SICU Rotation Overview
Written by BJN and AM
Last updated 12/12/2013
Welcome to the Anesthesiology Critical Care SICU Rotation! Our goal is to provide you with the
education necessary to take care of critically ill surgical and trauma patients. This document provides an
overview of the SICU rotation, including clinical duties and educational expectations.
The Surgical Intensive Care Unit (SICU) is a 20-bed high-acuity, multi-specialty critical care unit. The
surgical specialties supported in the SICU include trauma, neurosurgery, general surgery, transplant,
orthopedics, spine, ENT, plastics, vascular surgery, urology and high risk obstetrics. The SICU is adjacent
to the Level 1 Trauma Suite at Hillcrest. Over 1,800 patients are admitted to the SICU annually. During
times of peak patient admission, the SICU has the ability to overflow to an additional six beds in the
PACU.
The Medical Director of the SICU is Dr. Jay Doucet and the SICU Nurse Manager is Juana Burkhart RN,
CCRN. The SICU Critical Care Service attendings are general surgeons and anesthesiologists who are
board-certified in Critical Care. They are assisted by a fellow, who is a board-eligible or board-certified
general surgeon training for additional certification in Critical Care Surgery. PGY1/2/3 residents rotate
from various departments, including general surgery, anesthesiology, reproductive medicine, orthopedic
surgery, neurosurgery and others. In addition, there are usually 1-4 medical students on the team each
month.
The SICU is an “open unit”, meaning that surgeons from services with critical care privileges (trauma,
general surgery, and neurosurgery) usually retain primary control of their own patients' care while in the
SICU. For example, a vascular patient remains on the Red Service, and the SICU team acts as a
consultant team to this patient. Some services do not have critical care privileges - such as Urology,
Orthopedics, ENT, Plastics, OB/GYN, Interventional Radiology, Ophthalmology and others. In these
cases, the SICU Critical Care Team will act as the primary service while the surgical team will confine
their management input to their specialty issues. For Transplant Surgery patients, both the SICU team
and the surgical team co-manage the patient and both teams write orders. As with all patients in the
SICU, close communication is necessary between the SICU team and the surgical team. When it is time
for one of the SICU primary patients to be transferred out of the SICU, a formal sign-out must be given
to the surgical team.
Attending rounds are held daily for all SICU patients. SICU residents are expected to be aware of the
daily care issues for all patients and all services, and to write a daily EPIC progress note on each patient.
All resident notes will be co-signed by the SICU Attending. All medical student notes MUST be signed by
one of the residents in addition to the attending co-signature. After rounds, you will communicate daily
recommendations to each surgical team. You should know your patients well! This means a thorough
exam, review of the chart, pertinent labs/data, reading consultant notes, talking to the primary team,
and asking the RN about events that have occurred. This also means reading about your patients'
disease processes and looking up answers to questions that come up on rounds.
Important numbers:
Anesthesiology Airway/Code Pager - 290-2622
SICU Front Desk - 543-7428
Door code - 642
Main OR front desk - 543-6040
Scheduled Daily Activities
0600-0815:
0815-0830:
0830-0900:
0900-1100:
1100-1200:
Pre-round with communication/input from primary teams
Assemble rounds materials +/- review with SICU Fellow
Radiology rounds at the PACS monitor
Bedside rounds on all SICU patients
Daily SICU Didactic Conference, except weekends
After rounds and conference, the following should occur:
- Completion of notes (including signing the medical student notes)
- Communicate all recommendations to the primary surgical teams
- Carry out management plans on SICU team "primary" patients, including any procedures to be done
- Assure that your patients are stable
- Sign out your patients to the On-call SICU Resident (more detailed sign-out on "primary" patients)
- When these duties are completed, the Residents who are NOT on-call may leave the hospital (typically
early to mid-afternoon)
Note about POST-CALL PGY2/3 residents:
Each attending/fellow will have their own strategy for when the post-call resident is to be relieved, but
In order to comply with ACGME standards, you must leave the hospital after 28 hours max. This usually
means by 10am on your post-call day. Note that this does not apply to interns (PGY1) who do 16 hour
max shifts.
