In this video I show how I'd usually present a case in the ICU. These tips will be useful for medical students, residents, fellows, nurses, nurse practitioner, physician assistant or anyone working as part of the clinical team in an ICU.
⏰ Timestamps:
Main Structure of the presentation - 1:09
Systemic Assessment: - 3:50
Checklist - 11:53
I remember my first experience in the ICU as an intern, let's just say i felt like running away, but over the following days and weeks and months of back and forth rotation in the ICU i had to figure out a system ( I think we all do at some point) to survive and not only survive, thrive in the ICU. Most of the headache tho was presenting a good story to the attending.
In this video i'll teach you how I normally organize my presentation during rounds in the ICU and eventually as a senior morphed into how i did my chart review.
Working in the ICU for any one who does, Doctor, Nurse, APPs, and even non-clinical staff can be very challenging. As an intern, getting thrown into the humongous responsibility of caring for these critically ill patients can be very scary. I certainly felt like i wanted to run away. It is often very important to have some degree of organization to have the slightest chance of a sane day. So for me I have a template for the most important information on a patients' care based on the organ systems (advised by most intensivists to see patient assessments in a systems based view) and a checklist mnemonic. Below is a structure I use for presenting cases in the ICU, I hope you find them useful.
Main Structure
- Patients name and Age
- Reason admitted to the ICU
- A brief story about why they ended up in the iCU
- Active issues
- Labs and Imaging
- Systemic Assessment
- Plan
- Checklists and Orders
*Systemic Assessment*
It is important to go through the assessment and plan in systems and below are some of the important points to make when presenting a systemic assessment of your patient. If there is a specific diagnosis in each system you may start by mentioning that when you get to that organ system.
Nervous system
- Mention related diagnosis and plan, mental status, previous head imaging, mention if on sedatives.
Respiratory
- Mention related diagnosis and plan, chest Xray findings , ET tube position if patient is intubated, Vent Setting including mode, fio2/PEEP, rate, tidal volume, saturation, respiratory status, O2sat, Blood gas results (pH, PCO2, PO2, O2 saturation)
Cardiovascular
- Mention related diagnosis and plan, EKG, Cardiac enzymes, Blood pressure and Pressor requirements if hypotensive.
Gastro-intestinal
- Mention related diagnosis and plan, Liver enzymes, need for GI prophylaxis
Renal
- Mention related diagnosis and plan, BUN, creatinine, Electrolytes, Urine output, fluid goal
Endocrinology
- Mention related diagnosis and plan, Finger stick glucose, Hyperglycemia coverage, goal
Infectious Disease
- Mention related diagnosis and plan, presence of fever, leukocytosis, lactic acid, CXR, urinalysis, antibiotics
Hematology
- Mention related diagnosis and plan, CBC with differential results, goal for blood transfusion.
Checklist
Another very useful checklist to add to the daily presentation of cases in the ICU is the FASTHUGSBID. Please note we may have added additional elements compared to what you may be familiar with.
*F* - Feeding, Fluids
*A* - Analgesia
*S* - Sedation
*T* - Thromboembolic Prophylaxis
*H* - Head of Bed elevation (To at least 30° to prevent ventilator associated Pneumonia)
*U* - Stress Ulcer Prophylaxis
*G* - Glycemic Control
*S* - Spontaneous breathing Trial
*B* - Bowel regimen
*I* - Indwelling catheter Removal (All central lines, Foleys, justify need to keep them daily)
*D* - De escalation of antibiotics (Based on Microbiology data)
*It is often impossible to cover everything in your presentation or remember everything about the patient’s hospital/ICU course but by sticking to this format, you’re most likely to cover the most important part of the patient’s story.
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