 So after working nearly 70 hours in the medical ICU this week, I thought I'd share my favorite resource to help you crush it on your critical care rotation. Let's get into it. Hey friends and welcome back to channel. In case you're new here, my name is Lakshman, internal medicine physician. And here on the MD journey, we make content to help people like you succeed on whatever journey you're on, but doing it with less stress. Now I know for me personally, whenever I was a medical student as well as a full-time physician now in residency, the most stressful rotation in my experience has to be working in the ICU. And that's due to a combination of being in a stressful environment where there's a lot to know and the patients who are dependent on you for this knowledge are very sick. So it feels like there's a time element to it. And so in today's episode, we're going to talk about some of the best resources on how to prepare for an ICU rotation so that what you can acquire that knowledge you need, but doing it quicker, as well as how I go about learning and preparing myself as a full-time physician. And after you're done with this episode, I'll link down below another video on how I learned medicine in general as a full-time doctor, especially with my schedule is so full. So if you're interested, go ahead and check that down below. And while you're down there, you'll probably also notice a lot of free resources, including our free study rehab courses, simple three steps that we put all of our students through to help them get better grades, but with more free time. So if you're struggling with that, definitely check it out. But let's get into some of the best resources for your ICU rotation. Now, I don't know about you, but for most med students, including myself, as well as residents, one of the things that is just the most difficult to master has to be ventilators. That's simply because as a med student, you may not have a lot of experience working with it, much less making adjustments and changing them. But on your ICU rotation and definitely as a full-time physician in residency, when you're on your ICU rotations, you're definitely going to have to know how to look at a ventilator, know if it's working the way you want it to, as well as evaluate the results, and be able to know how to make adjustments based off those results. So one of my favorite resources to learn really the basics as well as some of the advanced techniques to doing better on ventilators has to be the ventilator book. That's exactly what it's called. I will link it down below. It's very cheap. I think it was like $14 on Amazon. It's also very, very short. But the beauty of it is that if you guys can see, if you're watching this on a video format, is that they'll have diagrams basically of what type of things you'll be seeing on your ventilator and basically gives you a troubleshoe manual. So things are going in the right direction on certain settings and make these adjustments. If things are not going well, think about these things. And after going through the book a few times, like I mentioned, it's a really quick read. It's very conversational. I do find myself holding on to a lot of the principles that he talks about in this book to when I look at the ventilator. Just a few days ago, I was admitting a patient who was found down, they had lost a pulse at their home. And we had no idea why. And simply listening to their lungs and looking at their ventilator, I could quickly just tell, I think this person is having a COPD exacerbation. They probably didn't have their inhaler. And sure enough, I called their husband who was at home and they said, yes, they haven't had any of their medications for two to three days. As soon as we started treating them for a possible COPD exacerbation while they're on their ventilator, all their numbers on the vent, on their labs, they got better. And that's kind of a beauty of knowing what patterns to look for. So if you guys are interested in mastering your knowledge of ventilators, make sure you definitely check out this book. Definitely saved my life a few times in residency. I'll link it down below. Now resource number two also helped me a lot in terms of both ventilators, as well as other ICU concept. And that has to be MedCram. I talked about MedCram a lot more on our episode about the best YouTube channels for people on their medical journey. So if you guys are interested, I'll also be linked down below. But MedCram was great for explaining some of those basic concepts. Even before I had went through the ventilator book itself, I'll link down below the ventilator playlist that you can find on MedCram. So super effective. It's also very easy to follow. If you go through their channel, you'll also be able to find other very ICU friendly topics, including things like acid bases and halers and more. And so if you're on an ICU rotation or if you're in residency and you just don't have time or attention span to read a book, I'll still recommend it. Definitely consider checking out free resources like MedCrams on YouTube. I'll link them down below. Now in addition to resources like the ventilator book, MedCrams, I have tried other books, things like the little ICU book. You guys have probably seen this on Amazon. It is very dense, so it's not going to be something specifically that adds to this list. But if you're interested, I'll link it down below in case you just want to reference the material to have to the side. Later in today's episode, I'm going to talk about the resources that I go to the most to help me learn. But I do want to first talk about what do I do in the situations where I'm asked to come evaluate a patient. You know, currently I work at an 800 plus bed hospital on any time I get paged to evaluate a patient. And sometimes I may get asked to evaluate a patient for a problem that maybe I still have a lot of experience with. So what do I do in those situations? Well, typically because time is so limited and those patients tend to be critical because another doctor has already deemed them to be, hey, I don't really know what's going on or I feel like they need more acute care than usually I use a lot of resources on my phone. And so I'll go ahead and share on the side. If you're watching this on the video format of different resources I like to use. So one of my mobile resources that I've kept on me for quite some time has to be MD on call. It's something I paid for a per once, but essentially it's a big reference material of any problem that I may be a counter. But so for example, if I have somebody that's hypotensive and I don't know how to manage it because I'm a brand new intern, then essentially I can get an idea of like, what are the reasons somebody could be hypovolemic. And as I walk into the room, I can already start to say, okay, like what labs should I be start ordering? How should I manage