Day in the life of an ICU doctor [specifically, a critical care anesthesiologist] 

I think most of us take *some* component of our work home with us. It's part of the profession and our commitment to serving our patients! But... it is *SO* important to know how to leave work at work in order to prevent burnout. Good luck in nursing school!

Hi Alex! Thanks for watching the video. I hope to post another video in the future really talking about my career path and decision to pursue anesthesia CCM. There were definitely times in the OR where I was *really* miserable, but now that I'm in a care team model, I actually don't mind the OR as much [and thus, at this point, am not looking to do 100% CCM]. I didn't think I'd like OR anesthesia as much as I do, but now that I'm not stuck in the 12 hour train-track cases, I feel like I can either spend my time focusing attention on education with residents OR I can take care of some administrative tasks if I'm only working with CRNAs. Perhaps that feeling will change with time, but definitely give OR anesthesia a chance when you finish!

I felt that with the devastation and destruction I was witnessing, I could not justify taking risks. This pandemic has really done a lot of damage; I do hope that we are finally moving in the right direction now. Stay safe!

Thank you for taking the time to watch!

Thank you so much!

It takes a village to provide excellent patient care!

CONGRATULATIONS on your acceptance to medical school! Glad you had a chance to see the power of good clinical teamwork during your PICU research -- please feel free to reach out at any time with questions or during clinical rotations [especially if you're thinking about anesthesiology and/or critical care]!

Hi Lexay! Thanks for watching. I'm so happy to hear that you've been inspired by my video; just remember that the road to medicine is long and hard, but it's a gratifying job. Please feel free to reach out with questions or for advice as you need!

Thank you for watching! I appreciate it.

So glad to hear it! Let me know if you have any questions along the way!

@@AmandaSXiMD I will definitely bend your ear. I’ve subscribed to your channel, but have lots of questions and needing some guidance on things. Thanks Doc!

I definitely like OR anesthesia MORE now that I'm an attending, but would feel less fulfilled without some time in the unit. Either way, we need people who like both so it works out! I hope things are manageable with COVID in Kuwait! Hoping you have access to the vaccine soon, too.

Our dietitians do not participate in our rounds, however we definitely work closely with them on ensuring adequate nutrition for our ICU patients! Do you regularly participate in your ICU's rounds?

I attend every weekday. On the weekends our staffing goes down to one dietitian for the whole hospital. So we rely on consults on the weekend. I also anticipate what nutrition support patients may need over the weekend and I will put in recommendations in a note and I let the weekend dietitian know what they should be looking out for. Say, a patient is on a high amount of propofol on Friday, but if that comes down over the weekend the pt will be underfed sometimes by 1,000 kcal or more if the tube feeds or TPN is not adjusted accordingly. It’s nice to hear, but unfortunate, that the intensivist and pharmacy really miss a dietitian being in rounds on the weekend!

Thanks for watching and commenting!

Thank you for watching and commenting! We can always use more smart people in pulm CCM/ID & CCM! Good luck to you.

What a great idea! I'll definitely start working on this!

Thank you for watching and your support!

Thanks for watching! I'm sure that YOU WILL MAKE THIS DREAM A REALITY for yourself! It's not always an easy road, but it's so worth it. You got this.

@@AmandaSXiMD thank you so much, doc amanda! 😍

Thank you so much for your comment and kind words. Please reach out if you have any questions along the way!

Same here! Still waiting on int but want to do critical care Anesthesiology

@@Naijagyal22 It's a great field!

Thanks for a great idea for a teaching video in the future! I have a couple of anesthesia-specific videos I'd like to create, but I'll add this to the list.

Hi there! Thanks for watching and commenting. I think CCM really makes you a better anesthesiologist and doctor overall so I highly recommend it! During the last few months of CCM fellowship was when I felt like I had a better grasp of how to manage patients and direct care. That being said, I still call upon my colleagues when I'm unsure about a path or direction to take to get their opinion or thoughts. I am constantly learning as an attending and find that to be one of the most rewarding parts of the job! Hope this helps!

Great question! Every year of residents it changes - critical care is quite popular among the residents at my institution because we have such a strong program so many self-select to come here. There has been a recent trend that many have been doing the dual training - cardiac + ICU [which, I don't say in this video, but I actually did apply to both but ultimately decided to only pursue ICU for various reasons]. Fellowship interest changes year-to-year, some years there's more interest in pediatrics or chronic pain!

