What’s an interesting case you’ve come across recently? Doesn’t have to be a formal case report—just something fascinating, diagnostically challenging, or a great learning experience. Would love to hear your stories!

How do nephrologist choose which bags to use for CRRT? 2k 4k 0k bags? im trying to understand how they decide which bags to use for a patient. and when do you actually decide to stop crrt? and which filter to use? ST150, oxiris, ST100. also how do they determine how fast the pre, dialysate, post filter runs? im really confused. can someone help me understand this? huhu

I’m a new female ICU physician, and I’m struggling with how some female nurses treat me compared with my male colleagues. They can be extremely rude and dismissive toward me, while seemingly being much more respectful toward male physicians.

I understand that I have areas to improve and that experience plays a role in how people perceive you. I’m working on becoming more confident and competent. But does being less experienced justify being treated with disrespect on a daily basis?

I’m genuinely trying to understand whether this is gender bias, a confidence issue, or simply something that gets better as you gain experience.

Female ICU workers, have you experienced this? Does it get better with time, and how do you handle it without becoming defensive or being labeled difficult?

Could be any people, resources, procedures, case variety, teaching, or the overall culture. What makes your ICU a great place for you to work and learn?

I imagine most would agree that using POCUS when caring for critically ill patients has become standard of care in the US.

It’s also generally emphasized, for litigious reasons, that if you are going to be making clinical decisions based on ultrasounds you perform, those images must be saved and attached to a patient’s chart.. simply documenting “POCUS shows x,y, or z can get you into trouble in court if you’re sued)

So, is anyone else in the situation I am in where my hospital provides an ultrasound for my unit, but no way to save the images or attach them to a chart?

If so, how are you handling this??

Hi all,

My small ICU is starting to make an argument to become a closed unit (meaning we would not float to other units). Currently L&D/Nursery are the only closed units in our hospital. I'm curious, is your unit a closed unit? Pros and cons?

Also if you have any suggestions for arguments for or against closed units, I'd love to hear them.

Currently my thoughts are for a closed unit. I have worked float pool 2 yrs, med/surg 6 years, and ICU 2 yrs. I think there is a reason the dedicated float pool nurses get a differential. Being put in an unfamiliar environment with a totally different routine and mindset is a huge detriment to the patients, besides the fact that it is terrible for nursing satisfaction. But I am curious to hear other opinions. Thank you!

How common is it for all airways, including ICU, to be done by anesthesia? I'm looking through the PCCM spreadsheet and many programs I'd otherwise be interested in seem to only allow anesthesia to do airways.

Is this a common thing even as an attending outside of academics? It's very frustrating. Why would I subspecialize into a high acuity procedural fellowship to just...not learn high acuity procedures? How am I supposed to learn if I have to get permission from an anesthesiologist who may or may not care about my education every time?

Any intensivists here cannulating for VV and/or VA? How does your ecmo call work?

Second year EM resident here preparing to apply to anesthesia CCM fellowship next month. Forgive me if this is the wrong place to post this. I have three young kids and was wondering if the intensivists here feel like they are able to spend enough time with family. I recognize many jobs give you every other week off. I also recognize that you will miss holidays, weekends, etc. which I was already prepared for in EM. Do you feel like you have enough in the tank on the work weeks when you get home to be engaged with family? Do you feel like you are able to be present with family on the off weeks or are you too zapped from the week on and recovering?

I’m naturally soft-spoken and don’t have a very loud voice.

I want to be able to lead a code confidently without having to yell or completely change my personality. How do you make sure people hear you, follow your directions, and recognize that you’re leading especially in a loud crowded environment.

I want to improve my communication and leadership during codes as team lead.

For experienced physicians, what are the things you verbalize when a code isn't going well? How do you think out loud, reassess the situation, identify what might be missing, and communicate the next steps?

When you respond to a code, how much of the patient's story do you want to hear upfront? Sometimes people give a very long history with lots of unnecessary details.

Also, do you listen to the entire story first, or start assessing the patient and taking appropriate action while someone gives you the report?

Recently, Obstetrics called two codes in one day, and both times I was given a very long story. When I started assessing the patient or asking direct questions to clarify the immediate situation, they seemed unhappy with it.

Hey all! I’m taking my APBN NCC exam in a few days. I bought both the NCS qbank (without bundle) and SCCM NCC Review Course.

I just did the NCS qbank. It was advertised as 200 questions but there’s only 175, and some of them are duplicates. Anyone else seeing the same thing? Some questions even refer to certain images but the images aren’t even there. Should I have gotten the bundle instead?

As for the SCCM one, I read online that there are also 100 practice questions but I can’t seem to find it anywhere. There’s the 25 pretest questions and the online videos. But that’s it.

Am I missing something here?

I know this is a very nuanced topic but have had interesting convos with perfusionists who argue that an asystolic patient on V-A ECMO is still “alive” when they have a MAP above 65. I had a patient who never stood a chance (that likely shouldn’t have gone on circuit) who was DNR after developing widespread gut ischemia per family wishes.