them? What type of things should I be doing? Or what my nurses know of? Who do I need to call and console? What imaging things do I need to order? And so this is like a nice little helpful thing, you know, I can also look up something. So if somebody is hypotentremic, that's a very common reason that I get called to emergency room. Somebody has a sodium of 118, 140 is normal. And so if I forget on how to treat that, I can quickly just look to say, okay, let's evaluate this patient. Do they need to come to the ICU? Is their sodium really real? What type of diagnostic tests do I need to order if I do admit them and how do I want to start managing them? Having a quick reference material, you know, MD on call is something I've been using since my intern year. Don't use it as much now because there's a lot of problems that I've seen over and over again. But things that I haven't seen, it's a great reference material. So you can use this app, you can use another one that is very similar. And they all seem to do the trick as long as you can quickly find what you need. Now in addition to MD on a call, most medical doctors and medical students are experienced with up to date. And you can essentially look up any problems. So again, hypotentremia and I can actually use their algorithms and pathways. So sometimes I may not have a lot of time to think, read about something, but I can ask myself, how do I want to evaluate it? And essentially go down the various different trees and then start a pathway and say, yep, their sodium is, you know, normal, they're not getting any of these types of things. Or they don't have any kidney problems. They're not on a diuretic. They look volume overloaded and saying, oh, okay, this person's sodium is probably due to the fact that they're really volume overloaded. You should fix that problem first. If I click no there, it's going to keep asking me problems to help me evaluate. It essentially gives me a nice train of thought. Now in addition to having those pathways up to date is also obviously great about having very long Wikipedia style evaluations of somebody. So I can essentially look at what type of things I should be doing, what medications they may need, what type of labs I should be ordering. So really good resource. Again, it's on my phone. So easy to refer as I'm walking down to the emergency room to evaluate a patient who I may just not be as experienced at taking care of. And the last resource is something that I've shared throughout multiple different videos, but I really do enjoy the Human DX app to really help me improve my critical care function. Because often in ICU, the cases that give us the most head scratchers are the ones where we just don't really know what to do or what type of things we should be considering and our diagnosis. So for example, this is a case that I did not that long ago. It's a 61 year old that shows up with shortness of breath and he has all the symptoms of somebody that I'd get easily called off to evaluate for the ICU. He has a fever, is not really responding, he's been up to date on all his COVID vaccines, etc. But still having shortness of breath, even despite being on oxygen. And the nice thing about this case is that you can essentially walk yourself through what type of things you would want to know on a patient. What labs do they order? Should you also think about ordering for your future patients and then what happens in their hospital course? And ultimately, they show me chest x-rays, I can practice the chest x-ray, for example, if I'm not really good at it. And ultimately, you will get a diagnosis. Now this patient had human rhinovirus, which is something that doctors often forget even in the ICU, because nowadays we're used to looking for diagnosis like COVID, pneumonia, other infections, but viruses and other common viruses like a rhinovirus, you may have forgotten. So doing this case really helped me say, oh, maybe you should order a respiratory viral panel on a patient who may not have a bacterial infection, may not have COVID, may not have heart failure. Just adding another diagnosis to my repertoire really helps me become a better physician for these patients as I continue my ICU rotation. And next, I want to transition to where I really get a bulk of my knowledge. Now, initially, when you're starting an ICU rotation, you want to learn the basics. You want to go through the ventilators, you want to learn basic management of patients who are crashing and how to treat things like sepsis and shock. But then you're going to have a certain phase where like, what is the right research-based, evidence-based things to do for a certain patient, and have those in your repertoire and have those growing over time. And so online resources like the ones I'm about to share with you really have made the biggest difference in terms of my confidence of taking care of any patient in an ICU setting. Number one has to be the EMCRIT project. So if you go to EMCRIT.org, I will link down below. It's a resource that I use just to learn medicine in general, but it's great for things like emergency medicine as well as critical care rotations like ICU. Every few days, you're going to have great breakdowns of major topics. But my favorite place to go is this Palm Crit area. So if you click up here, it's essentially going to take you to a big, big database. And just like before, you can essentially read about any topic. So if I wanted to learn more about pericardial tamponon, I can go ahead and click here. And this is actually what I do on some of my ICU rotations where, you know, it may be a quiet hour or two, and there's nothing really going on. I want to help myself learn something. I'll show you in a second how I do this. And the part that I really enjoy is that not only is it easy to follow, but the recommendations in terms of what type of things I should be doing are very evidence-based as well as helps me understand what's not important to consider and what is important to keep in mind to take care of these really sick patients. Now finding pericardial fusion is something that you may just come across as you're reading across the first two to three blog posts that are posted. But one of the things I really enjoy is their table of contents. Because let's just say, for example, I am struggling with topics in gastroenterology where I can go into gastroenterology and understand, okay, what blog articles do I already have? Maybe I should know how to manage a patient that has cirrhosis, or remember how to take care of SPP, or know, you know, how to look at a CTA, which is really cool for a patient who may have a GI bleed, or how I should be managing patients nutrition-wise, something we forget all the time in ICU and looking at these guidelines, how to look at a patient who shows up a pink or a Titus, and so many more. And they're super, super, super helpful. And