I am a current first year IM resident on J1 visa, really interested in pursuing a critical care fellowship since this is what I like and enjoy doing in my past training experience (nephro background with a lot ICU exposure, some procedures, some research )

However considering of prioritizing J1 waiver first being a hospitalist/nocturnalist at least 3 years to solve the visa issue, can anyone in critical care field comment on how will that decrease my competitiveness of critical care fellowship application? Anything I can do during my residency and hospitalist(job selection, research, etc) can boost my chance of matching in ccm after wavier completion? Any input will be highly appreciated! Thanks in advance

First year PCCM fellow in a relatively competitive program. I really wasn't sure if I'll match here but here we are - 6 months in and still on the struggle bus. Not sure how much of this is imposter syndrome vs true incompetency, but I feel significantly behind in knowledge compared to my co-fellows and sometimes even residents.

I'm struggling to find resources to start building my knowledge base. I reached out to my chief/senior fellows and they each naturally have a different learning style. They collectively advised against buying SEEK this early in fellowship, but I personally like structured learning (lectures/books then questions). Should I start SEEK? Should I start an Anki deck? Should I buy a text book? All of the above? Although my program has a "big name" and is solid on paper, I find our didactics subpar at best and we also don't have any protected time, so we're often interrupted by clinical duties during lecture times.

I was hoping for some you to share your experience and how you started building knowledge. I appreciate all the help!

Hello everyone, I am a 1st year CCM fellow (doing my 2 year fellowship). I definitely want to pursue a fellowship in pulmonary but not sure of the timeline. I am on J1 visa so getting the waiver done is important as well especially since I travel back home alot to meet my family. I was planning to find a waiver job at a university program in critical care and work with their pulmonary department and maybe do my fellowship there once the waiver is complete (not sure if there will be any program wiling to let me do 2 years of pulmonary in there pccm program since I'll already be done with CCM fellowship). Any advice would be highly appreciated.

I completed maybe 30 questions, largely unused. 11 months left. Pls message me if interested.

Hello, I’m a second year IM resident at a community hospital with a busy ICU. I’m interested in applying for PCCM fellowship next season. I have tried asking the faculty here, but none of them are actively participating in any research. I did get to write up some interesting cases, but want to do something beyond that- like a review paper/ analysing public data sets, but need guidance. Looking for fellow applicants/ current fellows for collaborating. Thanks!

Nocturnist IM here, admitted post cardiac arrest pt, who quickly developed ARDS with uncontrolled hypercapnia. Never seen like that, even in covid yrs. PCCM came later and was a but surprised too. Proning didnt help. No matter how we adjust vent setting, sedation, paralysing pt, couldnt control CO2 raise. On the other hand, O2 sar was 93-95% on FiO2 80%. Family whidthrew care in 10 hrs. Can someone explain me more? Any other cases like that seen? Any review articles?

Edit#1. Not ecmo candidate. Too specific, cannit disclose here.

Thanks in advance.

I’m a first year CCM fellow and I’m struggling with my leadership style on rounds. I recently got feedback that I don’t jump in fast enough when residents finish their plans, often because I am thinking about everything they have said and trying to synthesize it in my own mind so I sound more coherent. But in that pause which is only a few seconds my attendings sometimes jump in not giving me a chance because I took that pause. I am female, I’m small, I’m not super loud, and I try very hard to be thoughtful and not interrupt residents or other team members. But now it seems I’m seen as not being competent at leading rounds because of this and I’m not sure how to overcome this. Looking for any suggestions from anybody who has also struggled with this.

New PCCM grad here. Did my first stretch of ICU days recently. Albumin is used like nothing here as a pressor. I know the debate regarding albumin is still ongoing but I thought it has only shown clear benefit in cirrhotic patients/hepatorenal syndrome. I know the culture of every hospital also dictates what medicines are used etc. but using albumin to increase oncotic pressure when patient is clearly losing blood and needs blood is lost on me. Was also told by an APP that albumin is clearly the superior pressor. I was so confused but decided to say nothing. I am new here and everyone around me has been here for years. Am I missing something?

For context this is mostly a medical ICU with a home liver transplant program so many cirrhotic patients at any given time.

I've been a Cardiac ICU nurse for almost 4.5 years now but I'm about to move to Cardiac Cath Lab. During my ICU time I didn't think about getting certified (money, time, etc) but now I have the desire to (oddly enough). I was curious....would I still be Able to sit the CCRN once I leave the ICU? Or do I still need to be employed as an ICU nurse in order get it?

I am a recent grad pulm/crit attending and I work with a lot of APPs.

At my ICU, they do lots of procedures.

I went into critical care because I enjoy procedures along with the medicine.

Many of my colleagues are old and APP dependent and the APPs get lots of procedures when working with them.

I like to do procedures myself. One, I like them. Two, if there's a complication that I have to explain to someone, I'd rather be the one responsible. Three, I don't necessarily trust everyone else's technique.

I've been told that me not sharing procedures is a point of frustration for my APP colleagues.

Mind you we're all friends and get along pretty well. This is despite the fact that I think scope creep is out of control. But on a day to day basis, I make it work and give lots of leeway and try to be considerate of my colleagues' feelings.

