Saturday, October 13, 2007


I spent my day yesterday in the Surgical ICU, or SICU. Without question, I have to say that I have not seen many sicker people than I saw there. The acuity is very high, without a doubt. The experience is one that I will not forget anytime soon, especially because I'm going to be next door in the Shock-Trauma unit next Saturday.

I was there for 8 hours total, and I got to see a vascular intervention on a 44 year-old female with a history of Peripheral Vascular Disease, among other things. She had nearly total occlusion of the distal branch of her femoral artery, and she'd been there the night before in an attempt to get it dislodged. Someone dropped the ball, however, in that her PTT (Partial Thrombin Time) was at 120 seconds, well above the therapeutic range of Heparin, so her drip was shut down and the test was never re-done. Overnight, she re-occluded and had to go back to the lab for another intervention. When the Interventional Radiologist saw what had happened with her Heparin, he was extremely unhappy and he ordered it (as well as the tPA that she was also supposed to be getting) restarted. They placed a new stent into the area of the occlusion and were able to partially remove it, but she still didn't have good circulation below her knee at the end of the procedure. So I don't know what will happen next with her.

I also got to observe placement of arterial lines on two patients with different issues going on. I don't remember what their diagnoses were specifically, but they were pretty sick people. But later in the afternoon, at around 2:30, a young female patient, approximately in her mid-20's, was brought down from the floor. She had a history of a small bowel obstruction as well as a pleural effusion. She had a chest tube in on the left as well as a central line and numerous peripheral lines, and she also had an in-dwelling Foley catheter that had heavily concentrated urine in the catch container. She was in considerable respiratory distress, breathing at a rate of anywhere between 36 and 50, and even though her oxygen saturation level was acceptable, the who issue with the labor of breathing would catch up to her at some point and she'd likely go into respiratory arrest. So she was put down and intubated. A second chest tube was placed, and an arterial line was placed for monitoring purposes.

On that patient I actually got to be more than a mere observer; I assisted the intern who was doing the intubation with tube placement. It was pretty cool - the chief resident was there as well, and I'm not sure he expected me to do anything, but I think he appreciated my actions. I know the intern did.

Tonight (5:00PM to Midnight) I will be in the Pediatric ICU. I expect that to be a different experience. Personally, it is an issue I need to deal with; I have a hard time with kids who are patients. Not that I don't know how to treat them or anything like that, but emotionally they can be harder. So this is a step I need to take to resolve that. I'll talk about that tomorrow.

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