Critical Care Elective at U of T

[AbraCadaver]

I'm doing a critical care elective at U of T (Toronto General) in the fall and I'm hoping someone could give me some information/advice regarding what a typical day is like, schedule, call expectations, if there are any good resources you would recommend to prepare for this rotation and any other pearls you'd care to share

 

Thanks.

 

Abra

[cheech10]

Typical day:

Start at 0730, sign in rounds.

See patients individually until 0830 to 0900 depending on attending. Notes may be written at this time or during rounds, as the team decides.

Rounds run until 1200 or 1300, again depending on attending.

The entire multidisciplinary team, including pharmacist, dietitian, resp therapist as well as residents, fellows, and staff go from bed to bed, present each patient, get report from the RN, and make a plan for the day. Labs, meds, and CXR are reviewed on rounds, new orders are placed, and you move on to the next patient.

Lunch is usually provided at TGH, along with teaching, for 1 hour.

The afternoon is devoted to getting the work done for the day, implementing the plan developed on rounds.

Sign out is (supposedly) at 1700.

 

Call for residents is 1/(# of residents), usually 1 in 5 or 6. In house call, but you get to go home at 0800 the next day. For PGY-1s and med students, there is buddy call, and I'm not sure if call is mandatory or not for them currently (it was not as of 1 year ago, but I would recommend it for elective students as most of the work comes in after hours in ICU).

 

The unit has up to 24 beds, with ~16 being seen by the ICU teaching service and ~8 being seen by a non-teaching team that also covers the Rapid Response service. A large part of the service takes care of the lung transplant patients, who get very severe ARDS and episodes of sepsis post-transplant. They often stay for weeks at a time if they get sick. The rest is your usual septic shock and ARDS case mix, with a bit more ARDS than usual for the ICU, and the occasional big OR thrown in. No trauma, no neurosurgery, few strokes. Probably the best thing to get experience with here is how to treat severe ARDS. HFO, HFJV, and ECMO are all used here, and you'll probably see 1 or 2 of each during a month here.

 

As for resources, focus your reading on Sepsis and ARDS. Know the Early Goal Directed Therapy stuff well. Respiratory and cardiac physiology are favourite topics as well for the staff and come up daily. Know these and you'll do just fine. Many people recommend The ICU Book by Marino; it's an easy read, especially the physiology chapters. I recommend http://www.ccmtutorials.com as well. Let me know if you have any more questions.

[AbraCadaver]

Wow - thanks so much for the detailed reply. I'm sure it will prove to be quite helpful!

 

Cheers,

 

Abra

[future_doc]

Abra, you created a cool user name.

[ploughboy]

I recommend http://www.ccmtutorials.com as well.

 

Thx for the link!