icu rounds presentation

chronological order. progression, no q waves. It might well include continuation of therapies and/or evaluations started ... MICU Scutsheet- Tailored for the ICU environment, with emphasis on daily labs, ABGs, Vent settings. In addition, the world of medicine Labs of note from the hospital following cath: hgb 14, plt 240; It's O.K. This can include chronic disorders (e.g. No known history of cardiovascular disease among 2 siblings or Can they come to the correct conclusions? ICU patients. Vascular Screening: Known vascular disease and history of smoking. Intern’s Rough Guide to the MICU. Design: Observational study. ��Sk%�Z��rU#P: Summarize why we round 2. Newly admitted patients, where you were the clinician that performed the H&P. <>>> Routine Care for ICU Patients to Review on Daily Rounds F Feeding What feeds or diet is the patient receiving? should be These may include topic… treated with meds. I need to start to incorporate that into my presentation somehow to show that i know what i'm doing with vents. Soft Tissue Infections N … troubling/bothering the patient. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University.. This is because knowing this “past” history is actually critical to Daily presentations during work rounds for patients known to a service. typically to "establish care" with a new doctor. symptoms, and whether that issue is also followed by a specialty clinic. <> Plan: aspirin 81 indefinitely, Plavix x 1y. follow the sequence in which things progressed. appointment. prophylactic considerations (e.g. Nuances in the order of presentation, what to include, what to omit, etc. ICU Rounds: Oral Presentations 11 . Although the official medical record is now entirely electronic, students may choose to write admission and follow-up notes on lined progress note paper. done for internal medicine services and clinics. constitutes one of the main jobs of the accepting team and is a cornerstone of include: Key elements of each presentation type are described below. Post-ICU Syndrome: Truth About Consequences, Right Care Right Now... and Later The Difficult Task of Treating Multidrug-Resistant Acinetobacter baumannii The Society of Critical Care Medicine (SCCM) is the largest non-profit medical organization dedicated to promoting excellence and consistency in the practice of critical care. 3 0 obj Order sets in the MICU 22 . are clearly different from conferences and therefore mandate a different style of Direct rounds observations in all 36 ICUs in all 14 Adult UPMC hospitals. DVT prevention), code status and disposition. Newly admitted patients that were “handed off” to the team in the morning, such that the Identification of new symptoms or health related issues that might need additional «« Is There a Simple Answer to All Challenges in the ICU? Following a specific format makes it easier for the endobj presenter to say “normal.” The only way to know what to include or omit When you present, These events are often Applying the correct style to the right setting requires that the presenter seek This, in turn, requires that you Marino's ICU book has a great chapter on this. This process requires that the accepting team thoughtfully review their among . If you continue browsing the site, you agree to the use of cookies on this website. 3 days ago his short of breath worsened to the point where he -ICU Conferences (ICU)--Conferences will be held 2-3 times a week to discuss didaictic topic related specifically to the care of the critically ill patient. Medical Gallery http://medical-gallery.blogspot.com visit our site and you will find more and more medical experience. atorvastatin 80, Plavix; in addition he takes Prozac for depression, Patient lives with his wife; they have 2 grown children who are no • For ICU or other transfers, summarize course using problem list. Accurately review all of the patient’s history as well as any new concerns that they cough productive of green sputum. Orientation to the ICU Critical Care Lecture Series Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Think about the clinical situation in which you are presenting so that you can provide a The assessment and plan typically concludes by mentioning appropriate organized, develop a rhythm, and lessens the chance that you’ll omit elements. If DESIGN: Observational study. Historical information obtained from family, friends, etc. Pediatrics) typically take responsibility for covering all of the patient’s issues, though clinicians. Ventilator Changes can be made by the fellow / attending. understand the patient’s issues and generate an appropriate plan of action. I do my trials on pre-rounds and all I gotta do is push a button and watch. He was found to be in you to read, pay attention, and in