I am a new grad nurse and I am starting in the Surgical ICU. I want to start studying for my new job, but I have no idea where to start or what to look over. Please share any advice you have or your experience as a new grad nurse in the ICU. Thanks you so much.

I recently made the switch from anesthesia to critical care, and I'm facing a challenge. While I have a solid foundation in anesthesia-related topics like vents,airway and procedural skills like central lines, my knowledge of internal medicine is limited. When discussions lean heavily towards internal medicine-related stuff - like nuanced disease management, complex medication regimens, or subtle diagnostic differentials - I feel completely lost. I struggle to keep up with the conversation, and I'm unsure about the reasoning behind certain decisions. I'm hesitant to ask questions, fearing that my colleagues might think I'm uninformed or incompetent. Has anyone else experienced this transition challenge? How did you overcome it? Some seniors suggested I read Parrillo and Dellingers' textbook, which are more internal medicine-focused, rather than Irwin Rippe's. Any advice or recommendations would be greatly appreciated! Is this a normal part of the transition process?

Any good review book or course for the osteopathic surgical critical care test

Cross post from r/nursing

Hello all, I work trauma ICU and have limited neuro experience so I was looking for some insight into a patient I had recently and how you would have managed things!

My patient was found down, bystanders initiated CPR and EMS got him back in 1 round. They say downtime <5 minutes. MRI showed multiple acute and chronic infarcts, acute and chronic hemorrhages. Spiked one temp on admission, concern for meningitis but desats on turns and can't do LP. Keeps having what appears to be seizure like activity every time we try to wake him up (eye blinking, L deviated gaze, rhythmic BLE shaking). Initial EEG said no seizures. 24 hour EEG ordered and at least twice during it, I stopped all sedation and within 30 minutes noticed that activity starting back up so I restarted the propofol per neuro. On my shifts, he would also start to demonstrate this behavior with turns or when the propofol was titrated down but less strongly.

My understanding is it's dangerous to let patients seize so I wanted something to be captured but was also concerned about just letting this go on too long.

Read came back yesterday and showed diffuse slowing possibly sedation or encephalopathy throughout the entire exam, no seizures noted.

How are you supposed to manage sedation during a 24 hour EEG? My concern is I didn't leave it off long enough to capture any seizure activity although at least twice I had it completely off and saw what I thought to be clear seizure like activity.

I know these are important for prognostication so I was concerned I didn't manage the patient appropriately or should have kept the sedation off more. Also wanted to ask what's the limit of danger for letting patients seize if airway is protected already.

Thanks for the help and insight!!

Anyone know of a good AI note taker for ICU rounds? Something that I can just put on when I round with my residents that will create a note at the end? There is freed.ai but that’s for soap notes and encounters.

Should aminoacids/ protein be taken into account in the calculation of the supplied energy during nutrition in icu ?

Hello everyone, I’m thinking about pursuing a career in PCCM, primarily focusing on the pulmonary aspect. I would love to get some insight into the typical work schedule. Specifically, I’m curious to know if it's possible to have a practice that is predominantly pulmonary (around 90%) with only about 10% critical care, and without any night shifts. Any feedback would be greatly appreciated. Thank you!

I was just wondering if any of you have had experience using high-dose insulin as an inotrope? There is a bunch of solid litterature in toxin-induced cardiogenic shock and some (weaker) studies in non-toxin-induced cardiogenic shock. I was just wondering how your experience actually played out? Any issues in maintaining relative normoglycemia? Any adverse events? Any success in monotherapy or did you have to resort to other vasopressors/inotropes? Any structural issues (e.g. resistance from nurses or pharmacy)?

Also, what do you think these findings mean on the efficacy of epinephrine knowing that it can lead to hyperglycemia and that many studies on the efficacy of epinephrine did not account for the variable of concomittant insulin administration?

Has anyone had any good or bad experiences with neurocritical care locum tenens work? I am in the process of moving toward locums for the next several years and wanted to get some opinions- scope of practice, procedure complexity, hours, etc

CCM boards results are out and I unfortunately failed again. This is my second time taking it and got the exam same score - 344 (9 points away from passing). I’m not sure how the hell that happens. For studying, I did SCCM board review videos/lectures + Chest SEEK qbank x2 and SCCM book of questions. Strong clinically but have had issues with boards in the past. Honestly struggling with this mentally, feel like last year was a waste and not sure what to do differently. If anyone has any suggestions on what to do different, please send them my way.

For you all going to Critical Care Congress this year, how much are you paying for registration? I have 2 oral presentations, and to attend, I have to pay $1500 conference registration fees. Is it true I have to pay that much to present my abstracts? Please let me know if there is any other way around it. Thank you

PGY-2 here. Planning applying PCCM for fellowship in the coming cycle. I love the ICU and Pulm but I’m feeling as most second years do at this time I suspect- tired, over the hospital system, and wishing for more time at home with my husband and cat. Does anyone work part time as a PCCM MD? Thanks in advance!

