An updated induction pack from the unit will be sent to you at the start of your rotation via email. Alternatively this can be found on Connect(Addenbrookes intranet) under JVF ICU.

If you have the time it would definately be worth emailing Dr Stephen Ford (ITU consultant and rota co-ordinator for JF) to see if you would shadow a day before starting.

The most worthwhile thing to do before starting would be to look at how to document the review of an ICU patient; i.e via system. There is a good template for the ward round which is well-shared (I prefer Dr Featherstone's template), just ask any of the seniors to share with you on EPIC.

This is an absolutely fantastic block to have as an FY1. You will have the opportunity to see sick patients on a daily basis, learn from terrific doctors and engage in practical procedures that other FY1s may not otherwise get a chance to perform.

If you are feeling hesitant about ICU and want something to read beforehand, brushing up on your basic cardiac, respiratory, hepatic and renal physiology (and biochemistry) would be a great place to start. Other things are interpretation of ECGs, ABGs and CXRs.

3 main areas to the dept: - Beds 1-10 on level 3 (usually for the sickest patients). Beds 3,4,7,8,9 and 10 are side rooms. - Beds 11-15 on level 3. This area is separate from 1-10 and is referred to as 'the pod'. - Beds 16-20 on level 4. This is on the right on entering D4IDA and is referred to as 'the penthouse'. Tends to be an slightly less high dependency area prior to transition to IDA or ward.

There are difficult airway and lines trolleys (red) on both levels. The materials on these trolleys ideally should be for emergency. If you need any extra material in non-urgent setting then it should be in the store room on the right on entering JVFICU. Drugs and blood bottles/ syringes etc. are in the store room slightly further down on the left (opposite the reception desk).

===== The speciality team (e.g. MDT, other hospitals/depts, team structure, consultants/SpRs/CTs/other, etc.) =====Always 2 consultants on the unit + 2 registrars + 2 SHOs + 2 FY1s (weekdays). There will also be 1 registrar on for RRT (rapid response team) +/- an RRT consultant. FY1s don't carry a bleep but occasionally have to carry the SHO bleep if short staffed. This is also a crash bleep. If carrying this then go to all calls apart from neonatal, obstetric and 'part team' emergencies. This can seem scary but there should always be the RRT registrar at the crash call as well. All you really need to do is turn up with the crash backpack (big and red, outside the ICU drs office), and the drug bag (small and green, in the fridge in the ICU store room).

On any day of the week there will be a 'short day SHO' - i.e 08:00 to 17:00 and a 'long day SHO' - i.e 08:00 to ~20:45. The long day SHO will need to handover to the night team with the registrar.

8am-17.00pm mon-thurs, 8am-12.00pm Fri. All weekends and bank holidays are off + 9 additional days of leave which you can choose. Aim to coordinate this so the 2 FY1s aren't off together but doesn't matter too much. Team v. happy for you to do taster weeks study days etc. but make sure you give an emple time and notify Dr Ford (ICU rota co-ordinator) as early as possible.

As an FY2 you are on the SHO rota. Currently this is a 6 week rota; you will be paired with 2 registrars. Each 6 week block includes 5 weekday nights, 2 weekend nights, 1 weekend long days, 1 weekend short days and 1 week on annual leave.

No real variation from day to day - see below.

Teaching Friday Morning 7:30am-08:00am in the seminar room (Optional and not compulsory)

There is protected juniors teaching time after the X-ray meeting Wednesday at around 3ish. Dr Ford will send out a teaching rota alongside a long list of suggested topics to cover (although you're welcome to deviate from this). The session is expected to last around half an hour and be relevant to an aspect of ICU. Registrars to F1s will be included on this timetable and it's a great opportunity to get your teaching sign off for your e-portfolio.

General CUH F1 teaching on Fridays is usually at 12, and F2 teaching on Fridays is usually at 13:00

There is a great multi-disciplinary practice and teamwork on ICU. Between speciality teams, between the doctors of various grades, dieticians, the (really amazing) nurses, the physiotherapists, psychology team, and the microbiologists.

Start 8am with handover in Drs office half way down unit on right. Some jobs will be suggested during this - write them all down as the SHO/ registrar coordinating that day should allocate them after handover. At the end of handover the consultant will run through who needs CXR and PCTs (procalcitonins), and will then d/c RRT from the night. After handover the FY1s always order the portable CXR (on epic + ring 3121) and the PCTs (ring 3781 to add on to morning bloods - no need to order on epic. Please mention 'procalcitonin' rather than 'PCT' as this sometimes can be misunderstood for other test). There may also be additional jobs (death certificates, transfer letters, ordering CTs or USS (lots of these as all liver tx need US day-1 post op - call 1562077 for all ICU US), ringing parent teams etc.