Anesthesiology SICU Resident Roles/Responsibilities:
1. Respond to Emergency Airway management needs – carry code pager (x2622)
a. This is the emergency pager which is called for Airway/Respiratory/Cardiac Arrest
anywhere in the hospital and in the Trauma Resuscitation Suite (Trauma Bay).
b. OR Resuscitation is also called on this pager (OR 11).
c. This pager is only carried by Anesthesiology residents (not surgical residents).
d. When you accept the pager, it is your responsibility to assure the code bags are fully
stocked.
e. When you respond to a code situation and the patient is already intubated, it is YOUR
responsibility to make sure the ETT is correctly positioned in the trachea.
f. Once the airway is secured, you may assist with vascular access and other needs during
a code. Always check with the code leader before leaving.
2. Participate in SICU Rounds
a. Pre-round and be prepared to present your patients on rounds.
b. Complete notes using EPIC template (“MYSICU”)
c. Use a systems-based approach for presentation followed by assessment and thoughtful
plan.
d. Have knowledge of all primary and consultant patients (described further below).
e. Always include the bedside RN in daily rounds.
3. Wednesday M&M/Grand Rounds conference
a. Residents are required to attend 0630 Wednesday morning Grand Rounds. If for some
reason you are unable to go, you should let Anush know why.
i. Surgery residents also have their Grand Rounds conference on Wednesday
mornings.
ii. Every Tuesday, the plan for Wed morning rounds should be discussed so that
both the Anesthesia and Surgery residents can attend their Grand Rounds.
iii. The SICU service attending may delay rounds to allow attendance.
iv. The option also remains to not include the Trauma-Critical Care patients on
rounds given they have a critical care service caring for them (but this needs to
be determined by the SICU Attending).
4. Primary versus Consultant ICU Management
a. It is important to note that you should know all SICU patients well enough to be the
primary medical service. However, there are certainly some differences in
responsibilities depending on the SICU team's role in each patient's ICU management.
b. Primary Service – Services such as OB/GYN, Head and Neck Surgery, Plastics,
Orthopedics, Orthopedic Spine, Urology, Liver/Renal Transplant Surgery; often referred
to as our "primaries"
i. The SICU team is primarily responsible for these patients’ care.
ii. The SICU team will write all necessary orders for these patients.
iii. The SICU team is responsible for communicating all ongoing management
decisions/orders to the surgical service.
c. Consultant Service – Trauma, Neurosurgery, White Surgery (Acute Care Surgery), other
general surgery services
i. The SICU team will round on these patients and write a SICU progress note each
day.
ii. All recommendations will be communicated directly to the primary team.
iii. During normal daily hours, the SICU team will not write any orders on these
patients except in the case of an emergency. At night, however, the SICU team
may be cross-covering some of these patients (see #5 below).
5. On-Call SICU Responsibilities
a. During on-call hours (usually after 5pm), the SICU Anesthesiology Resident is
responsible for ICU management for all patients in the SICU except Trauma and
Neurosurgery. This means any of the general surgery services in addition to our
“primary” patients.
i. Sign out must occur from the primary surgery service to the SICU resident
assuming responsibility. You should not assume primary responsibility until you
have received a sign-out.
ii. At night, you will write orders and manage these patients as if you were the
primary team.
iii. There is always a senior surgery resident and a Trauma fellow/attending in the
hospital if you need any assistance.
iv. The SICU attending is always available by phone for help and can return to the
hospital if necessary.
b. You should call the on call in-house Anesthesiology attending (and/or upper level
residents) for airways and codes. Do not go to these emergencies alone.
c. If Trauma and neurosurgery are very busy, it is possible that they will ask for your help
in writing orders and placing invasive venous and arterial lines.
d. OR 7 and 11 setup and OR Resuscitations
i. See attached OR 7 and 11 checklists. The MOR residents should help with
setup, but YOU have the ultimate responsibility for these rooms being ready to
go.
ii. You should be the primary Anesthesia provider in the case of an OR
Resuscitation in OR 11.
e. If you have down time while on-call, there is a lot that can be learned by hanging out in
the Trauma Bay and observing/helping with management of trauma patients.
Didactics:
There will be a formal didactic conference each weekday from 11am-12pm. These conferences will vary
based on each attending. Sometimes the attending or fellow will lead the discussion, other times there
will be a presentation by one of the residents or medical students followed by discussion. On Fridays,
the Pharmacy team usually gives a presentation.
Conference location:
Trauma conference room across hall from SICU.
Door code 4-2-enter
Core Critical Care Topics: These should be reviewed either formally or informally during your rotation.
