Roles and Objectives for Residents
WELCOME TO THE SINAI HEALTH ICU
Intro to MSH ICU
Welcome to Mount Sinai! We are located on the 5th floor of Mount Sinai Hospital. We are a 24-bed CLOSED medical and surgical ICU with several programs of excellence, including high-risk obstetrics, complex oncological surgeries, high-risk hematology/oncology patients, and Acute Care Services, which includes Emergency and Critical Care Medicine. We are also responsible for providing Critical Care Response Team Services to Princess Margaret Cancer Centre.
Our ICU has a mix of medical and surgical patients. We also have a particular interest and focus on providing critical care services to high-risk immunocompromised patients, as well as high-risk obstetrical patients. In support of the surgical department, we also provide post-operative care to HIPEC patients in conjunction with General Surgery and complex sarcoma patients in conjunction with Orthopaedic Surgery.
Who Are We?
We are a collaborative, interprofessional group consisting of physicians, nurses, respiratory therapists, pharmacists, dieticians, physiotherapists, social workers and chaplains. Week to week, our ICU is led by two attending physicians to cover two clinical ICU teams and ACCESS (rapid response).
General Learning Objectives
Medical Knowledge and Management
Understand and discuss the differential diagnosis and initial approach to management for common ICU problems:
- Shock, sepsis, and circulatory collapse
- Respiratory failure/ARDS
- Altered LOC
- Multi-organ failure
Develop an approach to various technical skills, depending on your base training program:
- Central lines, arterial lines, EZ-IO
- Airway management
- Chest tubes, bronchoscopy
You will have the opportunity to gain experience as the Code Blue Team Leader with support from an ICU attending and/or fellow.
RESPONSIBILITIES AND SUPERVISION
During the day:
You will be assigned to either Team A or Team B for daily rounds. You are expected to take on the primary responsibility for the patients you are following (with support from the fellow and attending), including the following:
- Examining the patient and reviewing overnight events before interdisciplinary rounds
- Following up on outstanding investigations and consults
- Updating the patient and their family
- Attending family meetings
- Performing procedures (when appropriate)
As residents, you will be doing 24 hours of in-house call coverage for the duration of your ICU rotation. Overnight you will be responsible for taking the first call from nursing staff for any issues that arise for patients who are admitted to the ICU. You will also be paged directly for new consults from the ED. It is important to let the fellow on-call with you know when you are going to see a new consult.
You are not expected to be able to manage all of these issues on your own. Especially if it is one of your first rotations in the ICU, have a very low threshold to call the fellow or attending if there is anything you are concerned about or uncertain how to manage. You are never alone, and people expect to be called.
Contact the fellow or attending early in the following situations:
- A patient is deteriorating or is sicker than anticipated
- There are major changes to treatment recommendations from a consulting service
- A patient needs a new imaging test or procedure
- There are concerns re: family communication or goals of care
- There are issues with disposition or bed flow