Presenting Patients on ICU Rounds

Introduction

• Speaker: Eli
• Context: Guidance on presenting patients during ICU rounds.
• Audience: Medical students, residents, interns, nurse practitioners, and physician assistants.
• Objective: Understand why information is presented, not just how.

Approach to Patient Presentation

• Prioritize a low-stress environment.
• Recognize attendees have varied styles and expectations.
• Importance of understanding the 'why' behind data.
• Practice and repetition improve proficiency.
• Tailored for U.S. ICUs.

Pre-Round Preparation

• Attending's Morning Routine: Most attendings review all patients before rounds.
• Objective: Use rounds for teaching and patient improvement.

Key Components of Presentation

1. One-Liner

• Quick patient summary: name, age, hospital day, primary reason for admission.
  • Example: "Jane Doe, 68-year-old female, hospital day 6 for COPD exacerbation."

2. Overnight Events

• Gather information from overnight staff or nurses.
  • Report significant changes/events (e.g., self-extubation, blood pressure drop).

3. Vital Signs

• Avoid reading ranges; focus on clinical significance.
  • Discuss interventions (e.g., antipyretics, oxygen support).
  • Emphasize mean arterial pressure in critically ill patients.
  • Note changes in pressor support.

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

• Report net balance (positive/negative) over 24 hours and hospitalization.
  • Consider insensible losses and urinary output trends.
  • Identify potential fluid management issues.

5. Ventilator Settings

• Understand basic modes (e.g., pressure support, control).
  • Discuss FiO2, PEEP, respiratory rate, tidal volume.
  • Consult respiratory therapists for details.

6. Lab Data

• Focus on trends (e.g., CBC, BMP, CMP) instead of absolute values.
  • Relate lab trends to clinical scenarios.
  • Consider medication effects on labs.

7. Imaging

• Review and interpret images personally, not just radiologist reports.
  • Understand basics of echocardiograms.

8. Tubes, Lines, and Catheters

• Discuss duration and necessity of tubes and lines.
  • Plan for potential removal if unnecessary.

9. Medications

• Know all patient medications and their durations.
  • Discuss adjustments needed.

10. Physical Exam

• Tailor to attending preferences.
  • Consider sedation's impact on mental status exams.
  • Conduct thorough yet concise examinations.

Assessment and Plan

• Exclusion in Video: Details on assessment and plan not covered, as they vary by institution.

Conclusion

• Goal: Enable concise, effective patient presentations.
• Encouragement: Practice will lead to easier, more intuitive presentations.

Additional Notes

• Video aims to improve teaching methods and is part of the speaker's New Year resolution to grow an educational channel.
• Audience encouraged to interact with feedback.
• Video duration and format: Roughly 20 minutes.