Medical Versus Surgical Critical Care

When I was a medical student, I was surprised to find that a pulmonologist may be in charge of surgical critical care patients or an emergency physician trained in ICU could run a medical unit. But after this year of training, it makes sense. The issues that come up in critically ill patients are very similar regardless of whether a patient is "medical" or "surgical." A patient may have respiratory failure due to multiple rib fractures or a transfusion reaction or multifocal pneumonia or widespread infection, but a good intensive care physician should be able to support them regardless of the exact cause. The treatment of organ failure simplifies down to a knowledge of physiology and pathophysiology. Our training crosses disciplines because the issues that threaten critical organ systems don't care whether the patient is post-operative or succumbing to cancer or pregnant or a victim of trauma. The issues we focus on in the intensive care unit are in some ways universal.

Although the case mix differs between a medical unit and a surgical unit, the problems are largely the same: altered mental status, respiratory failure, hemodynamic instability, renal failure, fulminant liver failure, infection. For surgical patients, I need to recognize when someone needs to go to the operating room, but I don't need to be a surgeon to understand that. I have a superficial but adequate grasp of specific operations, and being an anesthesiologist helps a lot. Translating my skills and knowledge from the medical ICU to the surgical ICU ends up being quite easy. Over the last year, I have learned to care for a sick patient regardless of the cause and even in circumstances where we don't know what the cause of their illness is. I understand now why intensive care physicians of any background can care for patients in a mixed medical and surgical care unit.