Critical Care
During the BIDMC internship and residency, there is a great emphasis on evaluating and treating critically ill patients. There are several different ICU experiences at BIDMC, including MICU Orange (residents & interns), Finard ICU (FICU, residents & interns), and MICU Green (residents only).
Each intern completes, on average, two critical care months per year (usually one month in the medical ICU and one in the cardiac ICU). Critical care rotations expose the housestaff to a breadth of common disease processes, such as sepsis and septic shock, respiratory failure, and life-threatening gastrointestinal bleeding. The medical ICUs are geographically localized, though the MICU Orange team can have patients located in adjacent ICUs. The MICU Orange and MICU Green teams are located on BIDMC’s West Campus, and patients present with a broad array of critical illness. The Finard ICU is located on BIDMC’s East Campus (also the location of the Oncology services and several operating rooms). As a result, the FICU team frequently cares for oncology, obstetric, and surgical patients who are critically ill. Surgical patients are generally co-managed, allowing for a collaborative learning experience.
Highlights of Critical Care at BIDMC:
- Procedures, procedures, procedures: While in the ICU, interns have opportunities to place central venous lines and arterial lines and to perform other common procedures such as arterial puncture, paracentesis and thoracentesis. These procedures are always done with supervision by the attendings and the residents, but the intern is expected to be the primary operator.
- Attendings: In addition to critical care attendings who round with teams each day, there is a dedicated critical care attending in the hospital 24 hours a day at BIDMC.
- Nurses and Respiratory Therapists: ICU nurses and respiratory therapists at BIDMC frequently have > 10 years ICU experience and are willing to teach interns and residents in their areas of expertise!
- Teaching: Each morning before rounds, teams have a 30-45 minute lecture on various ICU related topics. Lectures have included discussions about early goal directed therapy, management of hypotension, vasopressors and IV fluids, ACLS protocols, and mechanical ventilation. Every Friday there is a journal club where one of the residents discusses a paper pertinent to a medical issue encountered while taking care of a current ICU patient.
- Schedule: Although you are on call every third night, the post-call intern leaves by noon and the swing intern and resident leave by 4 pm.
- You can do it!: After being in the ICU for a month and taking care of some very sick patients, you will know how to handle medical emergencies and to do so with a sense of calm and direction.
