Important Links
2024-2025 MICU Orientation
2024-2025 MICU Rounding Format
2024-2025 MICU Rounding Resident Expectations
2024-2025 MICU Nurse Rounding Tool
2024-2025 Weekly Didactic Presentation Schedule - Updated Often!!
2024-2025 Link to TEAMS Meeting (for ALL MICU ROTATION LECTURES)
Introduction & Workflow
The mission of the Intensive Care Unit (ICU) rotation is to manage critically ill patients with severe single or multisystem organ failure who require frequent monitoring and are commonly unstable.
The Sinai Hospital ICU is a 29 bed “mixed” unit admitting medical, surgical and neurological critical care patients. The typical census on the medical side of the ICU is 15-18 patients at any one time, with 2-4 new admissions per day. The medical ICU (MICU) is “closed” in the sense that all patients must first be reviewed and accepted by the intensivist and all orders are written only by the physicians in the MICU responsible for these patients.
The ICU differs from the medical floors and step down units in several ways.
Nursing is the primary difference between the ICU and the medical floor. The typical nursing ratio in the ICU is one nurse per two patients, though there are situations where this is extended to one-to-one. Nurses chart vital signs at least hourly, accompany patients on transports off the ICU, and are keenly aware of all issues involving your patients.
The intensivists cover the MICU 24 hours a day, 7 days a week without any disruption. They are available at all hours of the day or night, no exceptions.
The day shift includes two rounding teams - Team Yellow and Team Green, each with 1 intensivist, 1 intern, and 1 senior resident per day. Patients are ideally distributed evenly across the teams, so new consults and admissions are assigned by intensivists based on census.
There is a separate night shift team (1 intensivist, 1 resident, 1 intern).
Every patient that stayed in the ICU for > 48 hours needs a transfer summary. It should be done on the same day without fail.
It is our job not only to take care and responsibility for all the medically critically ill patients at Sinai Hospital, but to introduce all of you to the ICU, its work day, rules, customs and codes of conduct. This handbook will be amended accordingly over the years.
Other RESOURCES
How to fill out Death Certificates
How to do Admissions to the MICU
When to Notify the Attending Physician
Protocols and Policies to be aware of - MUST READ
CICU WORKFLOW -
Changes Effective 05/01/2025
Why?
The role of the CCU/CICU as a standalone entity at Sinai Hospital is changing.
What’s different?
Medicine patients with active cardiac issues requiring ICU-level care (i.e. STEMI, complete heart block) will be admitted to the MICU service serving as primary team with Cardiology serving as a consulting service.
Interventionalists will contact the MICU attending for STEMI/cath lab patients requiring ICU level care, as well as be clear on who will continue to follow the patients from cardiology and sign out to appropriate cardiology attendings if needed.
MICU Residents will utilize the CCU Admission Order Set when admitting patients to the ICU.
This has quality metrics, necessary protocols, etc. and is mandatory.
Cardiologists will follow the same pathway to transfer patients from another hospital or the floor requiring ICU level.
After-hours cardiac issues or questions will be directed from the ICU team to the cardiologist/service following the patient, akin to workflow for the rest of the hospital.
How does this impact communication with Cardiologists?
Interventionalists will contact the MICU attending for STEMI/cath lab patients requiring ICU-level care, as well as be clear on who will continue to follow the patients from cardiology and sign out to appropriate cardiology attendings if needed. Cardiologists will follow the same pathway to transfer patients from another hospital or the floor requiring ICU-level care. After-hours cardiac issues or questions will be directed from the ICU team to the cardiologist/service following the patient, akin to the workflow for the rest of the hospital.
How does this impact everyone else?
Starting 05/01/.25, if a patient suddenly has cardiac ICU-level needs (such as during a rapid response), the MICU intensivist should be called (not the CICU APP).
Please reach out to Dr. Sugumar if you have any questions or any area of doubt. Thank you!
Prior Didactic Presentations
Acid Base Abnormalities by Dr. Nag
Advanced Directives by Bailey Oros
Articles Hand-Picked by Dr. Ali
Brain death: a clinical overview - Journal of Intensive Care
CLOVERS - Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension
Corticosteroids in Sepsis and Septic Shock: A Systematic Review, Pairwise, and Dose-Response Meta-Analysis
DoReMIFA - The Dose Response Multicentre Investigation on Fluid Assessment in critically ill patients
Mechanical Ventilation - Negative to Positive and Back Again
PROSEVA - Prone Positioning in Severe Acute Respiratory Distress Syndrome
SALT - Balanced Crystalloids versus Saline in Critically Ill Adults
SALT-ED - Balanced Crystalloids versus Saline in Noncritically Ill Adults
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021
Vasopressors in septic shock: which, when, and how much
CONTACT NUMBERS
ICU Front Desk: ext. 25449
MICU Intensivist Office: ext. 27175
MICU Intensivist iPhone: 443-539-6012. Covered 24/7.
MICU Resident Workroom: ext. 25525
MICU Resident iPhone: 410-307-7663
Cardiac ICU APP iPhone: 443-422-4359
Neuro-Critical Care APP iPhone: 410-382-9639
SICU Provider Office: ext. 27163
SICU Provider iPhone: 443-827-4615