Junior Resident

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Junior Resident – Intensive Care Unit (ICU)

1. Position Details

- Job Title: Junior Resident – Intensive Care Unit

- Department: Critical Care Medicine / Intensive Care Unit

- Designation Level: Junior Doctor / Medical Officer – ICU

- Employment Type: Full-time

- Duty Pattern: Rotational shifts, including day shifts, night duties, weekends, and public holidays

- Reporting To: ICU Consultant / Intensivist / Senior Resident / Head of Department

- Functional Coordination With: Nursing Superintendent, ICU Nursing Team, Respiratory Therapist, Emergency Department, Laboratory, Radiology, Pharmacy, Infection Control Team, and other clinical departments

- Work Location: Adult ICU / Medical ICU / Surgical ICU / Multidisciplinary ICU, as assigned

2. Job Purpose

The Junior Resident is responsible for assisting in the comprehensive medical management of critically ill patients admitted to the Intensive Care Unit. The role involves initial patient assessment, continuous clinical monitoring, implementation of treatment plans under supervision, early identification of clinical deterioration, participation in emergency resuscitation, assistance with ICU procedures, and maintenance of accurate medical records.

The Junior Resident must ensure that patients receive timely, safe, ethical, and evidence-based care while adhering to hospital policies, standard operating procedures (SOPs), clinical protocols, and applicable professional regulations.

The resident is expected to work collaboratively with the ICU consultant and multidisciplinary healthcare team to improve patient outcomes, minimize preventable complications, and maintain continuity of care throughout the patient's ICU stay.

3. Detailed Roles and Responsibilities

A. Patient Assessment and Admission

- Receive patients admitted to the ICU from the Emergency Department, wards, operation theatres, recovery areas, or other hospitals.

- Obtain a detailed clinical history, including presenting complaints, history of present illness, relevant past medical and surgical history, drug history, allergies, and associated comorbidities.

- Perform a systematic clinical examination, including:

General condition and level of consciousness.

- Airway patency and respiratory assessment.

- Cardiovascular examination and peripheral perfusion.

- Neurological status, including Glasgow Coma Scale where appropriate.

- Abdominal examination and other system-specific assessments.

- Skin condition, pressure injury risk, and relevant lines or devices.

- Record baseline vital parameters, including heart rate, blood pressure, respiratory rate, temperature, oxygen saturation, and other parameters indicated by the patient's condition.

- Review available referral notes, previous investigations, medication charts, and treatment received before ICU admission.

- Assist the ICU consultant in assessing the need for invasive monitoring, ventilatory support, vasopressor therapy, or other organ support.

- Ensure timely entry of admission notes, provisional diagnosis, initial assessment, and the treatment plan approved by the responsible clinician.

- Identify immediate life-threatening conditions and initiate emergency measures within competence and hospital protocols while urgently informing the senior doctor.

- Verify patient identity, allergy status, medication history, and relevant consent documentation.

- Ensure structured handover from the referring team, including the patient's condition, ongoing infusions, airway status, pending investigations, and outstanding clinical concerns.

B. Daily Patient Monitoring and Clinical Management

- Conduct regular bedside assessments according to patient acuity and ICU protocols.

- Review vital signs, oxygen requirements, neurological status, urine output, fluid balance, and other relevant clinical parameters.

- Assess trends in laboratory results, arterial blood gases, ECG findings, radiological reports, and microbiology results.

- Identify abnormal findings and communicate significant changes promptly to the ICU consultant or designated senior doctor.

- Follow up on investigations and ensure that clinically significant results are brought to the attention of the treating team without delay.

- Implement prescribed treatment plans and monitor the patient's response.

- Review fluid intake, output, and cumulative fluid balance, particularly in patients with shock, renal impairment, or respiratory failure.

- Monitor blood glucose, electrolyte levels, renal function, and other parameters as clinically indicated.

- Assist in daily review of medication indications, dosing, allergies, potential adverse effects, and renal or hepatic dose adjustments.

- Participate in multidisciplinary rounds and communicate unresolved issues, pending reports, and changes in clinical status.

- Reassess patients after significant interventions, changes in treatment, or episodes of deterioration.

- Maintain continuity of care by ensuring that important clinical instructions are documented and communicated during shift changes.

C. Emergency Management and Resuscitation

- Respond promptly to ICU emergencies, including cardiac arrest, respiratory arrest, severe hypotension, acute desaturation, altered sensorium, and sudden clinical deterioration.

- Initiate immediate assessment and emergency support within training and competence while activating the hospital emergency response system where indicated.

- Participate in cardiopulmonary resuscitation (CPR) and advanced life support according to current protocols and the assigned role.

- Assist with airway stabilization, oxygen delivery, bag-mask ventilation, and preparation for advanced airway management.

- Assist in the evaluation and initial management of shock, sepsis, anaphylaxis, major bleeding, and acute respiratory failure.

- Recognize life-threatening arrhythmias and promptly alert the responsible senior doctor.

- Prepare emergency medications, resuscitation equipment, defibrillator, airway equipment, and vascular access supplies as required.

- Document the time of onset, clinical observations, interventions, medications, response to treatment, and relevant communication during emergencies.

- Escalate immediately when the patient's condition exceeds the resident's experience, available resources, or authorized scope of practice.

- Participate in post-resuscitation stabilization and documentation under the direction of the treating team.

D. Respiratory Support and Ventilator Management

- Assess respiratory distress, work of breathing, oxygen saturation, respiratory rate, and signs of respiratory fatigue.

- Monitor patients receiving supplemental oxygen, high-flow oxygen, non-invasive ventilation, or invasive mechanical ventilation.

- Check prescribed ventilator settings and observe parameters such as oxygen concentration, respiratory rate, tidal volume, airway pressures, and patient-ventilator synchrony, as applicable.

- Review arterial blood gas results and communicate significant abnormalities to the ICU consultant.

- Assist with ventilator initiation, adjustment, and troubleshooting only under appropriate supervision and according to approved protocols.

- Recognize potential ventilator complications, including acute desaturation, high airway pressures, accidental extubation, circuit disconnection, and suspected ventilator-associated complications.

- Check endotracheal tube security and documented tube position; report any concern regarding displacement or obstruction immediately.

- Assist with airway suctioning, humidification, oral care, and secretion management in coordination with trained nursing and respiratory therapy personnel.

- Monitor tolerance of non-invasive ventilation and promptly escalate worsening respiratory distress, impaired consciousness, or hemodynamic instability.

- Participate in assessment for readiness to reduce respiratory support and extubation, with decisions made by the responsible clinician.

- Support implementation of ventilator-associated pneumonia prevention measures according to hospital policy.

- Ensure that respiratory support settings, relevant observations, and changes are appropriately documented.

E. Hemodynamic Monitoring and Shock Management

- Monitor blood pressure, heart rate, peripheral perfusion, capillary refill, mental status, urine output, and other indicators of tissue perfusion.

- Observe patients receiving vasopressors, inotropes, and other high-alert medications.

- Ensure prescribed infusion rates, pump settings, vascular access, and monitoring arrangements are checked according to hospital policy.

- Review laboratory findings relevant to perfusion and organ function, including lactate where indicated.

- Recognize worsening shock, persistent hypotension, arrhythmias, and suspected infusion-related complications.

- Assist the senior clinician in the assessment and management of septic, cardiogenic, hypovolemic, and other