Try to get these jobs done so you can join the WR - not too much of a problem if you're a bit late because of this though as there should always be an SHO +/ registrar on the round anyway.

One consultant takes beds 1-10 and one takes 11-20, although often they will ask one of the senior registrars to take part of the pod or penthouse. The team then splits itself equally between these groups. The consultants often like to type their own notes on the WR while the juniors examine the pt. It's worthwhile logging onto a computer and doing jobs on the WR as well as otherwise you can end up just watching the consultants typing their notes. One of these consultants are “On-Call” for the day and usually go off for a bed meeting in the morning. Usually them and the other consultant will then alternate being On-Call for the rest of the evening and overnight.

The WR usually finishes about 12pm and from there you are essentially waiting for the Xray/ micro meeting which can be scheduled from anytime between 12.30-15.00 (the consultants decide the time on a day to day basis however it is usually at 2pm). Finish up any jobs left and if there's any extra time, which there often is, try to occupy yourself or you'll get bored. Ask if you can learn how to do CVCs/ A lines/ LPs, help in bronchs or intubations/ extubations/ changing traches etc. There are otherwise few basic procedures to do on ICU as generally all bloods apart from peripheral BC are done from lines by the nurses. Alternatively get on with an audit or filling out your eportfolio, or persuade one of the seniors to teach you something.

In the meeting one junior usually 'drives' (brings up the notes + imaging on the projector) and one makes a note for each pt. Volunteer to do this as it keeps you awake. If you're making the notes then make simple changes as you go (e.g. changing abx or ordering bloods). After the meeting run through the notes you've made and make sure everything that can be completed has been.

The afternoon WR then starts around 3ish - the consultants switch bed no's to see the half they didn't see in the morning. If you have jobs to do then there's not much point trying to join the round, but if you don't then ideally stay on the side you saw in the morning.

The day time then leave at 5pm and the 2 doctors on long days stay until 9pm to hand over to the night team. It is important for the 2 long day doctors to split on either side of the ICU so that they are aware of the patients to hand over.

For nights you come on at 20:15 and get a handover from the team doing long days. All patients get a review overnight. Normally you split the patients between yourself and the reg. Sometimes sensible to take a v. quick run round with the reg to identify any sick people/potential problems. Nights give you a bit more autonomy and you see can people by yourself. Generally no massive decisions to be made but it can make you feel clever!

JF ICU sees a broad-range of acutely unwell patients. Common reasons for admission include; pneumonia, acute pulmonary oedema, massive upper GI bleed, decompensated liver disease, post-laparotomy, post-AAA repair, post-cardiac arrest, and post-liver transplant.

You will encounter patients who are often severely unwell and have multiple-organ-failure. It is not uncommon for patients in ICU to have life-sustaining treatment withdrawn and this may be an unfamiliar concept initially - it is good experience to participate and experience the many patient family discussions where they discuss this.

ICU Dr's Office 6429, SHO 1562330, ICU SpR 1560701/157388, Consultant 152 820, Nurse in charge 157 180

Main Bay (beds 1-10) 2963/ 6647, Pod (beds 11-15) 59337, Penthouse (beds 16-20) 6436, ICU fax 01223 216 781, ICU pharmacist 154284/152482/ Ext 3980,2055

X-Rays 3121 , Pathology 3781, Biochem 154489, Virology 57035/57022, Haem 3073, Blood bank 3130 Vascular access 6020, CT SpR 6718, CT coordinator 3219, Neuro CT 2458, Portable US 1562077 MRI 6363 ECHO 3382, Neurophysiology 3136, PACs office 23223

Unbanded but splendid rota - perfect for picking up all the hobbies/ friends you neglected during your surgical rotation. Great team who are very keen for juniors to get a taste of what critical care is all about, and to have a go at as much as you can.

You will get to leave on time most days. When fully staffed during a normal day the job is pretty reasonable. Nights give you a bit more autonomy as you get to review patients by yourself, but they can be very complex and very sick!

Plenty of opportunity for procedures - central lines, arterial lines, pleural/ascitic taps, the odd chest drain + lumbar puncture, as well as picking up on basic ultrasound skills. Its best to get stuck in and show enthusiasm - the registrars are usually equally motivated to get you independent with line insertion in particular.