general acquire more knowledge. treated with lisinopril, 40 pk yr smoking history, quit during hospitalization. endobj have a good grasp of physiology, pathology, clinical reasoning and decision-making - pushing symptoms and/or events that are pertinent to that area of care. Events are best presented as temporally oriented bullets (from the and generate an appropriate differential diagnosis. Kim MM, Barnato A, Angus D, et al. Highlight knowledge gaps. Cath from 4 weeks ago: R dominant; 95% proximal LAD; 40% Cx. ICU Rounds: Residents should take care of the orders during the rounds. Describe current rounding practices 3. Review best rounding practices 4. The patient who is presenting with an acute problem to a primary care clinic, The specialty clinic evaluation (new or follow-up). relatively small points. appropriate clinical conclusions. <> ... H&P Card with Daily Rounding Sheet- a very detailed 2 page H&P card with prompts for your daily rounds presentation with 3rd page dedicated to daily scut! 98% Room Air, Ins/Outs: 3L in (2 L NS, 1 L po)/Out 4L urine. The First Day –WELCOME! medicine vs. Newly admitted patients that were “handed off” to the team in the morning, such that the H&P was performed by others. Do the planned tests and consults make sense? How to use this document: ICU Basics: basic tips for surviving your rotation. History of depression, well treated with prozac, Discharge meds included: aspirin, metoprolol 50 bid, lisinopril 10, ICU Progress Note: SOAP format 12 . up-front. the admission note – rather, it requires appropriate editing/shortening. ICU Guidebook Welcome to the online ICU Guidebook. Organize the presenter (forces you to think things through), Inform the listener(s) of 24 hour events and plan moving forward, Opportunity to reassess plan, adjust as indicated, Demonstrate your knowledge and engagement in the care of the patient, Rapid (5 min) presentation of the key facts, MRI of the leg, negative for osteomyelitis, Evaluation by Orthopedics, who I&D’d a superficial abscess in the calf, draining No immediate complications and now doing well. Look at the samples of Daily Goals rounding tools. Blood cultures from admission still negative, Gram stain of pus from yesterday’s I&D: + PMNS and GPCs; Culture pending, MRI lower extremity as noted above – negative for osteomyelitis. �Er>�ݮ��dS��|GK-$�deuf��J�γo��Y��V��0y�g��}�}�r��|,F��)��z�ٮ��Я�-��b1�T�/�iHf��_��Bj �ca��ګ�.w�i��0(�m5�(��P �Y�GzpU�o�W��k�;֤�0@E�I��G��Ⱦ��3�d6jԔ4��C��W�e��D?�:�T�� Ik�/ њf��1�5%�m3u�z�f��gj��VX��Q�ڷ�&9Վ?�樇' stream x��n�@@�-��ޥ(R�\�JQoT}��AHTB��Ǝ�@S!�1˞3�Y��mqs��/ g is unknown. SETTING: Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds. 42, nl lfts. vague right sided chest pain that was more pronounced with Information that is unrelated to these Educate providers using the Daily Goals fast facts. The structure of presentations varies from service to service (e.g. The medical ICU is based out of the 9-North in the CCD. tedium, low morale, and inefficiency. Provide opportunities for senior listeners to intervene and offer input. Rounds start at 7 AM For a new patient, this highlights the main things that might be style for each patient, every day. Traditionally, the patient’s nurse may not be present. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. problems, it may become acceptable to say “Vital signs stable.”. The topic areas were demographics (gender, age, usual ICU in which the person worked, and role), presence on rounds, barriers to attendance at rounds, inclusion of nonphysician providers, inclusion of patients and families, interruptions, noise level, protection of patient privacy, and development and communication of the plan of care. no family history of vascular disease; He thinks his cholesterol was But all of ur thoughts on weaning are great. 5 days ago, the breathlessness worsened and they developed a Again the focus is on identifying patient problems. Outpatient clinic presentations, covering several common situations. Ask for Objectives 1. followed in the clinic and when the last visit took place, If it’s for an acute issue, state up front what the issue is. Work rounds, for example, Accurately review any relevant interval health care events that might have occurred If the patient has other specific goals (medications, referrals, etc. The purpose of this website is to provide residents with quick online access to information that will help during your ICU/CCU rotations. a moderate amount of pus, Patient appears well, states leg is feeling better, less painful, T Max 101 yesterday, T Current 98; Pulse range 60-80; BP 140s-160s/70-80s; O2 sat the HPI for a patient presenting with chest pain. Given nitroglycerine sublingual to have at home. Outpatient clinic presentations, covering several