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--- intern:pgy2-pgy3_off-service [2019/08/12 16:43] – [UCH Vascular] melissa
+++ intern:pgy2-pgy3_off-service [2020/06/11 18:39] (current) – old revision restored (2019/09/22 15:14) jonathan
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 Surgery Clinic Charge RN – Meghan Amiot (x27582)\\
+We look forward to working with you in the STICU.
+I want to make you aware of the website that contains all of the protocols and guidelines used in the UCH STICU.\\
+http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/divisions/Trauma/Trauma-at-UCH/Pages/Welcome.aspx
+On the left hand you will find links to the STICU protocols as well as the TACS Service protocols and the STICU curriculum. The only link that is protected is the curriculum. The user name is criticalcare and the password is cusurgery.com.\\
+I want to make a special note to the Department Guidelines at the bottom of the page of STICU protocols. There you will find surgeon specific guidelines. As example, there is a protocol for the liver transplant patient care during the first 48 hours after transplant.\\
+While on service, you will participate in the resident critical care curriculum, managed by Drs. Martin Krause and Lauren Steward, including:\\
+)      Critical Care Didactic Lecture Series – 3pm on Monday, Tuesday, Wednesday, Friday\\
+)      Critical Care Grand Rounds – 12pm on 1st/3rd Thursday\\
+)      Ultrasound M&M Conference – 12pm on 2nd Thursday *free pizza\\
+)      Critical Care Journal Club – 12pm on 4th Thursday (residents will be assigned manuscripts for presentation) *free pizza\\
+While on service, please refrain from eating food in patient care areas and nurses’ stations. Also, all liquids must be kept in a closed container with a lid.\\
+If you have questions please feel free to contact me or Jason Brainard.\\
+Further if you have any suggestions about the protocols, interest in developing a new one, interest in a QI project, or other observations about the STICU education please let us know.\\
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 ==== UCH Burn ====
-Cover the ICU on Wednesdays when the ED resident is off and a weekend day
+Burn Service Information:\\
+General Information on how service runs:\\
+  * Usually Monday is your 24 hr call and Tuesday you are post-call day but check the schedule. Sometimes if they cannot find enough moonlighters they will change it up.
+  * Typically first Monday of rotation they will want you to round on all patient so that you know service.
+  * When you work overnight you can leave at 6am, you don’t have to stay for rounds!
+  * When the EM resident isn’t there then it is your responsibility to pick up the pager from the night intern and then go get sign-out from the ICU resident. On these days I would usually show up around 5:30 - 5:45, so I could try my best to get the night person from the ICU out by 6.
+  * You typically work one weekend day each week rather than blacks/golds because the EM residents complained because they apparently have to have one day off for every 7.
+  * On the days there is an EM resident (usually every day except Wednesday and the weekend day) I often would get to work between 6-6:30am.
+  * When both you and an EM resident are there, you go to the OR and are not responsible for the ICU. You do have to see any patient who is going to the OR  that day and write their note prior to the OR.
+  * During the day, between cases you need to be consenting people and putting in their pre-op orders for the next day. The EM resident and APPs will not do this so it falls on you to order blood, hold heparin drips and make sure people are NPO. Consent patient’s for everywhere they could possibly be operated on. Usually type and cross between 2-4 units of blood per case.
+  * Anyone who has a protected airway (ET tube or trach) can keep their tube feeds running prior to and during the OR.
+  * When you are in the ICU (when the ED resident is off) you often carry 6-12 patients. You always carry the ICU/stepdown patients but also any other patients the APPs tell you to. They usually divide the list evenly (even though you carry icu patients which are a lot more work than their floor patients but it is what it is). When there are two APPs, it usually ends up being 6ish patients and when there is only one it ends up being more. There is always only one APP on the weekends so it’s usually more patients then.
+  * On the weekends, once you and the APP have finished all the work on the floor patients you can go sign out to the crosscover intern and then you only have to cover the icu/stepdown people until 6 when the night moonlighted comes in.
+  * Overnight, you should go to the burn alerts/activations but if a burn alert is stable the intern should admit/work it up. The activations will almost always come to you but Jess and/or the attending will always come in for those so you won’t be alone.
