Internship & Residency
Surviving The ICU

Dr. Karl Newman

The ICU rotation can be a stimulating and challenging environment where the principles of critical care can be learned, practiced, and mastered. However, for many interns and residents, it can be a terrifying ordeal of overwhelming stress, debilitating sleep-deprivation, and soul-crushing clinical depression.

This week, Q Fever!'s I&R correspondent, Dr. Karl Newman, walks you through an approach to Surviving The ICU.

ICU! Do you C me? Get it? "C" me = "See" me!

Feel free to use that little riddle on anybody - it's cool!

I love the ICU. I'll never forget my first day there. The sights, the sounds... it's like my senior resident told me way back when:

Listen what I'm tellin' ya:
I C U gotta magic spell on ya
'Dat melena looks so swell on ya
Now I C U gotta magic smell on ya

I have to admit, though - it can be stressful dealing with life-and-death situations round the clock. So here's some advice to make life in the unit run a whole lot more smoothly for ya:

1. Adjust the PEEP.

WHAAH??!! Take it from me. So what if you have no idea what to with vent settings? You can't go wrong by adjusting the PEEP. Check this out:

Nurse: Dr._____, the O2 Sat is at 85%.
You: Hmmm. Yeah. 85. What was it before?
Nurse: Let me go check. (This will buy you a minute.)
Nurse: It was 95 at noon. It's 85 now.
You: OK. Oh yeah, what are the other vitals?
Nurse: Hold on. (Another 30-45 seconds).
Nurse: They're all OK.
You: Yeah. OK. OK, I think we should go up on the PEEP.
Nurse: What do you want to go up to?
You: What is it at now?
Nurse: I think it's at 5.
You: You think? Can you check?
Nurse: Dr._____, where exactly are you?
You: Yeah. What do you mean?
Nurse: Where are you. What are those sounds in the background. Are you at... are you at a PARTY?
You: Uhh...
Nurse: Aren't you supposed to be here in the unit?
You: What?
Nurse: Who's covering the unit right now? Are you even in the hospital? Are you even near the hospital?
You: Oh. I, well...

It's amazing how well this technique works! Quick note: if you can't adjust the PEEP, maybe it's time to start thinking about CPAP!

2. Telemetry is your friend.

HUHH?! You heard me! And it bears repeating. Telemetry is your friend!

Let's face it, we all hate missing TV shows because we're on call that night. Who wants to program a VCR or even knows how to do it? So do what I do. Spend your night watching TV in the call room, or wherever there's a TV. Turn off your beeper so you don't get interrupted - how rude!

The next morning, when your resident or your chief asks you where the hell you've been all night, just tell 'em you were watching the Tele monitor:

"I was watching the Tele monitor"

The truth shall set ye free!

3. Suction before you sleep.

WHATZAT??!! Yeah. The worst thing that can happen to you when you're working in the unit is to have mucus accumulate in your trachea and bronchi, causing aiway obstruction and respiratory distress. That's why it's so important to power up some Mucomyst an hour before bedtime, and have the Respiratory Therapist give you a good thorough suctioning prior to drifting off.

If you need it, they can also do a saline lavage and collect some specimens to send off to the lab... but don't let 'em do a blood gas unless they hafta, cuz, OH BABY, do they sting like a mo'fo!

Whooaaah! Looks like we're outta time, kids! Next time, we'll continue our Internship & Residency series with some anectodes my best buddy Bo told me last week 'fore they hauled him off to the Big House again... Till then, keep your settings on single chirp, and keep reachin' for the snooze!

Just tell 'em Dr. Karl sent ya!