The critical care subspecialty rotation is designed to provide a comprehensive fund of knowledge regarding the care of critically ill patients in the post-surgical or trauma setting. There are two surgical intensive care units (SICUs) with different patient populations - the Trauma Surgical ICU and the Surgical ICU. The SICU team consists of anesthesia, emergency medicine and surgical residents as well as a fellow and critical care attending staff working as consultants with the primary surgical or trauma services. The residents are expected to become facile at management of ventilators, support of failing organ systems, care of trauma patients, and the use of invasive monitors. There are daily rounds and formal didactic sessions for the residents.
The ICU rotation offers a wonderful chance to work in a team environment. While the call schedule is intensive (either Q4 or Q3), the non-call days are great for didactic learning and procedures. The month is filled with the opportunity to place lines, work with cutting edge monitoring systems (PICCO2), use various ventilator modes (MMV, PS, AC, SIMV, etc.), and learn to manage patients in the post-operative setting.
A Day in the Life - SICU
"The SICU usually houses approximately 15 patients, with a variety of general, thoracic, transplant, hepatobiliary, and neurosurgical illnesses. The Trauma SICU houses another 10-15 patients, usually with recent blunt or penetrating trauma, in addition to thoracic, vascular, and general surgery patients. Resident rotators are drawn from the anesthesia and surgical departments, which provides for great collaboration and communication with consulting teams. Rounds generally start at 7:30; I try to arrive around 7:00 to orient myself to overnight events (and, importantly, drink coffee). Rounds are led by the rotating SICU fellow and attending. After rounds complete, the team takes care of any urgent issues before heading to lecture. Lectures are usually 45-60 minutes and cover acutely-relevant ICU topics. After grabbing some lunch, residents usually divide up procedures and stabilize any lingering patient issues. As an anesthesia resident, I've gained a lot of familiarity with placing internal jugular central lines in the OR, but the ICU provides the opportunity to place lines at other sites, perform bronchoscopies, place challenging arterial lines, perform bedside echocardiography, and quite a few other non-OR based procedures. Evenings are covered by the on-call resident and the in-house anesthesiology intensivist. With any luck, I can grab some sleep - or at least some coffee while stabilizing the latest critically ill admission. All told, the SICU is a great rotation."
- Aaron Mittel