 What is up everybody welcome back to my channel for those of you who are new around here My name is Michael aka dr. Chalini, and I'm a fifth-year interventional radiology resident now Some of you all may be astute subscribers and have seen me post on Instagram and mention things on YouTube that I am currently Rotating in the surgical ICU And I've been in the search for ICU for almost four weeks now I'm about two days left and I have mixed emotions about it So in this video, I wanted to tell you exactly why I have been in the search for ICU What my thoughts are on it and if I think it's necessary for interventional radiology residents to do this rotation So stay tuned. That's what we are going to talk about in this video All right So I am officially back at home now and I wanted to start off by telling you all exactly why I'm even doing a Rotation in the surgical ICU also known as the sick you is what we call it for short So originally when I matched into radiology residency We're supposed to do a four-year radiology residency followed by a one-year fellowship in interventional radiology or whatever fellowship you choose during my intern year, they did this whole switcheroo on us and Started creating an entirely new Integrated IR pathway where you match directly into IR from medical school So let's back up a little bit because for my year They were actually ending all IR fellowships are all IR one-year fellowships and they had to create a Program essentially for diagnostic radiology residents to backfill or have access to interventional radiology This is so confusing. I know so they created something called ESIR or early specialization in interventional radiology Which is what I'm in and the reason I'm telling you all of this stuff to begin with is because they essentially created a schedule for all IR residents their final year of residency before they go into their last year of Residency slash fellowship of interventional radiology. So we have to do a certain specific set of rotations our fifth year of residency and Surgical ICU happens to be one of those rotations that we have to do So that's why I'm currently doing this sick you rotation and now that we got that out of the way I wanted to talk about some of the things I've noticed and some of the things I've learned While rotating in the sick you again because after all I haven't been in the sick you Rotating there since the very first rotation my intern year So I did a surgery intern year and the very first rotation as a doctor was in the sick you in New York City So it brought back some memories. But anyways, let's get into the 7 6 7 or 8 things I learned while being in the sick you So the first thing I learned while being in the sick you is that I still hate rounding I haven't done extensive ICU type rounds on patients in almost four years now and I still don't like it, which is why I'm glad I chose my current field of Radiology and interventional radiology because we don't round on patients for hours and hours and hours and It's not that they don't need to be rounded on because these patients do need to be rounded on there These are the sickest patients in the hospital And you need to have all of your eyes dotted and your teeth crossed when taking care of these patients because if you miss something along the way Stuff can go south really quickly now with that being said I personally don't like standing around talking about patients for three or four hours That's just not my personality And it's also the reason I chose IR over other surgical specialties because I love surgical anatomy I love using my hands and doing procedures, but I don't like how long it takes to do certain surgeries And for that reason, I know For that reason I did I are the second thing I learned while rotating in the sick you is that I love the team oriented Environment, you know, I was a swimmer in college I've been on a team my whole life and I tend to function in a team environment very well So for me it was really cool to see that again, and now I know I said I don't like rounding But what I did like around rounding was you go to each person in the team taking care of these patients For instance the intern would present the patient then the nurse would talk about any overnight events Then the pharmacist would weigh in about what medications the patient is Charlie on Then the respiratory tech would come in and talk about whatever event settings the patient was on And then we would go back to the resident who had finished presenting and then the dieticians and nutritionists would weigh in on the Nutrition plans for the patients. So it really was kind of a team environment Everybody has their certain specific field that they specialize in and that they are experts in and it was nice to have all of them The whole time you're rounding so you can bounce ideas off each other and I don't know. It's cool I like it the third thing I learned while rotating in the sick you is that Most residents in the hospital still have no idea what IR does It's nice to be in the trenches so to speak again and speak with the new grad interns and residents and just talk with them about what IR really does because a lot of the interns I noticed would just The attending would spit off an order to them that they need to go to IR and do this X procedure And then they would ask me about about the procedure and then When talking to them, I realized that they didn't even know what the procedure was or what IR actually does or What it takes to become an IR doctor, etc. Etc. Which got me thinking that I'm glad I'm kind of doing this channel because I want you all to be aware of our field because I Mean, I know I'm biased when I say it's the best field of medicine But we do so much for so many different services in the hospital that that I want them to know exactly what we do I actually had a resident tell me this when I was asking him about why they were ordering a procedure from IR and he said Well, usually we just send them down there and magically you guys just make them better and send them back So it's the in-between stuff that nobody has any idea what happened. So again, I'm glad I'm I have this channel And I'm glad I'm exposing everybody to the field of IR because it's the best all