At the end of the day, the feedback pissed me off because I'm the attending and it's my choice whether or not I want to share a procedure. I share a few here and there (arterial lines and the occasional central line) but I take all the intubations every time. I feel like I went to med school and sacrificed years residency and fellowship and with everything else being taken away from me in my role as a physician, at the very least I think I should still get to decide when I want to share a procedure. Also procedures are often the fun part of my day and I don't understand why I need to give them up to someone else.

But the feedback also bothers me in a way and I can't put my finger on it.

Also the same APPs I have seen complain about not getting procedures with me also complain about having to do every procedure with the other docs.

Is everyone just whining for the sake of whining? Am I a tyrant? Are my feelings valid?

Hi I'm anesthesia critical care trained. Looking for any pennsylvania OR New jersey critical care gigs that are 26 weeks on 26 weeks off, I want to be able to do anesthesia locums 18-20 weeks of the year.

Looking for any information on their level of acuity, night/weekend differentials, pay, how often you float, management, and overall job satisfaction? Any information is appreciated, feel free to dm me if you’d prefer 🙏🏼

No palpable pulse. Maxed on all pressers. Do you code or let it ride?

Interested in how others would treat

I would say I’ve done quite a number of central lines. However, one thing I sometimes encounter is somehow difficulty in advancing the guard wire…as if the tip tries to curve again at the end of the needle after going through. I’m not quite sure how to explain it but I hope folks understand what I mean. Is there a trick you guys use to advance your wire easily?

Hey all - there are a few different threads here on salaries, but it's all over the place and does not have the full context of comp - e.g., including shifts, schedule, PTO, benefits, location, etc. to make it useful. We all know that medicine needs more transparency and this information is key to make sure we are fairly paid. All the salary reports out there are just not useful - either too broad and not specific to our situation or cost $$$.

A few months ago, my anesthesiologist friend tested a spreadsheet format in the Anesthesiology sub-reddit and has crowdsourced >500 anonymous salaries for the community. It has become an extremely helpful resource for them to ensure they are being paid fairly. I have worked with him to extend the sheet and the questionnaire to other specialties as well - and a few specialties have already contributed hundreds of salaries in there. We only have ~10 CritCare salaries so far - so if we can all contribute our salaries to this, this could become a really useful resource for Critical Care as well

Let's do it together as a Community. This is fully anonymous, so it really decreases the taboo of discussing our comp.

Here is the salary questionnaire - https://marit.fillout.com/t/vfyw8PEHj2us

Let me know if you have any feedback on questions in there. And you see the data collected so far here. Add your comp info if you are willing, and it will unlock the full spreadsheet. The more data we get in there, the more useful it will be for all of us!

PS: This is for physicians and APPs in the US only

I am soon to be resident in IM and am very much interested in critical care. I am currently working in an ICU as a intern and I cant tell you the number of times I get lost as attendings and residents always look at the CT or the MRI images and all come to the same conclusion/know what they're looking at. I do not know the ABC's of brain CT anatomy and want to start learning from the basics. I want to atleast understand the words that are mentioned in a CT/MRI report. I wanna start from CT/MRI brain as that is most common radiological imaging we see in our ICU.

Any q bank for fficm or fccm ?

Has anyone read the new ATS critical care review book?

I have the first edition debating if its worth getting the second one.

PCCM here. I haven’t been able to find any great resources on instruction or management of a Gills procedure for subcutaneous emphysema (supraclavicular incisions with wound vac). Does anyone have any good links with instructions / case reports with management of this procedure? Everything I’ve found is just anecdotal.

Hi all, I’m likely overthinking this but do you typically numb the skin first with a smaller length needle then switch to a longer needle to numb the subQ tract just before the vessel? I usually just do a “one-stick method” where I inject the skin and subQ in one-go.

I am referencing the method used in this video: https://youtu.be/_WJuUoDEM0s?si=BibTMy0xJAEOQ_QS

Hi. I was hoping for some advice. I work full time and don’t have too much time. I don’t want to spend so much on chest review or seek questions. I passed pulm boards and I don’t feel the pulm seek questions were very helpful.

Anyways. I was thinking of board vitals or McGraw hill questions and maybe listening to audio pod casts or audio review.

Anyone have good recommendations for a (cheaper) question bank or audio lectures?

Ty in advance

Edit: Thank you everyone. The collective experience of this group has convinced me to just get seek. I trained at a very clinical oriented program and didn’t study much and still passed the pulm boards. However someone mentioned that CCM boards aren’t as forgiving and their stat checks out.

Let’s say hypothetically I am a student on rotation at a small community hospital, say 10-12 beds. Middle of the road acuity, no trauma designation. Say a patient came in to the ED with a PE or similar pathology, experienced severe pulm HTN and subsequent RV failure, and was brought to the ICU. A few hours of time passage between ED arrival and ICU admission.

