Resident 360 Study Plans on AMBOSS

Find all Resident 360 study plans on AMBOSS

For information on Covid-19, please see the NEJM Coronavirus (Covid-19) Topic Page.

Introduction

In the intensive care unit (ICU), you learn how to care for the sickest patients in the hospital. In critical care, every second counts. The goal of this rotation guide is to help you understand the studies that support clinical decisions for critically ill patients and introduce the important concepts that you will encounter daily in the ICU.

The topics in this rotation guide are organized as follows:

Other topics related to critical care are covered in the following rotation guides:

Hyperglycemic Emergencies (Endocrinology)
Acute GI Bleeding, Hepatitis/Liver Failure (Gastroenterology)
Palliative Care
Disseminated Intravascular Coagulation (Hematology)
Acute Kidney Injury (Nephrology)
Neurologic Outcomes after Cardiac Arrest (Neurology)
Cardiac Arrest, Syncope ,Overdose and Toxidromes (Emergency Medicine)

Jeffrey Drazen, MD, is a pulmonologist, critical care physician, and NEJM Group Editor. He is a Senior Physician at Brigham and Women’s Hospital, Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, Professor of Physiology at the Harvard School of Public Health, and Adjunct Professor of Medicine at the Boston University School of Medicine. Dr. Drazen served as Editor in Chief of the New England Journal of Medicine from 2000-2019.

This rotation guide was developed by a collaborative team of contributors including:

Writers: Leslie Chang, MD; Siri Kadire, MD; Mike Mi, MD; Andrea Merrill, MD; Rebecca Berger, MD (NEJM Fellows); Jordan Talan
Peer Reviewers: Daniela Lamas, MD; Paul Dieffenbach, MD; Raolat Abdulai, MD; and Joe Rencic, MD
Section Expert: Jeffrey Drazen, MD
Senior Editor: Ole-Petter Hamnvik, MB BCh BAO, MMSc
Last Updated: December 2022 by Laura McNamara, MD

Brief Case Presentations with Videos

Critical Care Videos

Placement of an External Ventricular Drain

Esophageal Temperature Measurement

Emergency Intubation in Covid-19

The video “Emergency Intubation in Covid-19” is intended for health care personnel involved in performing emergency endotracheal intubation in patients with suspected or proven infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the respiratory illness coronavirus disease 2019 (Covid-19).

Examination of the Neck Veins

Examination of the neck veins is routinely performed to evaluate right atrial pressure and to estimate intravascular volume in patients with dyspnea, edema, or hypovolemia. In patients with dyspnea or edema, it is essential to estimate the venous pressure and to perform the abdominojugular reflux test at the bedside, as described in...

Percutaneous Tracheostomy

A tracheostomy is a surgically created airway that is kept open with a breathing tube, or tracheostomy tube. The tube is inserted directly into the trachea through an incision in the neck. A tracheostomy can be created with an open surgical or a percutaneous dilation technique and can take place in the operating room or at the patient’s...

Personal Protective Equipment and Covid-19

This video demonstrates a procedure for putting on and removing one type of PPE that has been recommended by the CDC for use in U.S. hospitals to minimize the risk of exposure to infectious material during the care of patients with Covid-19.

Focused Cardiac Ultrasonography for Left Ventricular Systolic Function

Family Meetings on Behalf of Patients with Serious Illness

As is the case with medical procedures, family meetings require clinician training and a structured approach. The key functions of a family meeting are to build rapport with the family and to offer support, provide updates about the patient’s medical status, discuss...

Ultrasound-Guided Cannulation of the Subclavian Vein

Ultrasound Guidance for Pleural Catheter Placement

The indications for pleural drainage are diagnostic and therapeutic. This video demonstrates ultrasound-guided placement of a small-bore, pigtail catheter for drainage of a pleural effusion.

Monitoring Neuromuscular Function

This video demonstrates the assessment of neuromuscular function after administration of neuromuscular blocking agents. Because these agents can be lethal, clinicians should be familiar with the use of nerve stimulators and monitors in the assessment of neuromuscular function.

Positive-Pressure Ventilation with a Face Mask and a Bag-Valve Device

Needle Aspiration of Primary Spontaneous Pneumothorax

Nasogastric Intubation

Chest-Tube Insertion

Fiberoptic Intubation

Monitoring Ventilation with Capnography

Laryngeal Mask Airway in Medical Emergencies

Endotracheal Extubation

Use of Pressure Transducers

Peripheral Intravenous Cannulation

Ultrasound-Guided Peripheral IV Placement

Lumbar Puncture

Placement of a Femoral Venous Catheter

Arterial Puncture for Blood Gas Analysis

Insertion of an Intraosseous Needle in Adults

Noninvasive Positive-Pressure Ventilation

Prone Positioning in Severe Acute Respiratory Distress Syndrome

Geurin C et al. for the PROSEVA Study Group. N Engl J Med 2013.

In the multicenter PROSEVA trial, 466 patients with moderate-to-severe ARDS (P/F ratio <150) were randomized within 36 hours of intubation and mechanical ventilation to the prone or supine position. Prone positioning reduced 28-day (16% vs. 33%, P<0.001) and 90-day mortality (24% vs. 41%, P<0.001). All centers had used prone positioning in daily practice for more than 5 years and complication rates were similar in the two groups.

Read the NEJM Journal Watch Summary

Cricothyroidotomy

Pulmonary-Artery Catheterization

Orotracheal Intubation

Thoracentesis

Ultrasound-Guided Insertion of a Radial Arterial Catheter

Placement of an Arterial Line

Central Venous Catheterization — Subclavian Vein

Ultrasound-Guided Internal Jugular Vein Cannulation

Point-of-Care Ultrasonography

Four Videos on Point-of-Care Ultrasonography

Central Venous Catheterization

The placement of a central venous line is an essential technique in the treatment of many hospitalized patients. This video will demonstrate the placement of a central venous catheter in the internal jugular vein with the use of one of several variations of the Seldinger technique.

Brief Case Presentations with Pictures

Critical Care Images

Elevated Jugular Venous Pressure

A Complication of Central Venous Catheterization

Pneumothorax — An Uncommon Complication of a Common Procedure

Laryngopharyngeal Edema

Deep Sulcus Sign