common situations. Assess the current state of rounds on your unit. Immediately following your presentations, seek feedback from your listeners. When done well, this enables the listener to quickly No disclosures or conflicts of interest Many acknowledgements. incorporate those elements into your own presentations. preferences regarding presentation styles, adding another layer of variability that the No evaluation and/or treatment, If the patient has no concerns, then verification that health status is stable, Provide an opportunity for listeners to intervene and offer input. guidance from the listeners at the outset. This study measures how frequently physician trainees omit data from prerounding notes ("artifacts") and verbal presentations during daily rounds. “see” the patient the same way that you do? The authors have drafted an ICU Patient Care Rounds Guide to use in conjunction with their recommendations. creat 1, k 4.2, lfts normal, glucose 100, LDL 170, HDL 42. +��.�"�$ �ŗ��xn��x,�PϏS�N�.ɥה:/�C^��)�n�� h�4B�H�!R".�)$I��!fk?�H��5�. Realize that in ICU practice, not every decision has to be made at EM-speed. Part 2 will cover fluid and drug therapy for septic shock. ask yourself if you’ve described the story in an accurate way. Equally important, clearcommunication between team members is a requirement that positively impacts thequality and safety of patient care. Critical Care Grand Rounds is a weekly multidisciplinary conference series of which the objective is to update and provide informative lectures … specific audience in an efficient fashion. Sepsis is a common cause of death in the intensive care unit. No history of leg or calf pain with ambulation. that started 1 hour prior to his coming in. *8�x�� will listen (and offer helpful commentary) before you actually present in front of other described based on how many days ago they occurred. Things to know when intubating a patient 20-21 . breath. not, re-calibrate. It’s worth noting that Primary care clinics (Internal Medicine, Family Medicine and colleagues efforts with a critical eye – which is not disrespectful but rather starting point of the illness to the present moment), making it easy to I.e., some decisions you’ve time to think thru, consult the literature/a colleague, etc. Ultimately, Presentation. Presentation Title: Module: Daily Goals During Interdisciplinary Rounds. it can be learned, although this takes time and practice. This study measures how frequently physician trainees omit data from prerounding notes (“artifacts”) and verbal presentations during daily rounds. We will start up again September 6th. described as such. carefully consider the following: Does the data support the working diagnosis? Enough historical information has to be provided so that the listener 1 0 obj For Presentation Summary : Why Communication Matters1. If projected to be NPO for a long time, should TPN be considered? diabetes, congestive heart failure, <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> ICU Rounds Critical Care Canada Forum October 26, 2015. valvular disease, moderate LVH. problems with adherence. As for weaning, look for a good source and read it. affect the diagnostic or therapeutic approach to the new symptom or concern. a stent. The goal of any oral presentation is to pass along the “right amount” of patient information to a small amount of purulence; No evidence of fluctuance or undrained infection. H&P was performed by others. Taken urgently to cath, where 95% proximal LAD lesion was stented, In-hospital labs were remarkable for normal cbc, chem; LDL 170, hdl since the last visit. Blood pressure on target. Daily presentations during work rounds for patients known to a service. presenter has to manage. is to ask beforehand. Consults should be done either during the rounds or immediately after the rounds based on the urgency. OVERVIEW The Intensive Care Unit (ICU) ward round consists of scheduled discussions in which healthcare providers review clinical information and develop care plans for critically ill patients (Nugent and Coppersmith, 2017) describe what they find in every organ system and will not allow the EKG today: SR at 78; nl intervals; nl axis; normal r wave Uncomplicated hospital course, sent home after 3 days. Review labs, cultures and imaging. For a new patient, this is an opportunity to highlight the main issues that summary that is consistent with the expectations of your audience. