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15 April 2012

ICU- And now I don't

I have to say that my attention span is a little longer than the average ED doc. But it is a lot shorter than an ICU Critical Care doc.  I found my one week in ICU to be fairly boring as a student (I am not dissing the work or the unit's usefulness one bit). The patients tend to be comatose or close to it, so we can practice Glasgow Coma Scale reporting (Did you know you can be dead for days and still score 3?)  In addition, just about everyone has a endotracheal tube in their throat, so getting a history is pretty much impossible, even if they were awake.  I got a lady to squeeze my fingers when I asked her to, and I'll call that a win.  And that about sums up how much physical exam you can do on an ICU patient as a student.  I will say that every doctor and nurse and physio and pharmacist in the ward can recite their patients' story forwards and backwards. They know all these things because of how precarious the situation has become by the time you land in ICU, and often based on multi, Multi, MULTI factorial causes. They can keep it all straight, and have contingency plans with backups for every possible complication that could arise.  This is probably the most useful thing about being exposed to Critical Care- when discussing treatment we are always asked "what do you do if X fails?"

The first exposure I had to the ICU setting was when my cousin, Dwayne, was a patient after surgery for renal cancer. You can read his story HERE. He died a few days after admission to ICU- but was very compassionately and professionally cared for by the staff there.  I have also visited ICU as a student following burn patients. Now that I better understand the processes they were following, I have even greater admiration for the work the folks in ICU do.

In order to handle the slowness of the unit, I began to play a little game: How many tubes and wires can be attached to one person?  The week's winner was a transplant recipient at 32!  This included an indwelling bowel catheter AKA "poop chute" (they aren't going to take the poor guy to the bathroom, and bedpans only work if you can warn someone it's coming), urinary catheter, ventilation tubes down the throat, Nasogastric tube to get some much needed calories in,  Extra Corporeal Membrane Oxygenation (bypass machine), kidney dialysis, ECG (x12 leads), multiple chest drains, surgical wound drains and vascular access in a number of places.  The "loser" was on her way to improvement enough to move to a regular medical ward and had only 19.  And this one of the reasons that a stay in ICU is approximately $2000.00 per day. 

In OTHER NEWS, Rob has taken off from Oz's sunny shores for a visit back to Canada (and it was snowing when he arrived- he was very pleased).  Aside from forgetting to pack underwear, his flight was uneventful. I am a little jealous.

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