Wednesday, July 21, 2010

The ICU

I've had two days in the ICU now. Mostly it's been pretty fun. I really like that it keeps me way busier than wards ever did. Even with only 2 ventilated patients we have been quite busy just keeping up with routine things. I love art-lines, so much easier to do blood gases. Ventilators are my favorite, and it's been nice to see patient data and be able to make the changes necessary to the vent - in real time, right there. So different from school where everything is hypothetical. We extubated someone on my second day and she was still doing great when I left. I went to a bronch, which was a total schmoz and the dr was kind of an ass. I've met the doc before but she had a student today and was trying to impress her I think. Also, she was totally wearing a belly shirt - we talked for the rest of the day about weather she was pregnant or not (food or fetus?)

We received a patient who has ALS, and is ventilated. Since being paralyzed and ventilated he has gone on to add 2 children to his family of 6. WTF. Why would you have kids you can't raise? Unless his wife wanted them? I still think it is insane, but I can't pretend to imagine what it is like to be in his situation, I will now pretend to reserve judgement.

Finally allow me to complain about the difference between the school (imaginary land) and the hospital (real life).
Cleanliness. Carefulness.

Example 1. I had multiple competencies while in school. One was based around open suctioning technique. We were required to be entirely sterile and if we accidentally hit the tip of the trach with the catheter and did not notice (see how subjective this is on the part of the adjudicator) we failed. This was just one of the possible ways we could fail. The other day I watched an LPN in normal gloves repeatedly ram a sxn catheter down the trach of one of my patients. It was clear there was some sort of obstacle in her path. The tip of the catheter was now bloody. She turns to me and asks, did you plug this trach? Yes you idiot, I plugged it from the inside. Anyway, there was a fenestrated inner cannula in and she kept jamming the catheter through the fenestration and into the tissue behind it. Awesome.

Example 2. