Clinical Responsibilities

Each day you should review the following care categories. Connect with primary team to assure they are aware (and acting on) new results.

Medications

Review all medications in the Active medications list.

Pay special attention to sedation and analgesics. Are there any drugs on the list that can be discontinued? ICU has a primary role in management sedation and analgesia since it is intimately related to ventilator synchrony. Discuss with the ICU attending your plan to change meds. Your goal should always be to use as little as needed to accomplish adequate pain control.

Are there any other medications that can be discontinued? For any meds that are not Analgesia or Sedation, confer with primary service prior to discontinuing.

Polypharmacy is one of the areas for potential harm in hospitalized patients. Strive for adequate, not excessive Rx.

Radiologic Studies

As surgeons you should constantly increase your diagnostic acumen by examining radiologic images yourself.

By personally reviewing films, you cement your understanding of relational anatomy. Once you have reviewed the films, then (and only then) should you look at the radiologists interpretation. If something does not 'seem to fit' with what you think you see and what the read says, sit down with your senior residents or an attending to further discuss the findings.

It is not outside the realm of possibility that you could 'catch' a radiologic misread and save a patient from the potential harm of misdiagnosis.

Microbiology Cultures

The milieu of the Surgical ICU is one where infections can flourish if not actively kept in check. Fevers and leukocytosis should be investigated and responded to in a timely fashion.

Daily review of cultures falls under the domain of the ICU team AND the primary service. As part of your daily standard work, cultures should be reviewed.

Use of empiric antibiotic therapy should be limited and should only proceed after discussion with the attending of record.