Mastering ICU Patient Presentations

Aug 27, 2024

How to Present Patients in the ICU

Introduction

  • Instructor: Eddie
  • Audience: Medical students, residents, interns, nurse practitioners, physician assistants.
  • Objective: Teach how to present patients in ICU settings.
  • Importance of understanding the rationale behind patient presentation.
  • Emphasis on creating a low-stress environment for effective communication.

General Tips

  • Adapt to different expectations in various ICU settings.
  • Most ICU attendings are already informed about patients by the time rounds start.
  • Aim to analyze and interpret data to improve patient care.

Patient Presentation Structure

  1. One-liner Overview

    • Provide a quick summary, e.g., "Jane Doe, 68-year-old female, hospital day 6, COPD exacerbation."
    • Include patient's hospital day and reason for admission.

  2. Overnight Events

    • Highlight significant events during the previous night.
    • Gather information from nursing staff or previous shifts.

  3. Vital Signs

    • Present critical changes, not just ranges.
    • Discuss any interventions (e.g., antipyretics for fever).
    • Include context: oxygen levels, respiratory rates, blood pressure specifics (e.g., mean arterial pressure).

  4. Intake and Output (I&O)

    • Report net balance over 24 hours and during the hospital stay.
    • Note insensible losses and specific fluid intakes or outputs.

  5. Ventilator Settings

    • Share basic settings: mode, FiO2, PEEP, respiratory rate, and tidal volume.
    • Recognize any patient-initiated breaths over the set ventilator rate.

  6. Lab Data

    • Focus on trends rather than absolute numbers.
    • Correlate lab results with clinical interventions or medications.
    • Discuss significant lab values like CBC, BMP, CMP, etc.

  7. Imaging and Cultures

    • Review images personally, not just radiologist reports.
    • Discuss culture results, noting when they were collected.

  8. Lines and Catheters

    • Assess the need for tracheostomy or removal of central lines and catheters.

  9. Medications

    • Review all medications, including antibiotics and their duration.
    • Consider adjustments based on clinical progress.

  10. Physical Examination

    • Concise yet thorough; consider sedation effects.
    • Assess neurological status, heart and lung sounds, and abdominal and skin checks.

  11. Assessment and Plan

    • Communicate your diagnosis and treatment plan.
    • Decide on a problem-based or systems-based approach.

Conclusion

  • Practice and repetition are key to mastering patient presentations.
  • The ultimate goal is to improve patient outcomes through detailed data analysis.

Additional Notes

  • Aim to learn and adapt to different ICU settings and expectations.
  • Continuous learning and feedback from seniors are crucial for improvement.
  • Encourage a supportive and collaborative team environment.