If you are going to your first ICU rotation and you feel like you have no idea what to do:
I felt the same😄
I added a thread 🧵 with 8 tips for med students and new interns of #MedTwitter #IMG #ICU
Pls add your questions or tips in comments!
⤵️⤵️
1️⃣ Ventilator skills are game changers! Review some basics before starting.
2️⃣Great resources for studying:
🔸️@OnePagerICU summaries of most important icu pearls in one page🥹
🔸️@MedCramVideos great videos 😎
🔸️Rebel EM
🔸️EMCrit project
🔸️Marino's ICU book🤠
3️⃣Things to check for every ICU patient when pre-rounding:
🔸️Which drips/current rate
🔸️The RASS score
🔸️Ventilator settings (tidal vol., RR, FIO2, PEEP, mode)
🔸️Sedation and analgesics
🔸️intake/output
🔸️Access lines and if they need to be removed
🔸️Blood gas
4️⃣Review your basics:
🔸️Shock: how to distinguish different types of shocks, how to use vasopressors
🔸️Acute respiratory failure: ARDS, COPD/Asthma exacerbation, pneumonia
🔸️Pancreatitis
🔸️DKA
🔸️Post CPR
🔸️Altered mental status
🔸️GI bleeding
🔸️Stroke
5️⃣ Vasopressors: depending on the indication, we have different options to start with. Remember that you need a central line if planning to continue vasopressors with high doses (risk of tissue injury if extravasate).
My go-to is this amazing summary from @OnePagerICU @nickmmark
6️⃣Central line
✅️Indications:
🔸️Emergency access for aggressive volume resuscitation or use of vasopressors
🔸️Dialysis access
🔸️Monitor central venous pressure
⛔️Contraindications (some are relative):
🔸️Uncooperative patient
🔸️Anticoagulation
🔸️Infection at site
7️⃣Arterial line
✅️Indications:
🔸️Monitoring BP when too low or too high
🔸️Frequent blood gas
⛔️Contraindications (some are relative):
🔸️Absent pulse/raynaud's
🔸️Burn or infection at site
🔸️Anticoagulation
8️⃣Know your blood gas (I know, I'm scared too🫠)
This is a game changer to adjust the ventilator and a common step to adjust our treatment plans.
@OnePagerICU is here again to save us:
Resources to read more about:
✴️Central line: emedicine.medscape.com/article/80336-…
✴️Arterial line:
emedicine.medscape.com/article/199958…
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