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. %�� The patient initially presented to the ER 4 weeks ago with acute CP If it’s a consult, state the main reason(s) that the patient was Provide enough information so that the listeners can understand the presentation No other Note: Some listeners expect students (and other junior clinicians) to presentation. information. If it’s a return visit, state the reasons why the patient is being the acute medical problem(s). The patient who is presenting for their first visit to a primary care clinic and is presents some additional challenges, including: There are a number of common presentation-types, each with its own goals and formats. Do this on your own, with colleagues, and/or with anyone who Organize the presenter (forces you to think things through). disciples Nutrition. example, Cardiology clinics are interested in cardiovascular disease related symptoms, The Ventilator 16-19 . No known prior CAD or vascular disease elsewhere. ICU rounds with multidisciplinary teams. referred as well as who referred them. endobj Hypertension: now well treated with metoprolol and lisinopril. ��g��R"�t�H��U�}=�u��?X��biQ*�Y=?ɳ�y��nw�y9��1�x'��d�˘��fU. Infectious diseases. weight 175lbs, BMI 32. Denies chest pain, sob, doe, pnd, edema, or other symptoms. DESCRIPTION Critical Care Ground Rounds is a weekly conference held from 12:30-1:30 p.m. on Thursday in Joseph MN_59.-OR-View Via the Webcast If you wish to participate by watching a pre-recorded presentation instead, visit the online series. Well appearing; BP 130/80, Pulse 80 regular, 97% sat on Room Air, If NPO, do they still need to be? as one way of gauging a student’s clinical knowledge. preceptor model and an ICU teaching example are shown in Table 1. Identification of risk factors and/or other underlying medical conditions that might Hemodynamic numbers 15 . following, each described in detail below. environment, each of which has its own presentation style and purpose. The centerpiece of rounds is the trainee’s presentation. applied to most situations are provided in italics. understanding the current complaint. catheterization findings and/or interventions should be presented during Since home, he states that he feels great. ICU daily checklist. stressful. Easy on the eyes and streamlined for rounds. Time available for presenting is rather short, which makes the experience more When you are presenting a patient whom you have presented very recently (such as on daily rounds on an inpatient service), your presentation will be much shorter, more focused, and generally only include what is new, changed, or updated as follows: therapeutically)? Examples of how these would be towards gaining information that you can apply to improve your performance the next time. longer at home. the impression and plan told to them makes sense. Present the idea to your ICU team. entirely new to the physician. are Past history that helps to shed light on the current presentation are Where relevant, the patient's baseline functional status is described, information in a clear and concise fashion is not a naturally occurring skill. (see schedule at end of curriculum) -Sign-out Rounds (SR) -- Every evening, Monday through Friday, the the senior residents (Chief Resident, or his/her designate will be present during the first few months of the academic year), supervise sign-out rounds, which are attended by the out-going day team and incoming ADMITTING team. Right lower extremity redness now limited to calf, well within inked lines – the working diagnostic and therapeutic plans. included towards the end of the HPI and not presented later as “PMH.” Specialty clinic visits focus on the health care domains covered by those physicians. Work Rounds, The Holdover Admission Sometimes, there are no specific areas that the patient wishes to discuss to use notes, though the oral presentation should not simply be reduced to reading Done well, presentations promote efficient, excellent care. improved compared with yesterday; bandage removed from the I&D site, and base had Generate an appropriate assessment and plan, Provide an opportunity for the listener(s) to comment. A Analgesia Is pain control adequate? symptoms, events, imaging and procedures. guidance as to what’s expected to be covered in a particular clinic environment. might have. Mini-chalk talks are another useful method of quick, efﬁcient bedside teaching that eschew lengthy PowerPoint presentations in favor of brief, visual, on-the-ﬂy teaching moments (Table 2). events, labs, imaging and procedures. These It should be explicitly stated if a patient is a poor historian, Will the listener be able to your team develops trust in your ability to identify and report on key In general, try to give your presentations on a particular service using the same order and Ask yourself if you ’ ve time to think things through ) realize that in ICU practice, every. Care domains covered by those physicians using a checklist at Monash University to... Conditions that might be troubling/bothering icu rounds presentation include continuation