ECICU Moonlighting

Unit Resources

Please identify where the following resources are on the unit from the off-going on-call NP or resident:

• Sleeping room on second floor Zapara

• Unit fridge and microwave and trailer fridge and microwave

• Unit intubation supplies: Glidescope, bougie, Cook exchange catheters, Melker cric kit and Blue Rhino perc trach kit, difficult airway cart, LMAs (in the code cart), standard Mac/Miller blades, CMAC (in the OR)

• Unit code cart

• Unit line cart and additional supplies

• Cell phone and code pager

• Assignment board

• Unit key codes and phone numbers

• NP and Attending office

ECICU Exclusion Criteria

The following criteria are intended to serve as guidelines to identify clinical scenarios deemed not appropriate for patients transferred to East Campus.  The East Campus Level 2 ICU is capable of caring for a variety of critically ill medical and surgical (perioperative) patients, with several important limitations based on the immediate availability of certain (on-site) consultants, inpatient specialty services, diagnostic imaging, procedural equipment, and (on call) Operating Room.

Generally speaking, patients with the following diagnoses should not be admitted to the East Campus ICU service given the above limitations:

• Acute MI / cardiogenic shock / malignant arrhythmia needing PCI, invasive pacing, or urgent CT surgery

• Acute stroke / intracranial hemorrhage needing CT angiography, interventional radiology (IR), neurosurgical intervention or invasive monitoring

• Acute major trauma or burns / surgical or vascular emergency requiring urgent IR or surgical intervention

• Active GI bleeding needing urgent endoscopic, IR or surgical intervention and massive transfusion

• Massive hemoptysis or central airway obstruction d/t foreign body, stricture, or malignancy requiring urgent airway intervention in the OR by interventional pulmonology vs ENT/thoracic surgery

• Severe ARDS / decompensated pulmonary hypertensive crisis needing hyperbaric oxygen, nitrous oxide or IV epoprostenol

• Cerebral arterial gas embolism / CO poisoning or decompression sickness needing emergent (ongoing) hyperbaric oxygen therapy

• Rattle snake envenomation needing urgent anti-venom administration

• Obstetrical emergencies or any pregnant patients beyond first trimester

• Pediatric age patients

In summary, patients should be considered primarily for placement at the main medical center if they are unstable for transport or have any conditions requiring:

• Urgent procedural interventions (beyond standard bedside maneuvers by intensivist)

• Urgent cardiac cath labs

• Urgent chemotherapy or biotherapy needs

• Urgent MRI imaging (MRI at EC is not configured for gurney’d and monitored ICU patients)

• Massive blood transfusions

• OB or Peds specialty care

Finally, remember to reassess for improvements or worsening decompensation!  After deciding your differential diagnosis and plan of action, circle back and re-appraise the data and patient’s response to your interventions to determine if alternative dispo plan is needed.

Code Blue and Rapid Response

Pick up pager from OR before starting shift and drop off after ending shift in ICU

When the ECICU provider is holding the Code Blue pager, they are the primary person responsible for running the Rapid Response and the Code Blue.  The hours for ECICU response are 1900-0700 Monday to Friday and all holidays and weekends.  Family Medicine residents are the primary team during all other hours with OR Anesthesia covering airway only.  Family Medicine residents are encouraged by their department to come to nighttime events for educational purposes only.

Please notify your Attending upon evaluating the patient; they are ultimately responsible for the patient's condition. 

During responsible hours the ECICU resident or NP must complete a Rapid Response or Code Blue note for every page received.  Under type of note, type in either "code" or "rapid" (in the tab usually reserved for H&P or progress) and a note template will populate.  Only 1 note per Rapid Response or Code Blue is needed (multiple services responding do not have to each write their own note).  If the Family Medicine resident comes to the event and wants to write the note as it's their team's patient, that's fine- just work it out amongst yourselves so the documentation is complete.

Coverage area for the pager includes Acute Rehab (Units 1100 and 1500), DHS and Family Medicine (intermediate and basic care on Units 1200 and 1300) and Urgent Care (for Code Blue only).  Unit 1400 runs their own codes but does call a Code Blue for tracking purposes and to obtain more resources if needed.

Familiarity with the EC Code Stroke Policy (click here to view) is expected: call hyper-acute stroke x44099 to expedite transport to main medical center for complete imaging after ABCs; obtain hyperacute labs include CBC, BMP, PTT/INR, troponin; discuss case with Neurology over the phone including last known normal time (esp if in the last 12 hours or wake up) and s/s stroke.  You will then need to touch base with Neurology again to determine if the patient will be admitted to NMCCS for positive imaging or will come back to EC for negative imaging.  If the patient requires a level of care change after return to EC, that disposition should be worked out between Family Medicine and ECICU.

Familiarity with in-patient Acute Coronary Syndrome policy and procedure (click here to view) is expected.  For STEMI concerns, activate a ACS alert x44099; ECG should be faxed to the Cardiology fellow on-call and case discussed before further medications given and transport for PCI. 

Determine an ultimate disposition for the patient and coordinate care with the primary and admitting teams, taking into account nursing ratio and monitoring capabilities.  DHS will have an on-call person available to discuss the case with but they will not be acquainted with the patient.  Other teams such as Nsgy and Ortho will also have an on-call person who may or may not be closely acquainted with the patient.  Upgrade as the situation dictates to Family Medicine or ICU.

If admitting from Acute Rehab (which is a separate facility), be sure not to place inpatient ICU orders in the active Rehab chart.  Check out our tipsheet for step-by-step instructions for how to admit these patients in LLEAP!

ICU Patient Care

Attending Communication

M&M or Out-of-the-Ordinary Events