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To the critical care folks


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I am about to begin a critical care residency after 4+ years of EM practice. To those who have completed a CC residency, or those who have experience working in the ICU, are there any resources that you highly recommend? I have Marino's, the ventilator book (and the advanced ventilator book), and I am aware of EMCrit/PulmCrit and the internet book of critical care. What else? Any landmark papers or studies I should be familiar with?

For those who have completed a CC residency, how can I ensure that I make the most of this opportunity and get the most out of it?

I have an EM residency, so hopefully I know what it takes to maximize my time, but EM and ICU are different beasts so I seek your advice. ANY information is much appreciated!

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Check out The Bottom Line for good studies.

PETAL Network 

ALVEOLI, LOVS, EXPRESS

BICAR-ICU (although most people still use it)

VAST, ATHOS 3

ICU-ROX 

SOLIDARITY, RECOVERY 

 

ALBIOS, SAFE, SALT 

COACT 

All of the TTM trials...

As you know there are a lot out there. May be easier to find out the culture of your program, see what way they lean on things and focus your attention on those. (ARDSNet vent settings vs APRV, are they are VC center or PC etc)

Suppose which unit you'll be spending most of your time on will drive quite a bit of it too.

Good luck, I'm jealous!

 

 

 

 

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Bah.... there's so much I keep thinking of. 

My advice:

Get a strong grasp of ventilator management, understanding lung protective ventilation, plateau pressures and driving pressure.

When to use paralytics, when to prone.

You likely have a good grasp of pressors, look into specific situations where one is > than the other.

Antibiotics often aren't all that different from the ED where nothing has grown out yet.

Methods for assessing volume responsiveness (PPV vs PLR vs IVC etc)

Diuretics for desresuscitation.

You are likely super strong procedurally already so that will be a big help.

Critical Care Reviews is super helpful, sign up for the weekly updates, they do some great deep dives and article reviews and have a list of the top 100 CC articles: https://criticalcarereviews.com/index.php/majorstudies/landmark-studies/top-100-studies

Again, good luck!

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8 hours ago, cinntsp said:

Keep us updated on your progress.  I've been giving more thought lately to going back to do a CC residency(already did HM).  Did you decide to do a second residency for a career change, personal satisfaction, more knowledge, or what?

Career change. But with that, also more knowledge. Big believer in these types of programs so if I was going to change into a specialty with such a steep learning curve I wanted to transition in an environment where the big focus is on training me and helping me develop. Not thrilled about the 66% pay cut but it's only a year, right?

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On 12/15/2020 at 8:37 AM, dphy83 said:

Career change. But with that, also more knowledge. Big believer in these types of programs so if I was going to change into a specialty with such a steep learning curve I wanted to transition in an environment where the big focus is on training me and helping me develop. Not thrilled about the 66% pay cut but it's only a year, right?

Yep, only a year. :)

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Sounds amazing, I also am very jealous. I did an EM fellowship, have been out practicing for a while, but considering transitioning to CC. Please update here with your thoughts and experiences. I imagine that you’ll learn so much and be given even more opportunities than your classmates based on your wealth EM experience and procedural skills. 

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