Wednesday, November 28, 2012

"New patient resus charlie"

Posted by mariarx at Wednesday, November 28, 2012

Rotation 5 is in the bag! Hard to believe we have now crossed over the halfway point. For 5 weeks, I was in the emergency department pharmacy with Dr. Pam Walker (no relation to Dr. Paul Walker) and her amazing ED team at UMHS. The ED pharmacist has a unique role in that they are staffing the ED satellite by themselves (checking orders, making all the IVs, answering questions) as well as responding and working first line with all traumas/codes that come through the resuscitation bays. By the end of the rotation I was confident in my ability to jump in and do (mostly) all of their tasks, with supervision of course.

To paint a picture for all the readers - the adult ED is MASSIVE. 90+ beds split into 5 areas, and 3 trauma bays for critical patients, plus a psych wing. ED satellite pharmacy? Approximately 1.5 times bigger than my closet. Super tiny. The skills these pharmacists are not lacking are efficiency, space management, and time management.

The rotation started out with me working in the satellite, observing the workflow and getting comfortable being in that setting. The ED is definitely different than being on the floors - always lots of movement and energy. On the first day I got to respond to a trauma code in a resus bay. Pam and I helped the team with a patient that needed to be intubated. The first thing Pam does - leave me alone with the RSI (rapid sequence intubation) box while she runs back to grab etomidate from the satellite. Drawing up a neuromuscular blocker on the fly via shouted out directions was the moment I knew that I had to be on my feet and ready to go for the remainder of my time down there. I LOVED it. Over the course of the rotation I got familiar with antibiotic dosing, checking orders, how to use EPIC and Carelink and Worx simultaneously, and all that is needed in running a satellite by yourself. I also volunteered myself for 2 midnight shifts during the rotation to get a feel for the types of patients that are coming into the ED at 3am versus 3pm. It was not as difficult as I anticipated to be up all night. The 2 red bulls and bowl of candy helped as well. :)

Throughout the rotation I definitely got more comfortable with resus patients, and building up the ED pharmacist mindset of "what will they need next? What is the worst case scenario for this patient and what drugs will they need?" Those are key skills for an ED pharmacist, along with on-the-fly dosing, estimating a patients weight and height for said on-the-fly dosing, and the order to give them in (etomidate BEFORE neuromuscular blocker).  I practiced this by looking at patients who were "expected to arrive" to the ED, looking at the 1 sentence blurb that usually accompanied them, and coming up with a (fake) plan.

Projects for the rotation included topic discussions a few times a week, both one on one with Pam, joining the Cardiac ICU students for their critical care discussions, and leading the topic discussion about ACLS for the ICU P4s. I also worked on automated dispensing machine optimization for the multiple omnicells throughout the ED. Looking for administrative type projects seems to be my M.O. for P4 year.

In the end I really enjoyed the ED pharmacy rotation and would highly recommend it to any future P4s.  A++ would rotate again! For rotation 6, I'm at Meijer pharmacy for my community rotation. If you shop in Ypsilanti come on by and say hello! 

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