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The resident on call the previous night will pre round on all the patients (subject to change by residents—how you do this is up to you). Signout rounds M-F generally start at 4:30. The PICU residents are responsible for signing out to the incoming resident. The patient signout sheet is kept up to date by the residents. Help each other, do a good job with it. When one of the PICU residents has clinic, he/she should sign out to the other resident. If both residents will be gone for a given time period, please notify the attending on service as soon as possible (i.e., when you figure it out). The attendings have a backup system in place, we need to know when 2 attendings will be needed. The residents are responsible for assuring their compliance with work hours regulations, both daily and weekly. We do not keep you schedule. If you are finding it difficult to comply with the regulations, please let us know. PICU attending lectures generally occur daily in the conference room, generally at 11:00am. It is assumed you will be present and the attending on service will cover issues during the lecture. Procedures: Procedures will generally be done by the resident covering the patient, with supervision by the attending. There will be times when the attending will do the procedures and times when a more senior resident will do the procedure. Our first priority is patient care. As a general rule, lines on infants or hemodynamically unstable patients will be done by the attending. Intubation of patients who are not NPO, who are known to have difficult airways, who are extremely hypoxemic, or patients who are hemodynamically unstable will be done by the attending or an experienced resident. Orders: Bedside charts MUST stay at the bedside. Orders should be written on rounds as decisions are made. You MUST tell the nurse if you are writing an order if you would like it to be carried out in a timely fashion.
You will take on exam at the end of the rotation. It has been developed by a collaboration of Peds intensivists around the country and is used to tailor our educational objectives. It stays with us. A PICU reference guide is being developed in collaboration between residents and the attendings. It will exist at some point. Helpful tips PICU nurses are very experienced and invested in the care of these patients. Learn from them. Take their advice and concerns seriously. If you disagree with a nurse, please discuss the issue with the attending. If a nurse asks you to call the attending, do it. If in doubt, call the attending. The only stupid question is the one you didn’t ask. Follow up on anything that was supposed to happen (including labs and x-rays and CT scans. Even if you aren’t a neurologist, you will likely notice something really bad that we should know about). Keep the surgical residents apprised of any changes in their patients. If in doubt about orders on surgical patients, ask the attending the best course of action. Double Pages and Code 99 A "double page" is a page indicating the emergency need for the house officer named to respond immediately. A "Code 99" page indicates the need for cardiopulmonary resuscitation. One of the PICU residents must carry the code pager at all times. The PICU resident is a member of the code team.
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