Orientation Overview — SICU Rotation

The surgical intensive care unit is an environment where the team approach is used to care for critically ill and injured patients.

The ICU is a twenty-four bed, mixed medical/surgical intensive care unit. It operates as an open ICU, meaning the Surgical Critical Care team functions as a consulting service for all surgical patients in the ICU.

Open ICU Model

Because this is an open ICU format, you must take primary directives from the admitting team of record. This is typically:

• The Trauma service
• The Acute Care Surgery (ACS) service
• Occasionally: E1/2 services or Vascular

• Important rule:* The primary service is in charge of all clinical decisions except for:
• Management of the ventilator
• Management of sedation

These two domains remain under Surgical Critical Care direction.

During weekdays (except Thursday), the ICU team and Trauma Team round at 8:15 AM.

• Thursdays:* Grand Rounds, teaching conferences, and pre-op conference occur. Rounds may be scheduled at an alternate time. The on-call attending on Wednesday night is typically the attending covering Thursday morning. The covering chief resident is responsible for arranging round time on Thursdays.

In addition to reporting patient data, residents are expected to synthesize a treatment plan that is evidence-based for each of the patient's active problems.

"Go-To" Person for ICU Issues

In addition to presenting on morning rounds, you will be the first "go-to" person for issues in the ICU. Your role:

• Keep the primary team apprised of new issues
• Help manage patients while the primary team is in clinic or the operating room
• You are not expected to manage patients on your own — ICU patients are complex and require a team approach
• All clinical decisions should be ones that the chief resident and/or attending agree with

Stay Connected, Ask for Help

Your ICU rotation will be what you make it. The ICU is a place where you can further your understanding of disease pathophysiology. At times, this rotation will challenge you both intellectually and emotionally.

Know that even when things feel hard, there are always Chief residents and Attendings who have your back. Keep lines of communication open and never, ever hesitate to ask for help.

• Adapted from SurgCritCare. org for display clarity. Clinical meaning preserved. Verify against current institutional policy and attending guidance.*