right so the fourth thing I learned while rotating in the sick you is that Patient management is oftentimes directly correlated to what the imaging shows and what the radiologist says about the imaging So essentially what I'm trying to say is whatever the radiologist says guides management for that patient and that team that's taking care of the patient and I Know that is the whole reason why we do radiology because we want to help patients and guide them But after you're kind of separated from patient care for a couple of years now You forget that the words you're putting in your report actually matter and the team will act according to what you say So for instance when I'm sitting there opining about whether to call a pleural fusion Moderate or small which may not seem like a big deal to me But to the team taking care of that patient It may make the decision of whether or not they should drain that pleural fusion or just watch it and use Lasix or whatnot. So now in the back of my mind every time I'm reading a CT adam and pelvis or chest x-ray I'm always thinking about how is the team going to react to what I say the fifth thing I've learned while rotating in the SICU is that I Definitely do not miss taking care of critically ill patients. It's not that I don't like taking care of patients It's that it is extremely stressful managing critically ill patients again These are some of the sickest patients in the hospital They're critically ill and any small change in their management can have drastic effects on their outcomes the six Are we on six? the sixth thing I've learned so far in the SICU is that nurses in the SICU are on Point I don't think there's much more I need to say about that besides they are on point So the seventh thing I learned about being in the SICU is that it is a Fantastic far and away awesome rotation for med students I can't remember if I actually rotated in the ICU as a resident or as a med student. I don't think I did but I wish I did because It's just a great place to learn also med students in the ICU are able to act as like an acting intern So they follow and present patients in the morning on rounds They write notes on the patients and they are expected to know what's going on with that patient throughout the day as well So there's essentially a part of the team and you can be a part of the team And you're a valued team member while you're in the ICU rotating there The other thing for med students is they can get their hands dirty. They can you know do procedures They can do arterial lines. They can put in in G tubes They can help with Central lines. So I think it's great in that respect. So you get to Follow patients present your patients do procedures on your patients and ultimately You know give your opinion on the patient management and the eighth and final thing I learned while rotating in the ICU is that I I Secretly kind of miss discussing post-surgical or post-operative patients. I don't know. I've always loved surgery You know, I said before if I did do radiology or intervention radiology I would have done urology The reason I did not is because some of these surgeries can last multiple multiple hours You know four to eight hours sometimes even more and that's just not what I'm into However, I've always loved surgical anatomy and surgical procedures Which is why I did a surgical internship over a medical internship as my first year of residency But the best thing about IR is that I still get the post-operative management and care in all the anatomy that comes with it but I'm also an expert at the anatomy and the procedures aren't as long and arduous as some of the surgical procedures are so I Think it worked out in my favor So last but not least do I think it's good for an interventional radiology resident to do a SICU rotation during their fifth year of residency? I'm kind of indifferent about it to be honest with you I think there's good intention behind us doing the SICU rotation But but it's kind of difficult for a fifth-year resident who hasn't managed patients in you know four plus years To go back in the ICU setting and start trying to take care of these sickest patients in the hospital But it's hard for us to kind of find our place within that team that already exists So you have a surgical team who takes care of all these patients You have a fellow attending multiple residents and multiple interns who all take care of this unit You know 11 out of the 12 months that I'm not there and then I come along and it's kind of hard to know my place because I Either act like an intern again, which I don't really want to because I've graduated away from that I did my time an intern year and I don't want to do that again But me being a fifth-year resident in IR is not the same thing as a fifth-year surgery resident Who has been managing and operating on these patients for the last five years? So we're not the same level either. So it's kind of hard to find your place within the team that already exists Hope that makes sense. So I figured out the best thing for me to do is We do chest x-ray rounds in the morning every day And I'm definitely the best one reading chest radio drafts in the morning So I read all the chest x-rays for everybody and go through all the patients in the unit really quickly And talk about any pertinent findings or whatnot and then if there are any CTs or MRs or whatnot ordered Throughout the day or throughout the week I discuss them and go over the anatomy with the residents and interns as well And then I also give them, you know advice on what studies to order and whatnot because it can be complicated Which study to order for each patient so I helped them out with that a lot So I think that's good for that. So, you know, it's mutually beneficial. I learn from them They learn from me and it's good. So that is it for me today I just wanted to tell you all about my experience in the surgical ICU As always make sure you smash that like and subscribe button and follow me on Instagram If you don't already leave a comment below if I liked it I'll try to respond to it turn on the post notifications because you know I respond to those comments first First hour I will try to respond to everyone I see otherwise. I will see you off on the next video