Critical care!

Posted by Michelle at Friday, October 05, 2012

Salvete Omnes! A somewhat belated update from Rotation 3 here. (Rotation 4 is done today? Egads, *tempus fugit*!)

I greatly anticipated my third rotation with Dr. Denise Pratt at Sparrow Health System in Lansing since it was A) my first clinical and B) critical care! Needless to say, it did not disappoint.

I’ll provide a snapshot of my typical day in critical care. I arrived by 7 AM to work up my ICU patients. This meant identifying the patients assigned to my rounding team, reviewing their diagnoses, labs, drug therapy, and progress notes, and most importantly, making recommendations based on the above.  While this often required the assistance of large amounts of coffee, I absolutely loved having the ability to make global assessments of my patients. I had to evaluate everything from the mundane (stress ulcer prophylaxis) to the obscure (are my patient’s symptoms the result of a rare medication adverse reaction?)

After work up, rounds began at approximately 10 AM and lasted until *the acceptable time*. For some attending physicians, this meant 11:30 AM, whereas for others it meant 6:30 PM. I would make my therapy recommendations at this time, and also field any pharmacy-related queries from the medical team. Some of these questions I could answer from my topic reviews or by becoming fast friends with the drug info app on my phone. Others were more involved and required me to do things like call the lab to find out which stimulants are most easily detected on our drug tox screen.

Post-rounds, I would review my patients with Dr. Pratt. Some days we would have topic discussion about common diagnoses and therapies seen in the ICU: sepsis, pneumonia, COPD, CHF, acid-base disorders, sedation, analgesia, vasopressors, basic mechanical ventilation principles, diabetic ketoacidosis, stress ulcer prophylaxis, DVT prophylaxis etc. The range of medical problems seen in our patients was incredible: drug overdose, status epilepticus, serious adverse drug events, liver failure, encephalopathy.

Other duties of critical care rotation included journal club, a patient case presentation, and filling out multiple FDA MedWatch reports. If you are a student interested in tons of patient interaction, critical care may not be for you, as most of the patients are extremely ill and may be sedated or on mechanical ventilation. If, however, you are a student who loves to couple your extensive knowledge about complicated disease states with critical thinking skills to make great contributions in improving the care of your patients, then critical care is for you! :)

I loved this rotation. I think that came across in this blog.  :) The clinicians and pharmacists I worked with were excellent. But what was the absolute best part of this rotation, you ask? I discovered a major drug interaction in a patient, and the Chief of Staff called me a hero. **SO PROUD TO REPRESENT UMICH PHARMACY!** ‘Til next time, folks.