LLU MICU

HOME BASE:

You will be based in 4700. There is no "call room", just 5 nurses stations with first-come, first-serve computers. Your patients, as expected, are almost always in 4700 or 7200. Your patient list can be accessed on epic on patient handoff tab but a medicine resident will have to add the MICU black or yellow team to your account.


TEAM:

The attendings will change once a week (Monday-Sunday). You will share the patient load with 1-2 other interns and two 2nd year medicine residents. There is often a pulmonary critical care fellow who will round with you and may occasionally even round with you alone in place of the attending.


THE SCHEDULE:

The schedule is less intense than some other rotations but you still have a lot of call. They SHOULD email you your schedule before the rotation starts but they have forgotten to do that for some people, in which case you’ll need to contact the medicine office to get the schedule. There are no days off during the first few days so that everyone can get adjusted to the ward and figure out how things work.

Then you will fall into a Q4 call schedule that consists of:

  • Long call: admit until 2000
  • Post call: leave by 1400 on post call day (after rounds and work is done)
  • Short call: 6000-1800
  • A day off

You admit on both short and long call days.


CALL ROOM: None


DAYS OFF: Every fourth day off after the first 5 days of the rotation (average of 5-6 days off)


TYPICAL DAY: Rounds typically start at 8am but some attendings prefer to start earlier. The senior who is post call/ admitting overnight will round first so they can go home.

5-7am: Pre-rounding

8-Noonish: Rounding with the attending

Noon-6pm (short call) or 8pm (long call): Finish rounds, complete procedures, follow-up labs and imaging, admit patients


​Paperwork:

All lists are on epic and under patient handoff

  • H&P/consult: Remember to be thorough. These are medicine notes :)
  • Progress notes: Every patient needs one unless they were admitted after midnight that day. You can drag over the information from the previous day's progress note but be very careful about updating everything including the QI bundle. Otherwise the whole team gets the copy-paste lecture.
  • Discharges: Most patients are transferred out (to the floor or Kaiser).
  • Smart phrase ccc note, ccc quality

REVIEW: Sepsis, shock, stroke, GI bleeds, anything/everything pulmonary including ventilators and pulmonary catheters, electrolyte abnormalities, strokes (ischemic and hemorrhagic), vasopressors. Know your ACLS pathways, you may run codes while on MICU.

​PROCEDURES: You should get a fair number of central lines on this rotation unless your seniors are pushing to get them. Arterial lines are abundant. Intubations occur occasionally. How many procedures you get will depend on the fellow. They likely will have done few intubations and central lines themselves so it can get competitive.


WHERE TO FIND COFFEE: 4700 nurses break room. There's also hot chocolate and graham crackers/peanut butter if you're on Bland rounds and starving.


PEARLS:

  • Update the lists and notes daily! Your team will have to care for your patients 1 out of every 4 days and they should be able to figure out what’s been happening and what’s next for each one of your patients.
  • Write PRN orders for every conceivable human condition (itchiness, insomnia, pain, fever, agitation, hypotension, hypertension, nausea) when you admit a patient so that the senior won’t get paged at 3am. It will make your call days easier.
  • Carry the “Common Medications” list they give you when the rotation orientation happens. This is the list that has all the common drips and how to dose them. Don’t hesitate to let the nurses help you with them.
  • Make sure you are aware of what are formulary drugs for LLUMC-believe me you will get paged endlessly from the pharmacy about switching pt’s meds to formulary ones (ie lipitor to zocor).
  • Become friends with the case managers, as they will be your best help in getting your patients OUT of the hospital and off your service in a timely manner. Let them know about a patient the moment you think they’re nearing discharge so they can start looking for rehab facilities.
  • Work hard and be proactive. There are so many opportunities in this rotation to get procedures.