Medical Intensive Care Unit (MICU)
On to my next rotation: the MICU! Might be a little biased since this is what I want to do with my life, and undoubtedly my favorite rotation.
The team structure is fairly similar to wards except there's no med students. Depending on the hospital we're at, we might have a Q4 or Q6 day off structure. I've only done one rotation so far but I don't expect my second one to be very different.
My day usually starts around 5:00-30am (The world belong to those who wake up early!). I review night events, which are more frequent than in wards rotations, vitals, labs etc. prior to go see my patients. Teaching rounds start at 8am, ideally you have seen all your patients and written all your notes. On rounds, the post call team presents the overnight admissions and we all get some teaching from our wonderful ICU faculty. Then we go round on our patients with either our attending or the fellow. Meanwhile we attend urgent matters as they arise and we also answer codes in the hospital. When possible, we can perform procedures (arterial and central lines, lumbar punctures etc) under the supervision of a senior resident, fellow or attending. Same as in rounds, we finish our work and notes after rounds and we sign out to the on-call team once we're done. So not much different than wards except we have sicker patients, more procedures and more fun! We also look very cool and important running in the hospital and wearing scrubs.
I feel I need to talk about codes in the US (at least in our hospitals): it still fascinates me all that's happening in there. Once someone pushes the "code blue" button, there's a overhead call. Sounds like "May I have your attention please, code blue, 12th floor, room 421, code blue, 12th floor, room 421". That marks the beginning of a big flow of people towards that room:
- Some running: close by nurses, on-call MICU team (4-5 people), on-call CCU team (2-4 people)
- Some walking very fast: anesthesiology team for intubation (3 people), respiratory therapist, pharmacy
- Some can take their time: ICU attending, Xray tech, EKG tech*, primary team (4-5 people)
And somehow, with all those people - I don't know if you can imagine, that's really impressive it's like 20-25 ppl in one room while some are doing compressions, some intubating, some placing lines etc - it runs pretty smoothly. Everyone does his job, and there's one person (usually the MICU resident) who runs the code and makes sure it's somewhat organized.
*Yes, we do have EKG techs. They're in charge of doing EKGs. Which means most med students have no idea how to do an EKG! - In France, the EKG is by definition the job of the med student. Fun the first 10th times in 2nd year, kind of annoying in 6th when some teams ask for daily EKGs for all patients.
The team structure is fairly similar to wards except there's no med students. Depending on the hospital we're at, we might have a Q4 or Q6 day off structure. I've only done one rotation so far but I don't expect my second one to be very different.
My day usually starts around 5:00-30am (The world belong to those who wake up early!). I review night events, which are more frequent than in wards rotations, vitals, labs etc. prior to go see my patients. Teaching rounds start at 8am, ideally you have seen all your patients and written all your notes. On rounds, the post call team presents the overnight admissions and we all get some teaching from our wonderful ICU faculty. Then we go round on our patients with either our attending or the fellow. Meanwhile we attend urgent matters as they arise and we also answer codes in the hospital. When possible, we can perform procedures (arterial and central lines, lumbar punctures etc) under the supervision of a senior resident, fellow or attending. Same as in rounds, we finish our work and notes after rounds and we sign out to the on-call team once we're done. So not much different than wards except we have sicker patients, more procedures and more fun! We also look very cool and important running in the hospital and wearing scrubs.
I feel I need to talk about codes in the US (at least in our hospitals): it still fascinates me all that's happening in there. Once someone pushes the "code blue" button, there's a overhead call. Sounds like "May I have your attention please, code blue, 12th floor, room 421, code blue, 12th floor, room 421". That marks the beginning of a big flow of people towards that room:
- Some running: close by nurses, on-call MICU team (4-5 people), on-call CCU team (2-4 people)
- Some walking very fast: anesthesiology team for intubation (3 people), respiratory therapist, pharmacy
- Some can take their time: ICU attending, Xray tech, EKG tech*, primary team (4-5 people)
And somehow, with all those people - I don't know if you can imagine, that's really impressive it's like 20-25 ppl in one room while some are doing compressions, some intubating, some placing lines etc - it runs pretty smoothly. Everyone does his job, and there's one person (usually the MICU resident) who runs the code and makes sure it's somewhat organized.
*Yes, we do have EKG techs. They're in charge of doing EKGs. Which means most med students have no idea how to do an EKG! - In France, the EKG is by definition the job of the med student. Fun the first 10th times in 2nd year, kind of annoying in 6th when some teams ask for daily EKGs for all patients.
Hello,
ReplyDeleteI’m French so my question is from a French medical student point of view ^^. Are you sure to be able to work in MICU/anesthesie-réanimation ? Or there is another selection after that ?
Hello,
ReplyDeleteI’m French so my question is from a French medical student point of view ^^. Are you sure to be able to work in MICU/anesthesie-réanimation ? Or there is another selection after that ?
You need to apply for a critical care fellowship, but if you get into residency you should be able to get a fellowship spot. Critical care here is often mixed with pulmonary but you can do it with other internal medicine subspecialties (I'll be doing infectious disease/critical care). If you want to do anesthesiology then you'd have to apply to an anesthesiology residency before doing a critical care fellowship. Hope this helps!
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