ICU

I have just completed my ICU rotation and it was a different world altogether! I could write pages about inotropes and vasopressors or the different agents for sedation. I gained a wealth of knowledge and experience in this rotation including interpreting ABGs, including detecting superimposed metabolic acidosis,’ the different mechanisms of shock, cardiogenic, distributive and hypovolemic and assessment of pain and delirium in a critically ill population.

Something else happened that I will not likely forget anytime soon. This is not insignificant considering the fluctuating and dynamic environment of the ICU.

My oral exam was scheduled during this rotation and so, as you can imagine, my mind was also focused on completing a full patient work-up in 2 hours in order to successfully complete my exam and meet this CHPRB standard. Time management and prioritization has been one of my primary goals throughout this year. The residency program and my exceptional preceptors have been reinforcing this and providing me the opportunity to gain the necessary skills and training to meet the challenges.

Back to the point, a patient whose care I had become involved in had extensive coronary disease and renal failure among many things but was smiling while I reviewed his home medications and held my hand with a strong grip before I left. I needed to leave briefly for a Leadership and Management session and could not find the chart to order his home eye drops.

Two hours later, I ran up the stairs to grab the chart before heading home to do some reading. Again the chart was not by the bed. The intensivists was documenting as the patient passed. I acted professionally but my shock was tangible as he was still in his room.

I completely understand the necessity to provide excellent pharmaceutical care in an efficient, step wise approach. This was however, a crystalizing moment for me. I had only been out of ICU 2 hours. The eye drops would not have prevented ventricular fibrillation, he was critically ill and there was nothing that could have been done in this case. However, time is finite and suddenly refining my process for the sake of an exam seemed somewhat trivial. It had to be for the patients. The exam was simply a demonstration of this ability and the process to ensure completeness and competency.

With the rotation and exam complete!

Journal Club – ICU

Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients with Agitated Delirium (DahLIa): A Randomized Clinical Trial.                           (Reade MC, et al. JAMA. 2016;315(14):1460-1468.)

dexmedetomidine-journal-club

Adult ICU Rotation Goals and Objectives

Beginning my adult ICU rotation, I have outlined the following goals and objectives that I have identified for the next 4 weeks:
1) Goal: Demonstrate necessary skill to provide direct patient care
Objectives:
a) Consistently, identify, justify and prioritize patient-
specific drug therapy problems.
b) Complete patient work up in 2 hrs including interview and
resolution of top DTP.
c) Increase efficiency of care through increasing patient care
number.
These are quite fundamental and areas where I will continue to strive to improve to increase my proficiency in providing effective, timely and safe patient care and recommendations.
Specific to ICU, my learning objectives are to:
1) Understand the different types of shock and various shock treatments depending on etiology.
2) Improve ability in interpreting ABGs.
3) Electrolyte replacement, including magnesium and phosphate, to achieve normal
electrolyte balances.