Sunday, February 20, 2011

Resistant H1N1?

Posted by Jody at Sunday, February 20, 2011

I am currently in the SICU (surgical intensive care unit) at the University of Michian Health System with Dr. Pleva.

In the SICU there is never a dull day. There is always something going on, a new critical patient, ECMO or dialysis being started or someone coding. My rotation was in January which meant the flu season was well underway. The third week of rotation there were 5 patients with H1N1 in the unit and by the fourth week, one patient with resistant H1N1. The attending contacted the CDC to receive zanamivir (IV form of Tamiflu), which was still undergoing drug trials.

The unit consists of 20 patients and since I was on rotation with another student from my class, the unit was split down the middle. I was responsible for 10 patients. Needless to say, I was pretty overwhelmed. Last year I took the critical care elective, but I took it pass/fail so it wasn’t high priority on my list. Starting this rotation I felt very under-prepared.

Rounds started at 8:30am and I met with Dr. Pleva before rounds to discuss my patients and any recommendations, so it was necessary to work up patient in the morning before rounds.

What did I focus on when working-up patients? Most patients on the unit had poor renal function. I looked at all medications and determined with they were dosed appropriately. Next, I looked at antibiotics. I assessed what antibiotic regimens the patient was on – is the regimen appropriate, accurate dosing, any cultures/sensitivities, etc. Every day I had recommendations for the medical team. I never felt more involved in patient care.

Other requirements/activities on rotation….

There were topic discussions and journal club, typical of any inpatient rotation, as well as a final presentation at the end of rotation. Dr. Pleva also discussed ICU nutrition and explained how to write TPN orders for patients. I really enjoyed this aspect of the rotation and by the end of the month I was able to accurately write TPN orders.

Bottom line: Rotation in the SICU with Dr. Pleva taught me how to think like a clinical pharmacist. I needed to incorporate patient characteristics and the entire clinical picture in order to determine the appropriate dose for the patient. In the SICU, the majority of patients are obese with renal insufficiency in which Micromedex isn’t sufficient. When you have a patient 500lbs and on dialysis, clinical judgment must be used.

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