Monday, November 29, 2010

Caring for the Critically Ill

Posted by BJ Opong at Monday, November 29, 2010

I spent the month of November at Sinai Grace Hospital a place that I am very familiar with. I also intern at Sinai so I was very familiar with the surroundings and the staff, which made the month all the more enjoyable. My time at Sinai would be spent in the ICU’s dealing with critically ill patients. From the beginning I was told that to work in the ICU you have to look at it a lot differently than the general hospital population.

First, I had to realize that these were the sickest of the sick within the hospital and some of my patients were not going to make it. Secondly, I learned the goal of the ICU, which is to get the patient out of the ICU as fast as possible, the longer a patient remains in the ICU mortality increases. This differs from general hospital practice because you are to treat the patient’s main complaint or admitting problem. In the ICU the common admitting cause was shock secondary to pulmonary edema from pneumonia. This would develop while in the hospital or sometimes present to the ED with. More than any other problem pneumonia was most commonly seen in ICU patients. Pneumonia is so common in the ICU that any patient who presents with a spike in temperature or WBC and shows some sign of infiltrates on the CXR are treated empirically until sputum cultures return.

The ICU pharmacist we worked with throughout the month was also on the CODE team. His responsibility was to be present when a code blue (adult emergency) is called, and administer medications from the crash cart. The pharmacist would deliver the recommended doses of Epinephrine or Atropine as needed. During our first week we were fortunate to be present for a code blue. The room was filled with over 12 people of various medical disciplines trying to resuscitate the patient. Over 40 minutes later the patient unfortunately expired. It was a very gripping first experience at a code that I learned a lot from and will never forget.

By and large this has been my most enjoyable rotation to date. I think I enjoyed the ICU because of the fast pace that the teams work, and in part to the style of critical thinking that goes into determining the treatment plan for some very dangerous and rare conditions. While I was in the ICU I was able to learn about a lot of different and new treatment modalities. I would recommend that anyone who enjoys the fast paced work environment spend time in the ICU.

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