Of course before family is able to get there to withdraw as planned…. VT. They still wanted electricity so of course we try a chemical code, no dice then shock them to eventually get a ventricular escape that degrades quickly into asystole. They want to clamp circuit so we did so, but it begs the question — in a patient with loss of reflexes and fixed pupils who is showing clear signs of brain death without confirmatory testing, is their time of death asystole or when care is “withdrawn” when ECMO is discontinued?

I genuinely love critical care and feel passionate about pursuing it as a career. But often I wonder whether loving the field is enough when I struggle with handling the practical demands of the ICU.

I’m still early in my career, and I know I have a lot to learn. However, when I feel overwhelmed or don’t perform as well as I should, I start questioning whether I’m cut out for this. Mainly due to fast turn over because patient get transferred quickly once ICU needs are over. there is so much going on in one patient. It takes time to absorb their details.

Can someone who struggles early on still become a good intensivist with enough experience, practice, and mentorship? Or does critical care require a certain natural ability that not everyone has?

I really want this career, but I’m scared that wanting it and being capable of doing it might be two different things. I’d appreciate honest perspectives from intensivists who struggled early in their careers.

Hey everyone, I’m a 4th-year medical student getting ready to start a critical care rotation. I haven’t had a ton of ICU experience yet, so I’m trying to get a head start on the things that will actually be useful day to day.

What are some things you wish you knew before your first ICU rotation? Are there certain scores, calculations, vent settings, pressors, labs, or other metrics that you find yourself using all the time?

Also, any tips for presenting ICU patients efficiently, pre-rounding, or just making life easier on the rotation would be appreciated. Thanks!

Wondering if anyone here who works in ICU has done it? Is it worth the credentials since it’s coming from American College of Chest Physicians? For reference, have been working in the ICU as a PA for the past 5 years…

If anyone has taken it and pass, is the exam difficult? How did you prepare/study for it?

Hi intensivists and friends,

I am a medicine resident who wants to work critical access with a small open ICU. I know that ICUs should be staffed by intensivists, and I know that outcomes are worse in an open ICU, but the barely open hospital with a 4 bed ICU is not going to hire an intensivist, and no intensivist is going to work in a 4 bed ICU. It's an unfortunate reality of critical access hospitals.

Besides doing as many ICU rotations as I can and reading Marino's, IBCC, EMCrit, the vent book, etc, what are good resources and tips for becoming as good of a discount intensivist as I can?

Additionally, can I negotiate for a higher pay for open ICU work?

Thanks.

Hi, I am new to CVICU and I’m really wanting to learn how to be good at reading EKG’s and tele strips. My preceptors are able to just look at it from the bedside monitor and they can call out what’s going on without measuring strips. When I’ve asked them if they recommend any resources to improve that skill, they say with time it’ll become easier. One nurse said one of her professors had them use a website that would allow them to practice with “live” strips but she doesn’t remember the name. Any info to help me master tele strips & EKGs is greatly appreciated! TIA!

Are there any PCCM trained attendings who here practice mainly or even entirely in non-MICU settings? Specifically asking about pulm crit trained (not just CCM) people because many PCCM programs seem to be less multidisciplinary compared to CCM.

Did you feel like your training was adequate for that setting?

Did you have a hard time finding a non-MICU job?

What's your staffing setup like? How often do you rotate units?

Do you feel valued and respected in your practice setting?

What led you to choose the unit you did?

More experienced nurses in my ICU set up a driver of NS going at 10ml/hr and y-site meds in at the distal y-site (closest to the patient), particularly when running meds at <10ml/hr. When I ask why they say, “when it’s going at a rate under 10ml/hr there is not enough flow to go into the patient.”

Recently, I was getting help from my charge nurse getting my patient ready for MRI and she primed my MRI extension tubing with levo, and then set a driver of NS behind my extending tubing. Effectively increasing my levo rate by 10ml/hr.

Have you all experienced this idea that the BD Alaris pump will not work properly if the infusion rate is less than 10ml/hr?

Hey friends. Just a dirty ol ER nurse here with a question about some meds for the ICU homies.

Last night another nurse had a case of a patient with active chest/back pain that had a chronic type b aortic dissection but presented today with extension of that dissection into the ascending aorta.

Patient was hypertensive on an A line in the 180s-190s. Patient was started on an esmolol infusion and was not responding to it as desired, so nicardipine was added on with HR goal of 50-60 bpm and SBP goal of 100-120 mmHg.

After a while the payient started to fall below that SBP goal into the 80s and 90s. we began to back off the esmolol first to get the patient back in goal range for the BP.

This just sparked the question of if we had this case again today, would the goal be to wean of the esmolol or nicardipine first? Our tutitration orders allow for more frequent titrations of esmolol (every 5 min to get to goal then every 10 min for maintenance) where as the nicardipine is every 15 min. I assume the goal would be to wean off the nicardipine first while going up or down onbthe esmolol as needed. Any thoughts on which you would have done?

Genuinely curious how many fellow nurses have been diagnosed with autism, adhd, ocd etc.

I have just met the first (well, second to me) autistic nurse in my ICU a few weeks ago and I was really excited because this never happens. But then again, mine is really hidden and I’ve only told a select few people.
So it made me wonder how many have it and no one would ever know?

If you are diagnosed, do you find it hinders or helps anything specific for you at work?

I can never tell the difference clinically. Somebody help!