Attending code blues
  • Being exposed to ventilators
  • Things that are less obvious to junior doctors include:
    • Communication – end of life discussions, patient conversations, breaking bad news, big family meetings
    • Getting a feel of what ICU means to patients and families and what the ramifications of an ICU rotation are on patients and families
  • The things you love as you are coming through ICU as a junior such as procedural skills, team work and weeks off, are also the life of a registrar
  • As an Intensivist though this changes a lot – Intensivists become more involved in teaching and education and family meetings are a larger part of the role
  • It is important to consider the different role of the registrar and consultant if you are considering a future in ICU
  • Burn out is high in ICU as Intensivists are more involved in end of life discussions and high acuity treatment
  • It is a privilege but can also be a burden for some individuals
  • Try to maintain a balanced workload and keeping up with hobbies outside of work is important
  • Use weeks off to try and be healthy, exercise and socialise
  • ICU has a good support network with social workers, registrars and Intensivists
  • You are never alone and a lot of the staff have had similar experiences and are great to talk to. Debriefing can be very cathartic
  • Burnout is very topical at the moment with the college and society paying attention to it
  • The solutions are not so clear
  • Not being overworked is a key factor
  • Over 10 years ago, Intensivists were working 1:2 and on call and this is gradually changing to a more balanced lifestyle with more non-clinical weeks
  • There are small things happening around the edges and in individual Intensive Care Units as well
  • When you do your ICU rotation, make the most of it, pitch in and add your knowledge
  • Try and get as much out of the rotation as you can
  • Remember to try and appreciate what the patients and their families go through as well

Tags: #advanced life support,#breaking bad news,#communication,#end of life,#ICU,#intensive care,#Intensive Care Network,#intensive care unit rotation,#Life in the fast lane,#Positive End Expiratory Pressure,#teamwork

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