so having these articles that are really easy to follow and you feel like, okay, cool, like I actually understand knowledge and evidence-based of a specific topic without reading a big textbook, this is knowledge that I haven't been able to find anywhere else. And I definitely don't have to read a bunch of journal articles. It just kind of presented nicely, cohesively. And I can essentially look at whatever I want to learn next, and add those to my to-do list. In a similar fashion to the EMCrit website, I really do enjoy the OG life in the Fastlane. This was a website that really taught me a bunch of things, including chest x-rays and EKGs. And it's still kind of the resource I love using for that. So if you're struggling with EKGs and chest x-rays, chest x-rays has to be like the staple of something you'll have to master in a pulmonary ICU. You can go through anything. So if we look at just EKGs, you can essentially look at the EKGs by a diagnosis, but you can also just make yourself do practice the EKGs and seeing if you pick up on what they consider to be important. And so it's a great tool to both teach as well as practice. In the same way, if you go up to here where it says CCC, you can essentially find their entire compilation of everything that's considered to be critical care. And you can go through it or you can search it. So if I wanted to go through AA gradients and forgot exactly what that meant, I can go ahead and read this really quick and easy to understand, kind of break down of it. And then keep this as a reference material. And again, I'll show you in a second how I go about doing this. Now lastly, I want to share not necessarily a resource, but kind of a method of how I go about learning everything. So I've shared in that video, an episode about how I study as a doctor full time. I'll link that down below for full description. But one thing I do and I see a lot is that there's going to be topics that I want to learn more and more about. So for example, recently, these are just the topics that I focused on this week. So things like LVO, you know, obstruction, capnography, a tips, I had a patient who down went for a tips procedure because they had really bad cirrhosis. And reading more about those, adding those notes, and I can always continue to fill those up. So I was reading the Pulmcrate website, for example, on a recent call day, where the schedule was overall okay. And so essentially, I just opened up my notion, I pull up the topic. So in this topic, we're talking about LVOT obstruction, something that's very common in cardiology, but just in ICU in general. And not only does it give me a breakdown of what an LVOT obstruction is in the first place, but also kind of little frameworks of how to understand what's going on, both anatomically, physiologically, and what situations I may find somebody with an LVOT, what it looks like on an ultrasound, what clinical findings I should be using, as well as what type of things I should be treating. So what kind of pressure should I be using, how should I be treating them with fluids or not fluids, and making these notes and adding extra pictures over time. Now I know that if I have a patient in the future that may have an LVOT obstruction, I can just go to this chapter that I've made for myself in notion, pull it up my phone. Again, speed is the matter of the game in ICU. And as I'm going to go see a patient, if they have LVOT on a recent echo or found something I'm concerned about, I can quickly just go through my notes as if it was like my own personalized up to date, then I can quickly say, Oh, okay, this is what you need to do. You need to use phenyl ephrin, you can use norenephrin, maybe use consider using a beta blocker to possibly help. So all of those kinds of things I've picked up through learning these chapters and putting them in my own storage kind of second brain as a physician and are super, super effective during my time in ICU. But those my friends are some of my favorite resources that I love to use in ICU. Now if you did enjoy this, a few resources that I do recommend checking out down below. One, if you're still on what you're studying, definitely consider checking out our free three step study program or our free eight step study program where I show you exactly step by step how is able to go from 10 hours a day to five hours a day in medical school. So if you're struggling with your studying, that's where you should go. Now if you're on your rotations in medical school and you want to do better, including things like your ICU rotation, definitely consider checking out our crushing clinicals program where I show you essentially how to become an honor student and be on your way to get the residency of your dream. And then last but not least, if you're about to start residency, if you're about to start your intern year, or if you're already there and you're struggling, you just want to make sure that you become a superstar physician earlier than later than definitely consider checking out the intern survival guide. It's the same strategies that I use during residency during my intern year to feel like not only could I learn medicine, not only could I do well as a patient care, not only could I be efficient and doing things like, you know, pre-rounding and taking notes and getting out of the hospital on time, but also having balance in my life while I felt like my career was going the right direction. So if you want to make sure you become a superstar physician without all the stress that comes from being a brand new doctor, definitely consider checking out those programs, which I'll link down below. But as always, my friends, hopefully you guys enjoyed this video. Hopefully this gives you a little bit of light of simple resources you can use to really make a big difference in terms of your knowledge base for an ICU rotation. But without my friends, if you guys do have any questions, make sure you comment down below. And while you're down there, go ahead and hit that like button to help support this video on YouTube through the YouTube algorithm. If you're new to the channel or if you haven't joined the community just yet, go ahead and hit that subscribe button and notification bell to get more videos like this on a weekly basis. And if you're listening to this on a podcast, all I ask is a quick thank you as you go to your favorite platform, hit that follow or subscribe function, as well as going to iTunes and leaving a quick honest review helps us get in front of more people and help more people just like you on their medical journey. If you did enjoy this episode, definitely consider checking out this episode on how I study medicine as a full-time doctor, as well as this episode right here on how I use Anki like a pro to really just help me change the game. Hopefully you guys enjoy those and I will see you guys in the next one. Peace!