Thursday, January 8, 2015

Saturday December 27, 2014

Today was my second 24 hour call day.  This time, it was on a weekend, which meant that I would need to round and write notes on all the patients in the wards, Nursery, NICU, PICU.

Tangra was taking care of a very sick kid in the ICU who started out as a fever of unknown origin, which then progressed to decompensation, respiratory failure, upper and lower GI bleed, DIC - presumed to be from a serious infection.  He was intubated after coding.  Tangra had been on the telemedicine site with doctors from the Tripler Army base in Hawaii discussing his case. 

Without going into great detail about his case, there had been several setbacks - including the hospital running out of his sedation medications and the patient waking up.  It was also discovered that the hospital's CT scanner, which was rumored to be "broken", was actually still sitting in a shipment container in the harbor - where it had been for several weeks due to ?the holidays (nobody seemed to really know).  This case is a good example of how much the hospital needs resources - both in trained nursing and physician staff, and equipment.  It is crazy to think that this actually happens on US soil.

Throughout the week, the patient improved on the vent and then was extubated.  His respiratory status was tenuous, but stable.

Anyway, my call that day was again very interesting.  I ended up sitting in the ICU almost all night watching the patient and adjusting medications, monitoring machine settings... something WAY outside of my comfort zone (since we had literally one month of MICU in residency, and most of the actual management of those patient are not done by residents, but by critical care attendings).  I took for granted the excellent nursing staff we have at HCMC - namely that you can trust them to call you when a patient's vitals change, or even trust them to correctly use lines, administer medications, etc.  While I don't blame the nurses here (they are wonderful people, but  way overworked and the acuity of the patient population is ridiculous), it seems that you have to explicitly double and triple check everything that goes on in the ICU.

I was also called away to the ER for admissions and consults.  There was also a couple of C-sections that Dr. Marrone ended up coming in to help on.

Throughout the night, the ICU patient's respiratory status and cardiac status remained stable... until about 6am, when he became tachypneic and started desatting... long story short, he ended up getting reintubated, which made me feel absolutely terrible (though, after talking to Tangra and Dr. Marrone,  I don't think I made any gross errors in his management... I definitely am not cut out to be an intensivist!).  Thankfully, both Dr. Marrone and Dr. Shushunov were in the hospital at the time and took over care of the patient.

All in all, it was an exhausting call, though an amazing learning experience.

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