How to Present Patients in the ICU

Introduction

• Presenter: Eli
• Focus: Teaching how to present patients during ICU rounds.
• Audience: Medical students, residents, interns, nurse practitioners, physician assistants.

General Tips

• Aim for a low-stress environment.
• Understand the reasons behind the presentation format.
• Familiarity and comfort come with repetition.
• Presentations help in teaching and improving patient care.

Preparing for Presentation

• Recognize intensivists are detail-oriented.
• Understand most of the information is known by the attending.
• The presentation is for teaching and clarification.

Elements of Patient Presentation

One-Liner

• Brief summary to orient the group.
• Example: "Jane Doe, 68-year-old female, hospital day 6, here for COPD exacerbation."

Overnight Events

• Obtain information from night shift staff and nurses.
• Include major events like self-extubation, changes in vitals, etc.

Vital Signs

• Avoid reading ranges; focus on significant changes or interventions.
• Include temperature, oxygenation level, respiratory rate, and blood pressure.
• Mention any use of medications for fever or blood pressure changes.

I's and O's (Intake and Output)

• Check net positive or negative fluid balance.
• Urinary output trends are important.
• Note any IV fluids, boluses, or diuretics used.

Ventilator Status

• Know basic ventilator settings: mode, FiO2, PEEP, tidal volume.
• Understand respiratory rate settings versus spontaneous breathing.

Lab Data

• Emphasize trends over absolute numbers.
• Discuss CBC trends, electrolyte levels, and glucose trends.
• Discuss BUN and creatinine for kidney function.

Imaging

• Review images personally, don’t rely solely on radiologist reports.
• Familiarize with reading different types of imaging.

Culture Data

• Report results and timing of blood, urine, and respiratory cultures.

Tubes, Lines, and Catheters

• Assess necessity of existing tubes and potential for removal.

Medications

• Discuss all current medications, duration, and any necessary changes.

Physical Exam

• Conduct a concise but thorough exam.
• Focus on neurological status and physical indicators of health.

Conclusion

• Assessment and plan should reflect personal analytical skills.
• Practice leads to ease and proficiency in presentations.
• Encourage direct feedback for improvement.