top of page

Cedars PICU Rotation

Residents Orientation to PICU Rotation at Cedars Sinai

​

Welcome to the Pediatric Intensive Care Unit (PICU)/Congenital Cardiac ICU (CCICU) at Cedars Sinai Medical Center. We hope your rotation in the PICU will be satisfying to your learning experience.

​

Although the census may be low, our patients tend to be complex and very interesting to follow.  The congenital Heart Program has been providing care to many patients with congenital heart issues from the neonatal period to adulthood, so the span of age of patients you will follow will be interesting and unique to this unit.

​

The purpose of this orientation is to provide you with general information about our daily and weekly schedule. 

​

We hope it will you know what to expect and what is expected from you during your two weeks rotation.

​

Our PICU is staffed 24/7 by an intensivist who will be available to support you, teach you, and answer your questions. 

​

You will be rounding with the attending on service for the week who covers the unit Monday through Sunday. Night shift attending comes in at 4 PM or 6 PM on weekends.

 

The 2nd/3rd year resident responsibilities include:

​

  1. Follow at least 4 patients on daily basis, unless the census happens to be less than 4.

  2. Participate in morning attending sign out rounds at 7 AM, PICU rounds, and 4 PM sign out

  3. Prepare to present your patients in rounds. (Please see below with suggested format for presentation in the PICU). You are encouraged to make suggestions, interact with the team and teach the nursing staff when indicated.

  4. After rounds you are expected to follow up on what is decided during rounds, i.e. weaning to extubation does not last too long, that aggressive diuresis is indeed aggressive, and that consultations and test results are obtained promptly.

  5. Check every morning before rounds with charge nurse on any possible admissions.

  6. Review all new x-rays before rounds each morning and notify the attending of any unexpected findings before rounds.

  7. Communicate to the attending any problems or concerns you may have.  This is a new rotation and your feedback is important.

  8. Participate in our weekly conferences:

 

Monday: 7:30 cardiac case conference, bedside rounds after case conference (at AHSP, 3rd Floor, Conference Room A3101- A3102)

11:30 multidisciplinary rounds in the PICU

 

Tuesday: 7.30 am lecture in the PICU conference room

9 AM Bedside Rounds (after CHP faculty meeting)

 

Wednesday: 8:00 AM multidisciplinary rounds, or monthly CCICU 7:30-9 AM

PICU MD/RN collaborative meeting

 

Thursday: 8:30 AM bedside rounds

​​

Friday: 7:30 QI meeting , bedside rounds after QI meeting, 11:30 multidisciplinary rounds.

 

In addition, there are didactic lectures on Tuesdays at 7:30 AM intended for the entire PICU staff on topics related to patient managements.Schedule will be made available for you when you start.

 

   9. You are not required to take night calls but you are welcome to stay late when we have unstable patients or patient on ECMO support.

   10. Procedures:  you are welcome to observe and assist in any procedures including providing moderate sedations for procedures, line placement, bronchoscopy, and intubations.

   11. You are expected to attend cardiac case “huddle” to learn about the patients who are undergoing cardiac surgery.  Arrangement can be made to allow you to attend cardiac OR cases and follow them in post op phase.

   12. One on one teaching by the attending will be expected and topics can be chosen based on cases in the unit.

   13. Your evaluation and feedback from both physicians and nursing staff will be provided at the end of your rotation.

   14. Always feel free to discuss with the unit attending any questions, needs, or feedback on how we can make your rotation more enjoyable and more productive.

 

Have fun,

Cedars PICU Team

 

Suggested PICU Patient presentation in rounds

​

  1. Age, diagnosis, # of days in the PICU

  2. Major highlights of events in the last 24 hours

  3. Daily data: Physical exam, lab results, CXR/CT findings, Intake/Output

  4. Objective assessment Per System:

​

Neurological:  Sedatives and narcotics doses: drips doses and PRN doses, how many PRN doses did the patient receive.  If neurosurgical patient with an external shunt (EVD): report if open or clamped.  At what level it is kept (cm of H2O).  Amount of CSF drained.  If with ICP monitor, report ICP pressure level and if patient had spikes and what we are doing to reduce the number.  If patient with seizures, report EEG findings, if any seizures occurred, length etc.

​

Respiratory:  On oxygen, Non-invasive ventilation, or on the ventilator.  Ventilator settings, ABG’s, Sats, Endtidal Co2 level.  Wheezing and bronchodilators if asthmatic.

​

Cardiac: POD #, ECMO day # if on ECMO. Inotrops and current doses, rhythm, HR, BP, cardiac output assessment data (NIRS, lactate  etc.).  Rhythm and if on pacemaker, settings.  Cardiac medications and changes made.  If post op, Chest tube output.  If on ECMO, flow setting and data.

​

Fluids/lytes/ nutrition:  IV fluid, TPN, Urine output, diuretics and changes in doses.  Fluid balance in 24 hours. Latest electrolytes and adjustments.  If on feeds, caloric intake. Monitoring labs ordered.

​

Renal:  Bun/Creatinine.  IF in renal failure or on dialysis, CRRT, flow rate and negative fluid balance post dialysis or net balance per hour

​

Heme/ Coagulation: Last CBC, if in DIC last lab values and blood products given.  If on anticoagulation, doses of heparin and latest labs. If with a clot, latest studies. Platelets value and any transfusion

​

Infectious disease: Lines in place and how many days it has been in place, fever, increase CRP, CBC and manual diff. antibiotics, culture results. Any investigation.  Always discuss isolation status and respect the rules of isolation when examining your patient.

​

Social issues: Family meeting, SW support, etc.

​

Links to websites with PICU related resources

​

​

Updated: July 31, 2021

​

bottom of page