Hey all, IM PGY2 here. Really struggling on deciding Hospitalist vs Nocturnist vs CCM only. 37yo, married and planning to try for a kid this year, we went to stay in the East coast preferably anywhere from FL to NC in the suburbs near the city. I enjoy both positions, I like procedures. What I’m struggling with is, is it worth the extra 2 yrs of residency being the location/states I’m limiting myself to work at after? What is the potential salary difference between both and types of settings? I don’t mind working in an open icu but I heard those are mostly in rural areas. I know a friend that just got offered $380k as nocturnist 7on/10off in Minnesota. Is that foreign in the SE coast? I would like to stay above $350k a year as Hospitalist and if I’m dedicating the time for CC, I would like to stay above $500k. Is that feasible?

TBI, brain contusion , after car crash . No possibility to ICP monitoring . When You whithdrawal sedation ?

I apologise for this ridiculously silly question. Please bear with me. During intubation: Is it ETT then CO2 monitor then filter then ventilator? or is it ETT, filter then CO2 monitor then ventilator?

And does the position of the ETCO2/filter change during hand ventilation?

Thank you very much.

I have this argument constantly, particularly in patients on CRRT. I’m of the opinion that in most scenarios, iCa should be supplemented based on the pH normalized iCa even in patients with acidosis (unless actively and significantly becoming more acidotic) because we are always trying to correct pH, and as the pH goes up the iCa will drop. Especially with CRRT.

I can understand the argument that the iCa is not exactly accurate for an acidotic patient if you correct for pH, but we tend to be pretty conservative with calcium replacement and I feel it makes sense to avoid having to chase the iCa to avoid hypocalcemia as the pH climbs. Thoughts?

Hi critical care friends. Quick question about IABPs and measuring catheter placement. Do these catheters have markings on them like a PA catheter? Do you measure the position outside the body or do you just confirm the positioning via daily chest x rays?

In the past years I have been attending more and more cardiac arrests on the floor with patients not having any IV access. I have an EZ-IO gun in my fanny pack and usually place a humeral IO if no access can be achieved by the 2nd set of compressions (or earlier if I think its going to be a major problem). It’s much faster and safer than the blind fem central. Has this been a practice adopted by others? I know meds aren’t the major priority in Acls, but quickly and safely placing access for post ROSC care is important.

Hello,

I am a PGY-4 Critical Care fellow (EM -> Anesthesia CC) looking for some supplemental resources for learning critical care. Not a huge fan of cracking textbooks, but I will if I must. Mostly, I am looking for free videos, podcasts, and websites.

I am already a fan of the IBCC website and podcast, in addition to derangedphysiology (though it is a lot of text to work through).

Let me know if you have any other easily digested resources that made you a better intensivists.

Current PCCM Fellow. Planning to start the job search in a few months.

A pattern I noticed was that apart from 1-2 exceptions, most new faculty (assistant profs) in programs were from the graduating class.

I’m hoping to relocate after fellowship and aim for academic jobs. Preference is university, affiliated or privademic programs. I have family in Indiana, Ohio, NC, Virginia and Maryland so prefer these locations.

I’m at a mid tier university program. Have received 2 foundation grants and 1 intra mural grant to fund my research. These are obviously not as prestigious as NIH grants, nor do I have any pedigreed schools to boast of in my resume.

I am curious if I have a shot at any faculty positions in the above mentioned states? I don’t mind reaching out to these programs. But I wonder how to strengthen my application when applying for these spots.

It’s important I end up in these locations for personal reasons. So want to make sure I give it my best shot. Appreciate any advice!

New article by Wunsch et al, published in AJRCC in Aug 2024 rehashing the long debated risk of Etomidate for RSI in critically ill patients. The article posits that use of Etomidate poses unnecessary risk of mortality when compared to Ketamine. It seems to be a compelling argument for use of other induction agents (primarily Ketamine) in critical patients.

A few issues with the article:

Regarding widely-accepted evidence of adrenocortical suppression, the authors excluded anyone receiving steroids on day 0 of mechanical ventilation. Assuming that most providers expect to see AI, it would be reasonable to assume that a high proportion of them would given parenteral steroids.

Lower proportion of those receiving Etomidate had major surgery -> therefore, more likely received induction agents in less-controlled environment.

Does not account for physician specialty/expertise, location of use (ED vs ICU vs OR vs ward).

Do we trust these results? Should we altogether avoid Etomidate in critically ill patients?

Did it work just fine? Or you got screwed (at least initially, lol)?

Hi ya'll! Have a question regarding CRRT dialysate/replacement formulas with regards to calcium content when not using RCA. If NOT using ACD for anticoag within the circuit (systemic heparin instead), do you have to have calcium in the dialysate/replacement bags? I.e. running Prisma 4/2.5 instead of something like say 4/0/1.2 or 2/0? Or, would running a 4/0/1.2 be OK if doing frequent ionized calcium checks and replacing PRN? Attempted a deep lit dive, but am away from my institution's subscription service and am unable to get at a lot of the kdigo information. Thank you!!

Hello first year CCM fellow here going to start looking at jobs within the next 6 months to start applying. Was wondering what average salaries look like in your state and practice setting. I know patient population, census and specialty help is important but I want a general idea what I can expect offers to look like and when to negotiate or what wiggle room I have.

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!