ICU Handover (MMC) MMC specific Two ends (north and south, north has the paeds beds)

A consultant, a registrar and a resident on each end, with a spare reg doing outreach. Sometimes there is a Paeds Consultant, which halves the workload for the consultant (not you, though) on the North end. The outreach reg attends MET calls/Code Blues. Grab the bag and go along, if you want. The bag is located next to the medications room, behind the desk on the north end. Morning rounds start at 8am, maybe later depending on the consultant on. The consultants will do their own little handover, likewise the Registrars and Residents. Then, a formal round of reg handing over to consultant and making a plan for the day for each pt. Evening rounds at 4-ish, which is less about active management and more about keeping things steady overnight. o Lets push on. - S. Wilson, on every ward round, x5. o At the rounds, try and predict what theyll want and get it ready while the initial chat is underway. Pull up x-rays for resp. patients, cultures for infective endocarditis, etc. o Some consultants (Dr. Wilson when hes warmed up to you a bit, Prof. Ernest, Gopal) teach a lot on rounds (esp. Gopal, who blitzes through seeing the patients, but makes up for it by grilling the entire team about dialysis or aspirin or a bunch of random stuff) Depends on how busy it is, but usually PM is a little more relaxed than the morning. Dr. Wilson really likes Acid/Base, so be ready for that. The residents are probably who youll spend the most time with and are usually keen to let you do things. Help them out with discharges and grunt work if things get hectic but theyll usually tell you that you dont have to do that. TEACHING: o Tuesdays 1 4pm: Grand rounds (no food); usually two hour-long presentations by a consultant. If youre lucky, Prof. Wright or even Prof. Parkins might talk at you for a couple of hours while you sit in awe. The last hour is the M&M, where they discuss patients that died over the last week. o Wednesdays 2 4pm: Resident teaching, where the regs teach the HMOs. Tag along. Its official and the HMOs are expected to be there, but its a little sporadic due to the fluctuations in ward activity. o Thursday 1pm: Intern teaching that you can crash. Youll probably get an email about it. You will probably get roped into the Transfuse study; all it involves is going around to each patient chart every morning and stamping whether or not the pt is eligible for the study. When an eligible pt is going to receive PRBC, you have to enrol them into the study, and fill out daily data. Pretty simple once youve done it a couple of times. Youll get a letter of participation at the end that is nice for a CV. Crackers, toast, spreads, coffee, milo all available in tea room, BYO mug. Cheese cunningly hidden in small fridge under where the coffee is; re-stocked Monday, wont last past Tuesday/Wednesday. Secret biscuits hidden in storeroom somewhere; never found them.

General stuff useful for ICU The ICU Book by Paul Marino is pretty useful. There should be an electronic copy floating around in the bowels of the internet somewhere. Patients are usually in ICU for a narrow range of things, like ventilatory support, close monitoring, etc, so there really isnt all that much to learn. TOPICS to cover: o Acid/Base o Ventilation; intubation, SIMV vs BIPAP vs CPAP, tracheostomies, ventilations vs. oxygenation o Cardiology; cardiac output/index, managing BP, MAP, interpreting JVP o MET call criteria for your hospital o Interpreting CXRs o Hypo/hypertension and their mx. o Dialysis/haemofiltration o End of life issues; legal stuff, organ donation, etc o Declaring death, brain and heart. o A basic neuro exam (very basic; squeeze my hand, wriggle your toes, open your eyes) to test level of consciousness) o All about CVCs & PICC lines; anatomical landmarks, procedure, complications, etc. o Drugs: adrenaline, norad, aramine, some other important ones Ive forgotten about. o Electrolyte imbalances: Mg, Na, K, lactate, urea. At least at MMC, all the immediate post-CABG care is done at ICU. So, maybe learn about them and what the aims are for their care. MMC has a form specifically for admitting cardiothoracic surg pts; do a few admissions. Theyre pretty straightforward. Might be worth looking up things like bypass time, co-morbidities, level of intubation, etc. o Usually, aim for good urine output, good amount draining from chest and mediastinum (theres a reason why there are two drains like this but, again, Ive forgotten already) CI > 2.5, MAP > 75, etc. Basically, trying to wake and wean and extubate them and send on to the wards. Procedures: Usually cannulas, or urinary catheters; plenty of unconscious people to practice on. If you are een try your hand at an art line or a CVC. Learn where stuff is. Probably the biggest thing you can do to be useful. If your res is doing a CVC and needs more saline or a biopatch (veryone forgets the biopatch), or fetching stuff in the middle of an arrest makes a real difference. Sign up for BASIC, an ICU course. Google it; many major hospitals (Frankston, MMC, Alf) offer it and while its about $200 I think its worth doing, for knowledge and for CV purposes. Some places even offer it to students for free, and I think the Alf actually requires you to attend it (all paid for). The book they send out is pretty much all youll need to know for your ICU rotation, so it might even be worth doing before you start.