The months spent in the ICU as an intern are daunting, terrifying, and yet immensely rewarding. It ain’t all about urine lytes and calculating free water deficits up on the fourth floor! Easily some of the highest yield months of residency, the ICU is where we further refine our abilities to differentiate “sick vs not sick,” manage crashing patients, and care for multiple critically-ill patients simultaneously.
Focus on the First 24 Hours
The ICU experience is important for us to learn about what happens when our crashing patient enters that magical kingdom called the hospital. During my first month of critical care I recall feeling overwhelmed by the complexity of the patients and the attention to detail required of the attendings. But participating in the first 24 hours of a critically-ill patients care makes for tremendous learning. The level of autonomy given to our interns is remarkable. From day one you’ll be placing lines, running codes, managing vents, and working closely with your upper level EM resident.
EM MICU Team
Unique to our program is that we run our own independent MICU team composed entirely of EM residents and a critical care attending. This is learning at it’s finest! During my first week I recall admitting a septic shock patient who required intubation, hemodialysis line, arterial line, and multiple vasopressors. While standard fare in many ICUs, our program’s approach to education is anything but standard. In addition to performing the procedures I was given the opportunity and equal footing to present my assessment and plan – the importance of which cannot be stressed enough. The value of small-group learning with an attending is vital for maximizing learning while on service.
Dedicated Didactics with Critical Care Faculty
In addition to small-group learning on rounds we generally receive impromptu didactics several days a week. Topics include anything from proning during ARDS and the utility of procalcitonin, to stories of backwoods shenanigans and hilarious ramblings NOS. The culture of respect for our interns fosters incredible learning opportunities, experience, and mentorship from off-service faculty. Additionally, these faculty are a great resource for those interested or considering critical care fellowships.
Return to the Department with Confidence
While the days are most certainly long, the learning is immense and highly rewarding. The months spent in the ICU will have you returning to the ED more confident and prepared to take care of the next sick and undifferentiated disaster coming your way. Our EM program offers front seat hands-on learning at the bedside for those interested in taking advantage of it!