+  * When an alert/activation come, go down to the ED and take initial photos and send to attendings. You will then have to fill out a Lund and Browder.\\
+ In the OR:\\
+  * Wear shoe covers and eye protection always the cases are messy
+  * Takedown whatever dressings you are dealing with then all attendings prep with a chlorhexidine soap on lap pads that the scrub will have in a bucket for you. Prep limbs circumferentially and torso to bed (if involved in the excision). Dr. Wiktor likes you to prep the donor area with a chloraprep stick. Dr. Duffy does not use hand table (Wiktor and Wagner both do).
+  * Drape using blue towels and a million half sheets. The scrubs are pretty helpful with this.
+  * They put tumescence in everything with Pitkin’s solution. Bleeding is typically stopped with Thrombin spray then epinephrine soaked telfas. Dr. Wagner and Dr. Duffy are ok with VERY judicious use of the bovie (spray saline/GU solution on area of bleeding and then stop bleeding. Dr. Wiktor does NOT like the bovie and puts Vicryl stitches in anything bleeding.
+  * Grafts are put into place using Artiss spray and occasionally staples. The dressing for grafts are:
+  * Limb:  Mepitel 1, bacitracin (+/- Medihoney), kerlix and Ace if on a limb
+  * Front or Back: Mepitel 1, bacitracin (+/- Medihoney), burn pad, therabond
+  * Dressing from Graft donor site typically is Mepitel transfer Ag, kerlix, ace
+  * Cover the ICU on Wednesdays when the ED resident is off and a weekend day
 hour in-house call on Mondays
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 Must alert the intensivist as well as the pulm transplant attending and the thoracic fellow for all
 major issues including worsening shock, hypoxia, need for reintubation, bleeding, etc as above
+====  UCH STICU  ====
+Here is a very brief and candid rundown of the STICU. You show up every morning at 0600 and get sign out from the night person. Essentially you just claim whomever - the APPs will be there to tell you who you should take on the first day and then you can try to pick up the same patients on the days thereafter. The night person will present and write notes on all the new patients but you will "claim" them and take over their care once the night person has left. You get ~2 hours to prep your patients - which is usually more than enough time. The note template is ""Create in NoteWriter" and type "Progress" and then choose "ICU Progress (Systems) UCH IP".\\
+You will begin rounds at 0800 and usually the night person goes through all their patients first and then will break off to go write their notes and then the day team finishes rounding. In an average day the team will consistent of 1-2 residents, 2-3 APPs, and 1 fellow. There is a Gyn Onc fellow there right now as well and she essentially acts similar to the residents or APPs. Some mornings she isn't there because of other Gyn Onc obligations. In addition, you have your attending, pharmacy (usually Bonnie), and nutrition (Caitlyn).\\
+Presentations are you give a brief summary of the patient and state overnight events. Then nursing goes through their portion. Then you run the patient head to toe. Some attendings (i.e. Ferrigno) like you to list the pertinent vitals or labs. Some attendings want to know I&Os whereas others just want to know relevant outs (i.e. drains, tubes, urine). Usually the attendings will tell you ahead of time what they like, otherwise it's just learning by trial and error.\\
+You will get random admissions throughout the day. Usually they have a general idea of which patients will be coming to the unit and then of course there are any TACS patients that pop up that might need to come in. The APPs DO NOT admit after 0300. After rounds, you get work done - procedures, notes, consults, etc.\\
+At 0300 there is lecture most days. They are actually pretty useful and are usually given by the fellows or APPs. They last about 30 minutes and there is no pre-reading. Once a month there is grand rounds on a Thursday that is at noon. You do not have lecture that day.\\
+For night shift, you have to show up at 0300 and then usually go to lecture and then get sign out. If there is no lecture you still have to show up at 0300 and get sign out then. At night you'll occasionally be on with a fellow but not always. Most attendings want to be called or texted about admissions, starting someone on pressors, massive transfusion, or unstable patients in general. Otherwise you have some free reign to manage patients if you feel comfortable. The one exception is transplant patients.. as you know they are very particular so I would usually just default to calling them.\\
+TACS Tuesdays are always super fun :/. The TACS second year presents the patients to a giant team of lots of people of whom I know only half. It sucks for the second year on TACS because they usually aren't super privy to what's happening in the unit. But nice for you because you just write the note and don't have to present.\\