Gainesville Neuro ICU
The Neuromedicine ICU service is the service that sees patients with neurological and neurosurgical diagnoses that require an ICU level of care. Commonly, ICU level of care is necessitated by needing a high level of respiratory support (i.e., mechanical ventilation), administration of vasoactive medication drips (vasopressors, ionotropes, antihypertensives, sedatives and analgesics such as propofol or dexmedetomidine or fentanyl, etc.), continuous renal replacement therapy (CRRT), hydrocephalus requiring extra-ventricular drainage, and patients at high risk for decline who need to be monitored closely (i.e., Q1 hour vital sign or neurochecks). The NeuroICU is split into 2 teams (Blue and Orange) with medical students assigned to both teams. The Orange team only sees patients in the NeuroICU, while the Blue team also sees ICU consults anywhere within Shands.
The patients admitted to the NeuroICU represent nearly any subspecialty of neurology or neurosurgery. Some examples of diagnoses seen include hemorrhages (intraparenchymal, subarachnoid, subdural, etc.), large ischemic strokes, large cerebral edema, neuromuscular junction disorders at risk for respiratory decline (Guillan Barre, Myasthenia gravis, etc.), Seizures/Status epilepticus, brain death, a wide variety of high risk neurosurgical procedures, etc. The NeuroICU is in located primarily in unit 47 of the East Tower, and the provider workspace in the back of the unit.
Expectations:
- You are expected to bring your own laptop for chart review, writing notes, etc. as most clinical environments do not have enough computers to support their dedicated clinical staff as well as rotators.
- Prior to your arrival, you should contact the ICU fellow or senior APP to receive patients who you can see and present at morning table rounds. This shows initiative and creates a good first impression.
- You are expected to pre-round on your patients prior to the start of regular work hours and should arrive early enough (typically 6:30 am- 8:30 am) to accomplish this. You should not leave at the end of the day until all assigned work for your patients is completed.
- Attend expected work hours of 6:30am – 4pm, which includes ICU sign out, ICU rounds, grand rounds, teaching noon conferences.
- Attend morning report if you are able to be efficient enough pre-rounding to attend. Morning report starts at 8 AM in the neurology conference room 5546 (door code 3520#) and it occurs every day. An attending or resident usually will present a case or review a topic of interest. This is a safe space to participate and ask questions!
- Rounds will typically start at 8:30am (though some attendings may be somewhat earlier/later than this). Be prepared to present your patients during formal team rounds with the attending. You should ideally discuss any questions/concerns about your patients with the fellow and APP prior to formal team rounds. Be sure to have a complete and concise plan for your patients (the team can help you with this). All ICU presentations should be SYSTEMS-BASED to ensure we are not missing anything in these complicated patients – it is typically most effective to present every problem within the appropriate systems.
- You should aim to follow 1-2 patients every day. The most successful medical students will do more than report findings, but also interpret them, and suggest a plan of action for the patient’s care. Doing so efficiently and concisely relays clinical maturity.
- Participate in advancing your patient’s care, including helping with procedures and any tasks that need to be accomplished. There is no such thing as “scutwork” if it benefits the patient and the team! Take pride in contributing however you can.
- See new admissions, taking a complete neurology history and physical when appropriate. Typically, ICU patients are not the best for completing your BSE requirement.
- See assigned patients in follow-up, taking a focused neurology history and physical (AKA SOAP) appropriate for the patient.
- Plan to demonstrate your neurological examination in front of the attending during the bedside portion of rounds. The initial/admission examination should always be a complete exam, but follow-up exam can focus on the pertinent aspects. Clarify expectations with your team if you are not sure if a focused exam is appropriate.