Intubation is quick, but central line and airline access are never established due to inexperienced providers and got awful communication (“oh, wait are you doing an a-line? Should I do a central line? Oh you’re doing a central line? Where’s the a-line kit?” Imagine this for ~1 hour.) Patient codes, and even during the code there is awful communication (no closed loop, people yelling over one another, code meds given before time, random pulse checks, etc.) Unsurprisingly, the patient does not does not survive.

My questions are as follows:

1. How do I ensure that I get brought to a sufficiently prepared hospital by EMS if I know I’m going to need a high level of care? Is there a magic word that will earn me a trip to the nearest level 1 center? Studies have shown over and over again that survival rates are better in centers that are equipped and practiced at running these high-level codes and transfusions.
2. What would you do if you were trying to resuscitate this patient in a place like this and had no access to things like IR or ECMO? Would you have tried to move the patient to a different facility as soon as you heard of them? What would your first and subsequent steps be upon their arrival to your ICU, if you weren’t sure the etiology of their RVF?

Thanks in advance. What a terrible experience.

My current place has an interventional cardiologist as the medical director who at best ignores the CICU. The surgeons and intensivist teams want to replace him. When these discussions grew into a possible reality we were informed that per ACGME requirements a cardiology fellowship must have a cardiologist as the CICU medical director. When we investigated it says ‘ideally’ not mandatory. I have not been to a lot of different hospital systems but is this the norm now? Curious how other people’s CICU leadership is structured.

I’m curious about nursing leadership structures in hospitals other than my own, particularly in critical care units. I’m a relatively new nurse manager of a 20 bed MICU in a large academic center and was previously the assistant nurse manager. A friend in another hospital told me that her similarly sized unit has a director, a manager, and 2 assistant managers. The reason I ask is that I feel absolutely tasked saturated. There is so much that I’m responsible for that I’m finding I can just barely get everything done, and feel like the things I do get done are just good enough, nothing great.

I’ve worked at this hospital for 8 years and nowhere else, so I’m trying to see what the norm is and if I’m getting screwed and by how much.

Thanks

Hey all, I’m looking to improve my oncologic critical care knowledge and can’t find any specific review courses. Do you have any ideas on where I can get some focused onco-critical care training? I’m IM-CCM and didn’t have a ton of oncology during training.

For Pulm. Murray vs Fishman ? Any thoughts? Thanks in advance

2nd year CC attending. Cover micu/cvicu with open heart cases on average 14-16 patients, just one intensivist on per shift and no mid level. There’s days where it’s 7 pts and days when it’s 20. Except for the days when it’s very high census the job is fairly manageable and I’m happy with it. The suits are now rolling out a new program because according to them we are not a busy icu compared to their sister hospitals. The new program is virtually covering a 7 bed low acuity icu about 4 hrs away. They are planning on hiring an APP who will run the show there and round with us virtually once we are done with our rounds here at our main job and call us for admissions and troubleshooting etc. So essentially the way they are selling it to us is that we are covering a small icu with help of an APP remotely and it is during our 12 hr scheduled shifts (day/night) and they are not paying us anything extra for it.

I see this as being asked to do a second job, more liability, and more cognitive burden. At the very least I think we should be compensated at fair market value for a virtual icu job. I took this job 4 months ago and when I signed my contract there was no mention of any of this. My colleagues are older, married with kids and for them to leave is a hard sell so they are not making too much of a fuss. I don’t want to but I am willing to walk away but wanted to see what y’all thought. Is this reasonable what they are asking us to do?

I have experience in a surgical subspecialty but I frequently round in the ICU so I do have exposure. I am hoping to ultimately end up in critical care when the time is right. Any course recommendations? Ideally online or books since I would spend all my CME $$$ on flights for a conference.

Hi all. I (28f) have been spending some time on an ICU ward. Really not going into too much detail but I am a student. This is in the UK. There are magical things happening daily but holy hell, the individuals I am seeing that have zero quality of life who are in vegetative states, suffering, in pain, uncomfortable from the relentless suction and repositioning….. they smile every now and then at bubbles or something but this can’t be right? If my child or myself was in this state with all dignity lose (not by the care but just in general) and no way of mobilising or living without this intense medical care I wouldn’t want it. I see parents spending their whole life’s revolving around someone who is no longer there anymore or even never has been. It seems so sad seeing a human being in this state and it seems so wrong to keep them alive. Oxygen, tracheotomies, peg feeds, stomas, catheters all at once with two hourly repositioning and secretions constantly. I feel like I’ve been undercover and the healthcare teams are incredible and I can’t speak about the families as I know it must be so painful for them but surely the individuals can’t be happy.

If your dept uses Epic EHR, what do you use for a physical rounding sheet or handover/signout between shifts? I’m Cerner we had a rounding list we printed that was great with vitals and meds and room to write. In Epic there is the handover but you have to complete electronically, if patients are “VIP”/anonymous they don’t show up as the right room, etc. Specialty depts, residents and APPs tend to update the Epic handoff sheet but CCM are thus far not eager, and prefer email signout.

What do you do, and is it efficient? Do you do a group CCM/APP signout at shift change?

What about surgeons etc who want the updates from an email?

Has anyone tried the Whirl add on to Epic for custom rounding sheets?