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.

Hey everyone

I am ICU PGY-4 , i have elective rotation and i am considering doing it in Echo.

I am looking for a center in Europe that can offer an elective rotation in this matter for 4 weeks, for international/visiting residents

I have sent plenty of emails and got no responses

Any help and suggestions would be greatly appreciated

Thank you!

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?

I've heard this a handful of times, and best I can figure out it's from the late 80s.

Is there any updated literature suggesting this is true, and how much volume are we talking to be meaningful to consider drainage? I'd imagine a pleural effusion on CXR in the 80s meant alot more than a small-ish parapneumonic effusion picked up today on pocus.

Thx!

PGY6 PCCM fellow here. I will never for the life of me understand why CMV causes pneumonitis but SARS-CoV2 causes pneumonia. It seems like we should be consistent with our nomenclature here. It’s like calling it “aplastic anemia” when it’s really “aplastic pancytopenia.”

Any thoughts on the subject?

TLDR: old man yells at clouds

I'm a second year resident who wants to go into critical care. I've been trying to place US guided IVs as a way to practice for art lines in addition to it just being good practice. At first I got a few but I've made a lot of unsuccessful attempts recently. I'm getting frustrated though because I often am able to get flash but then have a tough time threading the catheter in. Anyone out there who is good at US guided micropuncture- how many sticks did it take until you became successful? Any tips for getting better at this?

Curious what others do for this. 30 y/o pt with DKA when insulin refills couldn't be obtained and they ran out. AG 26, serum CO2 11, pH 7.22. Normal hemodynamics and mental status, normal renal function (just a little dry). I admit to the ICU because hospital policy says it HAS to be that way and none of our hospitalists likely know how to fix mild-mod DKA w/ fluids and subcut insulin (so pr is on a drip). Comes to ICU and with 3L fluid and <6 hrs of insulin ggt they're better and go home the next day day (less than 2 midnights).

Do you bill critical care time? We are more of an open/consultative ICU but obviously have some policy constraints too. I was looking at this as more of a level 2 consult (maybe a level 3) but there just isn't that much thought/effort that I put into it since it's mostly protocol-driven (MOSTLY).

Different Intensivists in our group had differing opinions about how to approach billing for a pt like this. Curious about others thoughts.

Our unit, a surgical trauma ICU at a tertiary care level I, tried implementing a form of nurse led rounds a few months ago. We had initial buy-in from our unit medical director, but push back from a few attendings and residents. Do any of you have any experience implementing nurse led rounds and could share some insight? This is an ongoing project and we want to tweak it to increase nursing input during rounds while still giving residents the opportunity to learn and grow from rounding.

I’ve had 2 instances in the past 3 months where a guidewire has physically become stuck or sheared within the introduced needle of an Arrow TLC kit. Yesterday, I had to remove the wire and introducer needle en bloc to safely extract it. I talked to my attending, and he’s had the same problem at another hospital he works at. Curious if this is a widespread problem. I suspect this is due to cheaper goods used in manufacturing or some other quality control issue.

Has anyone used any of the tools out there for writing notes in the ICU? I would think only the options that integrate with your EMR would be a possibility, as unlike clinic, a lot of the patients can't speak...

Per title. Got admit yesterday. ED says PNA but i spent signoficant time and figure out patient has new onset HF (50 yo ish). I did pocus, extended labs/workup. etc like 1 hr time was spent. HTN emergency, on drips, IV diuresis.

Is it a thing in your area? I am asking on behalf of a critical care attending from an European country where it is not a thing, but it may become a thing soon, or at least this friend wants to make it a reality in the coming years. Any good resource to look further into it?

I’m curious to learn the schools of thought/current EBP on VA ECMO management.

When do you consider a need for LV unloading and what is your method of choice (atrial septostomy vs Impella vs IABP vs LAVA)?

How much does pulsatility matter to you and your practice? Why? If fluids/blood will help with pulsatility then where do you draw the line for how much fluid you give?

Thanks!

Hey everyone I wanted to know if books or a book that is a good resource to study for the CCRN exam. I appreciate any advice thank you!

Hi all, I’m a fourth year BscN student about to start my preceptorship in the ICU and I’m just looking for any advice or tips and tricks I should know going into it. I’m super nervous but super excited to learn and find my feet in the icu!!

I'm in my last year of fellowship and looking to do tele ICU PRN. Any recommendations on companies to or avoid