ICU Patient Presentation – Study Notes

 General Principles

• ICU presentations are about synthesis, not recitation.

• Attendings usually already know the data → your job is to analyze and organize it.

• Style may vary across attendings/institutions, but clarity, brevity, and clinical reasoning are always valued.

• Goal: use data to improve patient care, not just “read numbers.”

Structure of the Presentation

1. One-Liner (Orientation)

   • Name (or initials), age, sex.

   • Hospital day.

   • Chief ICU problem.

   • Example: “Jane Doe, 68 y/o female, hospital day 6, admitted with COPD exacerbation.”

   • Sets the frame immediately.

2. Overnight Events

   • What happened in last 12 hrs?

   • Source: sign-out, nurses, bedside check.

   • Examples: self-extubation, hypotension, ↓ urine output, new fever, vent changes.

3. Vital Signs

   • Don’t just list ranges → interpret significance.

   • Temp: febrile? antipyretics given?

   • Oxygenation: sat % + O₂ source (RA, NC, vent).

   • RR: spontaneous vs vent-driven.

   • BP: focus on MAP if art line/pressors. Mention titrations.

   • HR: tachy/brady context.

   • Relate changes to interventions (pressors, fluids, PRNs).

4. I’s and O’s

   • 24-hr net balance + cumulative.

   • Urine output (ml/hr trends).

   • Insensible losses (approximate awareness).

   • Inputs: IVF, boluses, tube feeds, meds.

   • Outputs: urine, drains, chest tubes, emesis, stool.

   • Interpretation: volume status, renal perfusion.

5. Ventilator (if applicable)

   • Mode (PRVC, SIMV, pressure support, etc.).

   • Settings: FiO₂, PEEP, rate, tidal volume, driving pressure.

   • Patient’s actual RR vs set RR.

   • Overnight changes? RT notes?

   • Know basics; RT is expert, but you must understand trends.

6. Laboratory Data

   • CBC: focus on trends (WBC, Hb, Plt).

     • Steroid effect, bleeding, hemoconcentration vs dilution.

   • BMP/CMP: trends more important than static values.

     • Sodium changes (consider IVF, diuretics).

     • Electrolytes (K, Mg, Phos) – tie to clinical risks.

     • BUN/Cr: AKI? Pre-renal vs intrinsic?

     • Glucose: ranges, insulin use.

   • Culture data: what was drawn, when, and results.

     • Negative cultures → think if re-culture needed.

     • Positive → know sensitivities and antibiotics on board.

7. Imaging

   • Don’t just quote the radiology read → look yourself.

   • Present relevant findings concisely.

   • Chest X-ray: lines/tubes, infiltrates, effusion.

   • CT, echo: summarize key pathology.

   • Echo: not just EF → valves, RV function, pulmonary pressures.

8. Lines, Drains, Catheters

   • Central line duration, foley days, ETT days.

   • Consider when devices can/should be removed.

   • Think ahead (e.g., trach after prolonged intubation).

9. Medications

   • Know ALL meds: antibiotics (drug + duration), pressors, sedation, fluids, insulin.

   • IV rates, infusions, drips.

   • De-escalation opportunities.

10. Physical Exam

    • Tailor to ICU context, be concise.

    • State sedation/intubation status.

    • Neuro: attempt to wake, follow commands, localize pain.

    • Heart, lungs, abdomen, skin, lines/tubes.

    • Mention changes from yesterday.

11. Assessment & Plan

    • Not covered in this teaching, but:

      • Institution-specific (problem-based vs systems-based).

      • This is your time to synthesize and propose next steps.

Takeaways 

• Present like you’re analyzing for solutions, not just reporting.

• Always think in trends and context.

• Anticipate the attending’s next question (“so what?”).

• Use ICU data to guide management and show your reasoning.

• With practice, this flows naturally and efficiently.