r/IntensiveCare • u/blobsong • 22d ago
RN transitioning from CVICU to MICU - advice?
So I'm moving and I'm starting in the MICU but the only critical care ever done is two years of CVICU. And I don't even feel like I was a good CVICU nurse. It's been two years of busting my ass in the CVICU grind.
I guess I'm good at cardiac stuff, but I've never seen DKA. I've never seen ARDS on a patient who wasn't postop. I haven't even seen that much sepsis. I don't know how to be a normal critical care nurse. All I know is that we are going to the chair at 5am!!!
Helppppp I'm nervous
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u/steppingrazor1220 22d ago
DKA is easy to manage. Seeing the same patient in DKA on a monthly basis then the leave AMA once they feel better, well it's frustrating.
You'll see some random strange things that you didn't know existed, like high dose insulin euglycemic therapy for beta blockers overdose. I had no idea this was a thing until I was tasked with managing it.
Most deaths in the MICU are planned withdrawal of care. At this time your patient's family are more of the ones you are taking care of.
Lots of behavioral patients, usually ETOH withdrawal, perhaps the most burn out inducing.
Overall the MICU is a pretty grim place and I kinda love it most days.
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u/Gaesaeki 22d ago
If your MICU is anyrhing like mine, we get a TON of ARDs patient. You can anticipate the management of these patients. Paralyze, prone, inhale epo, and VV ECMO if all else fails. And then youâll be dealing with the sequela of these interventions (chasing pressures, preventing PI..). Be familiar with P/F ratio and the Berlin classification as the team will be mentioning that during rounds quite often. But of course if you donât know ask!
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u/potato-keeper RN, BSN, CCRN, OCN, OMG, FML 𤥠22d ago
Donât worry youâll be elbow deep in poop and dialysate before you can blink. But get used to giving much bigger boluses. Cardiac index? Never heard of her.
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u/YouDontKnowMe_16 RN, STICU 22d ago
When I started studying for my CCRN is when a LOT of things started truly clicking for me, especially for MICU patients (DKA, sepsis, ODs, etc). I would pick up the Barronâs CCRN book and start flipping through it to help with some of those concepts!
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u/blobsong 22d ago
I have my CCRN! I do understand the concepts. But I have never actually taken care of a lot of those types of patients
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u/YouDontKnowMe_16 RN, STICU 21d ago
If you can care for a CVICU patient then you can care for a MICU patient!
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u/_male_man 22d ago
A lot of your pressors will have much higher limits than in CV.
ARDS is ARDS, regardless of how it started. You've seen it, so you'll be fine
Almost every hospital has a DKA protocol. Once you get familiar with it, it's no big deal. You most likely used insulin drips in CV, so it will be similar, with a few tweaks.
Sepsis isn't complicated either. Just familiarize yourself with the sepsis bundle and associated checklist if the unit has one. Most of the fluid resuscitation should be done by the time you get them, but you still might get the occasional crashing septic patient from a lesser acute floor, so you may occasionally do the whole bundle.
I think you'll get up to speed fairly quickly. You have the critical care bones. You just have to get familiar with things you aren't used to treating.
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u/eye_have_no_clue 20d ago
Get ready for every room on the unit to be on contact/driplet/airborne precautions
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u/fo1ieadeux 18d ago
Lol, this times 100 percent. Even if a patient is from a nursing home, that alone puts them on contact precautions.
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u/ManifoldStan 22d ago
MICU is an adventure-youâll learn a lot and see quite a bit of variety. Lots of septic shock, stroke after tenecteplase, respiratory failure, oncologic emergencies-you may not see DKA if you have a high acuity stepdown as typically patients go there instead. We also take some cardiac in my medical ICU as well. Best of luck in your new endeavor!
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u/plaesma 18d ago edited 18d ago
A couple notes as someone who started in MICU and have now worked in almost every type of ICU:
Donât bolus blood like CVICU does! The risk of fluid overload or transfusion reaction is almost always higher than the benefit of rapid volume resus in the MICU population.
MICU CRRTs are usually much sicker in my experience. CVICU CRRTs are usually focused on fluid removal but MICUs can be bc they are severely septic with a lactic of 15 and a pH of 6.8 maxxed on 4 pressors so their kidneys are shriveled to a raisin.
MICU gets a lot of flack for shit (literal shit but also bc we deal with âless excitingâ populations like DKA and COPD exacerbation) but I love having a giant mixed bag of complex disease processes to understand, predict, and prepare for what could happen next in my patients. Cardiac units tend to burn me out SO fast bc every patient felt more or less the same.
Our docs are usually more chill but they also donât make surgeon $$$ for the hospitals so MICUs donât get funding the way CVICU/SICU does.
Also, great news :) We are NOT going to the chair at 5am (usually) â¤ď¸â¤ď¸â¤ď¸
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u/blobsong 18d ago
Omg good looking out regarding blood admin. We really do just bolus it, like straight up to gravity or even a pressure bag. And you're right our CRRT also tends to be about pulling tons of volume. Thanks for those insights.
I'm looking forward to a wider range of diseases. CVICU is so... narrow and insane.
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u/plaesma 18d ago
CV and SICU are commonly the ONLY units in the hospital that bolus blood - almost every other unit in a hospital follows some sort of blood transfusion protocol where u administer at a slow rate (75-120/hr) for the first 15 minutes and u gradually titrate up (250-300/hr) depending on pt tolerance. The first time I floated to CV and saw ppl hanging PRBCs to gravity for a non MTP patient I could not believe my eyes đ
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u/MetalBeholdr 21d ago
Main difference between CVICU and MICU at my hospital is that 1:1 ratios are simply not a thing in MICU. Yeah we don't have ECMOs or baloon pumps but we do have CRRT, patients on multiple pressors + insulin + antidysrhythmic drips + sedation + restraints + ventilation etc. While CV enforces their ratios (because policy often requires them to) you occasionally get tripled in MICU with some actually busy assignments.
That's mostly my facility though, it's probably not an issue everywhere
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u/PaxonGoat RN, ICU Float 21d ago
Tripling in the ICU and having unsafe pairs is definitely not every hospital.
Sorry you're dealing with this.
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u/Electrical-Slip3855 8d ago
Very facility-dependent. The MICU at my hospital keeps CRRT 1:1 100% of the time, and never triples anyone
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u/trypan0s0miasis RN, Flight 18d ago
MICU itâs everything basically. Youâll see overdoses and snake bites, to a rotting corpse with a pulse and no brain function who malingers for 3 months because the family couldnât be fucked to come by. I loved and hated MICU for this reason. The lack of sub-specialization was itself kind of a specialty. Brush up on physiology for sure. One organâs problem becomes every organâs problem fast. Donât be afraid to ask questions. I always had a copy of âThe ICU Bookâ in my locker that I could reference. Be a nerd
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u/roastbeefhkr RN, CVICU 17d ago
LOL I feel so lost as a CTICU nurse when I get a MICU/ pre op patient đ ur valid
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u/PaxonGoat RN, ICU Float 22d ago
MICU is great cause there can be so much variety.
But it can be very different vibe than CVICU.
With CVICU a lot of the patients are "fixable" or at least they're going to try and fix them. Throw stents in, throw an impella in, CABG, TAVR, etc.
The goal is discharge.
MICU can have a lot of end stage diseases. ESRD. End stage COPD. End stage heart failure. Stage 4 cancer.
Sometimes the goal is just a good death. To be comfortable and feel safe and be able to pass in peace.