Shock
Mechanical Ventilation
Weaning from MV
ARDS
SIRS, Sepsis, MODS
Hemodynamic Monitoring
Head Injury and ICP Management
Neurological Illness and Critical Care
Electrolyte and Acid-Base Abnormalities
Renal Failure
Hepatic Failure
Use of Blood Products in the ICU
Coagulation Disorders
DVT Prophylaxis, PE
Infectious Disease and Antibiotics
Nutritional Assessment and Support
Vasoactive Drugs
Analgesia, Sedation, Paralysis
Hypertensive Crisis
ACLS Protocols
Gastrointestinal Hemorrhage and Prophylaxis
Procedures:
Consent is required from the family member, or from the surrogate decision maker for all procedures
which are not emergent in nature (e.g. central lines, PA catheters, arterial lines, dialysis lines, and
bronchoscopy). After a procedure, a note is entered into EPIC with the attending selected as the cosigner for billing purposes. To do this, the resident must first place the order in epic, for placement of a
line, or bronchoscopy, etc. The order is then signed. After the procedure, the rounding-consult tab is
selected and the ‘procedure notes’ is selected. The order is then highlighted for the procedure done.
Click on “document order” and fill out the template as appropriate. Strict sterile precautions are
mandatory for all arterial and central lines placed in the SICU (unless truly emergent). This includes
washing hands, gown, hat, mask, sterile gloves, full drape, skin prep with chlorhexidine.
Professionalism:
Residents are expected to maintain a high degree of professionalism when interacting with other
members of the SICU team, nurses, patients, family members, other surgical teams, and all ancillary
staff. Occasionally there will be differing opinions in terms of patient care or in terms of daily routines.
One of the greatest skills you can take away from this ICU month is the refined ability to communicate
professionally, respect others' opinions, and learn to be an effective consultant (which will be absolutely
crucial to your future career as an Anesthesiologist). Remember that you represent the Anesthesiology
Critical Care Medicine division in addition to the entire Dept of Anesthesiology, and that you are a role
model for medical students. Many critically-ill patients are depending on all of us to work in harmony in
order to provide them with the best possible care. Be the person who is a positive leader with a good
attitude and this will benefit you long after your SICU month is over.
Reading Materials and other information:
 Books (we have copies in the Anesthesia Resident Lounge):
1. Marino PL, Sutin KM. The ICU Book. Lippincott Williams & Wilkins 2007. (also available online)
2. Wilson WC, Grande CM, Hoyt DB, eds. Trauma: Critical Care. Informa Healthcare 2007.
 “Introduction to Critical Care” written by Beverly J. Newhouse, MD, pdf version from J.M. Ehrenfeld
et al. (eds.), Anesthesia Student Survival Guide: A Case-Based Approach, Springer Science+Business
Media, LLC 2010.
 There will be papers referred to and given to you by individual attendings or fellows.
 Website: http://www.ccmtutorials.com is an excellent website developed by the Society of Critical
Care Medicine to assist residents in learning critical care.
SICU Faculty:
You should feel free to contact any of the ACCM faculty with questions/concerns. In addition to the
Attending on-service, your point faculty are Anush and Bev for questions about the rotation, issues that
arise, and revisions to this document so that it can be appropriately updated for future residents. We
look forward to working with you and hope that this will be a valuable experience for each of you!
Anesthesiology Critical Care Faculty
Dr. Anush Minokadeh, Director of Anes-Critical Care and ACCM Fellowship
Dr. Beverly Newhouse, Associate Director of Anes-Critical Care, Residency Education Director
Dr. Erik Kistler, Director of ACCM Research
Dr. Kimberly Robbins, Associate Director of ACCM Fellowship
Dr. E. Orestes O'Brien, Director of Critical Care Echocardiography
Dr. Zeb McMillan, Director of ACCM Journal Club
Anesthesiology SICU Rotation Coordinator - Julie Nguyen or Karen Bradley
jungyuen@ucsd.edu or anesresidency@ucsd.edu
Surgical Critical Care Faculty
Dr. Jay Doucet, Director of SICU
Dr. Raul Coimbra, Chief of Trauma
Dr. Vishal Bansal
Dr. Leslie Kobayashi
Dr. Todd Costantini
Other Trauma Surgery (and Burn) Faculty
Dr. Jeanne Lee
Dr. Bruce Potenza