I'm better about replying on my IG account @amandasximd - also look out for shadowing events that I participate in [I usually post them on my IG].

Thanks for watching the video! When I'm assigned to daytime shifts, I typically care for ~10 patients, but on certain other units, that can go up to 18-20 patients. On nights, the census is closer to 20-26 patients. As a resident/fellow, I worked between 60-100 hours/week depending on the week. Now that I'm an attending, generally I work 50-70 hours/week when I'm in the unit. I have a mixed practice, so I also work in the operating room, which can change my weekly hours worked. The European system feels so different from the U.S.! Do you ever work longer weeks?

Thanks for watching and commenting! I go over some differences between medical intensivists and critical care anesthesiologists in my video here: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-YZYfJLSWXh4.html I think that our daily routine as an ICU doctor does NOT differ between medical intensivists and critical care anesthesiologists, however, both specialties can practice medicine outside of the ICU, and I think that can be different. Also, depending on the type of ICU being practiced in, that can be a bit different, too. Having trainees also changes the workflow. Hope this helps!

@@AmandaSXiMD Thank you!

Sorry to hear that you're not happy as an anesthesiologist. Like everything in life, there are downsides to the specialty. In fact, I just recorded a video talking about some of my personally perceived downsides. I hope you'll be able to find something within the specialty that you're passionate about though!

Great question! There's a difference in the # of years of training, skillset and day-to-day clinical work. For # years of training: - IM is 3 years of residency and pulmonary/critical care is 3 additional years, so 6 years of training (you can opt to do a 2 year fellowship in critical care alone to make it 5 years of training if just interested in critical care) - Anesthesia is 4 years of residency (sometimes internship is at a separate institution like I did, but that's in the minority now) then 1 year of critical care fellowship, so 5 years of training For skillset/training: - IM residency provides a lot of background in outpatient and inpatient medicine, but most programs are less focused on procedural skills, physiology, and ventilator management - Anesthesia residency offers procedural skills (intubation, lines, etc), focus on physiology (anesthesia OR cases are a constant lesson in this area!), and ventilator management (we use them every day!); anesthesia requires that you like the OR environment, which is a big difference from IM Day-to-day clinical work: - Pulmonary critical care can have a pulmonary clinic (outpatient) with long-term patients AND time in the ICU. They can also practice 100% ICU, but in that instance, it might make sense to just do a 2 year fellowship in ICU alone - Anesthesia generally means you're spending time in the OR AND ICU; frequently it's more challenging to find a split between OR/ICU coming from anesthesia (generally need to be at a large medical center) I hope this helps! I plan on making a video really breaking down the pathways to critical care soon.

@@AmandaSXiMD Thank you!! Extremely helpful and insightful, current 1st year and just keeping my options open. Love the channel and what you do

Yes we do! During residency we rotate through different types of surgical subspecialties [e.g. orthopedic surgery, general surgery, vascular surgery, thoracic surgery, cardiac surgery, etc] as well as through obstetrics, pain medicine and the ICU. This gives anesthesia residents broad exposure for practice!

I take care of adults only. Pediatric ICU is staffed by pediatric critical care (though there are some pediatric anesthesiologists that have been grandfathered into PICUs).

Hi there! Yes, cardiac anesthesia is a sub specialty of anesthesiology. You need an additional year of fellowship to practice cardiac anesthesiology.

You're a very astute viewer! When we respond to airways and need to intubate, it's common for patients to have low blood pressure after intubation, so I carry vasopressors [medications to raise blood pressure] in case of emergencies so I always know I'm prepared. These medications include phenylephrine and epinephrine. There are also a couple pens in there!

@@AmandaSXiMD you're not the 1st person to mention that.... :-) Thank you for all the hard work you and the medical community have been doing!!!! One 💘

So true!

One year!

@@AmandaSXiMD thanks for replying; I’m a fellow respiratory therapist and I’m debating whether going to medical school would be the correct fit, I really enjoy anesthetic medicine as well as critical care

It's a long journey, but your respiratory therapy experience would definitely be a big asset if you decide to pursue critical care anesthesiology!

Thank you for sharing this. There are definitely challenging portions of the job as an intensivist as you point out including tough conversations and a high rate of burnout. I am just at the beginning of my career, so perhaps I'm still in my honeymoon period, but at this point, I still love what I do in the ICU and hope that this passion continues on for the rest of my career.

In the U.S.!