ICU Presentations

To avoid repeating ourselves during rounds, we have reordered the way we present ICU patients -
Here is an outline of what we want to hear:

• One Liner: Hospital day #, POD#,  mechanism of injury, summarize injuries and operations
• Overnight Events:
• Systems: (When presenting each system give the exam, data, and plan)
• Neuro: physical exam
• GCS (ex 14 s/t x)
• Sedation/drips/RASS score
• Sedation Holiday
• TG level
• Pain management/drips 
• If not on drips then how much prn sedation and pain meds required in 24H
• Pertinent meds: ex amantadine, propranolol
• Resp: physical exam
• Intubated vs extubated, day x of x/trach collar/nonrebreather/face mask/NC
• Vent: AC/SIMV/PS with settings of x
• ABG: on above settings
• SBT
• CV: physical exam
• Vitals (ranges), any need for pressors?
• EKG
• Fluid Management:
• Devices: PIVs, TLC with location, day x of x, clean vs dirty, Alines- location, day x of x
• Foley day x of x (silver foley?)
• Can any of these be removed?
• Fluid Balance:  I/O, UOP last three shifts and average per hour                         
• Cr x from x
• Current IVF and TIVF 
• Net fluid balance
• Does pt need diuresis?
• Drains: type/location/output- last three shifts and 24h total
• Chest tube, suction vs water seal, leak vs no leak, tidals
• Bladder pressures
• GI: physical exam
• NPO (on Pepcid)/CLD/general diet
• TF of x at rate of x with goal of x (ex. TF of perative at 20cc/H with a goal of 65) +/- glutamine or     arginine, via NGT vs dobhoff
• Will increase TF every x hours with residuals every x hours, hold for residuals greater than x
• NGT output last three shifts
• Nutrition Labs: present on Monday and Thursday, trend prealbumin and transferrin
• GU: only if specific urologic issue
• ID: physical exam- questionable wounds
• Tm, WBC x from x
• Abx day x of x for x bug
• Bl/U/Sputum Cx
• qD Bl Cx
• Heme: 
• Recent transfusions
• Hb x from x, Plt x from x, INR x from x (Coumadin per protocol if appropriate)
• Endo: 
• Na x from x,  K x from x, list other abnormalities
• Accu checks: last three, on ISS/insulin drip
• How much insulin has pt required in last 24H
• Musculoskeletal: physical exam
• NWB vs WBAT
• PT/OT/Rehab recs
• Restraints
• Wounds: describe wounds if not already done above
• Skin: all ICU patients to be checked head to toe every Monday and Thursday
• Report date of last skin exam, decub location, stage, therapy
• Prophylaxis: 
• GI: Pepcid vs diet
• DVT: SCDs B/L LE vs ex LLE only, hold chemical anticoagulation s/t x           
• Lovenox at x dose
• Heparin drip a x s/t x
• Coumadin per protocol if appropriate
• Psychosocial:
• Pastoral Care
• Psych issues: ex PTSD
• Dispo: What needs to be done to get pt out of ICU
• Social work recs
• Message of the day

 Notes:

Don’t forget while the above has a lot of data, your plan should be incorporated as well
Fit consultations recs in appropriate system
If you have nothing to report on a system then say the system and “no events” or “no current issues”
Items that are in bold above should be said for every patient even if they are WNL

Thanks to Dr. Sallee Jones for putting this outline together.