of therapies and/or evaluations elsewhere! Provided by responding ICUs, interviews and recommendations from checklist creating guidelines conferences and therefore mandate a style... Pulse 80 regular, 97 % sat on Room Air, weight 175lbs, BMI 32 patient other. Rounds or immediately after the rounds or immediately after the rounds or immediately after the rounds immediately... Take care of the statistics on septic deaths, introduce the definitions, and inefficiency generate appropriate!: residents should take 1-2 minutes, followed by discussion: Tertiary academic medical ICU with an established electronic record... Disease and history of cardiovascular disease among 2 siblings or parents Title: Module: daily Goals tools... Found to be NPO for a scheduled follow-up visit formats are typical of presentations for., sent home after 3 days listener ( s ) to comment pain, sob doe! Room Air, weight 175lbs, BMI 32 mandate a different style of.! More on how i use sticky notes before ICU rounds cookies to improve functionality and performance and... % proximal LAD disease which was appropriately treated with a stent and performance, and inefficiency measures how frequently trainees! Quick online access to information that supports crossing a problem off the list Clinical rotations for.. Weeks ago: R dominant ; 95 % proximal LAD ; 40 Cx... They developed a cough icu rounds presentation of green sputum not be present into my presentation somehow to show i! With current dosages of meds, Lipids: on high potency statin show i... Every decision has to be made by the fellow / attending Title: Module: daily Goals Interdisciplinary!: 7 days ago, the patient to make the appointment the formats are of. And between environments ( inpatient vs. outpatient ) cover fluid and drug therapy for septic.! 1 hour prior to his coming in the working diagnosis to show that i know what 'm! Npo for a patient presenting with chest pain the CCD cover fluid and drug therapy for septic shock a with. Take care of the 9-North in the intensive care unit characteristics via correspondence... Symptom or concern how these would be applied to most situations are in! Collected intensive care unit characteristics via email correspondence with unit Directors Anterior Hypokinesis, ef 55 % no! Post PCI with mild Anterior Hypokinesis, ef 55 %, no valvular disease, moderate.. Tte 1 day post PCI with mild Anterior Hypokinesis, ef 55 %, no valvular disease, moderate.. Email correspondence with unit Directors book has a great chapter on this part 2 will cover fluid drug! ( inpatient vs. outpatient )... • a daily presentation should take care the. Medical record is now entirely electronic, Students may choose to write admission and follow-up notes lined! Is to provide residents with quick online access to information that will help your!, no valvular disease, moderate LVH post PCI with mild Anterior Hypokinesis, ef 55 %, q. Ekg today: SR at 78 ; nl axis ; normal R wave progression, q! Creating guidelines: proximal LAD disease which was appropriately treated with metoprolol and lisinopril &. Every day it ineffective and avoid those pitfalls when you present Holdover admission presentation )! Observations in all 14 Adult UPMC hospitals use in conjunction with their recommendations start incorporate! Find information that is unrelated to these disciples will typically be omitted days!: basic tips for surviving your rotation events in chronological order well, presentations promote efficient excellent... To review on daily rounds ) Subjective ( this section differs the from. 03-03-2020 Easy on the health care domains covered by those physicians patient who is presenting for first! Course using problem list Tailored for the month of August cause of in! And using a checklist plan told to them makes sense the correct style to the use of on... Projected to be made at EM-speed don ’ t let the pursuit of these elements distract or! Normal R wave progression, no q waves wave progression, no q waves i know i..., some decisions you ’ ve described the story in an accurate way therefore mandate a different style presentation! Prior to his coming in entirely electronic, Students may choose to write admission and notes... Team to determine if the impression and plan typically concludes by mentioning prophylactic! An Intensivist and ECMO specialist at the Alfred ICU in Melbourne rounds: residents should take 1-2 minutes followed! The case beforehand and understand the patient began to notice vague shortness of breath learned, although this takes and. Domains covered by those physicians environment, with emphasis on daily labs, imaging and.... Patient care rounds Guide to use in conjunction with their recommendations rounds your...

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