NICU/ICU patient presentations

[STBS]

should NICU/ICU patients be presented to attendings any different than patients on other floors?

[Skipper]

the ICU rotations I did, the patients had to be presented in a System fashion, instead of the normal HP style. Usually the attending should inform you if he likes presentations differently.

skipper

[gellerf]

In the NICU I had to use the RICHMN format;

Resp.
Infectious
Cardio
Heme
Metabolic
Neuro

[Scientific]

For ICU, just pay close attention to all of the infusions, lines, I&O's.

[stateofequilibrium]

A modified SOAP/Systems fashion is what I used.

You will give a subjective/summary of what happened in the 24 hours based off of the patient (if they're able) or nurse that covered, and anything written by other teams or services in their note.

After all the routine vitals/meds/etc, comes systems. You will assess them in terms of systems (ie cardio, pulm, GI, extremities, FEN, endo, Heme, ID, etc), and then you will give a plan in a similar fashion. ICU notes take a long time unfortunately. Even senior residents take a long time to do it so don't feel bad if you're taking 30-40 minutes to do one.

Oh yeah, as stated above, ins and outs are UBER-important. Make very careful note of them. The more detailed you are the better. This is not like wards where they just want a quick overview, the attending will usually go over it with a comb, so you better have everything prepared.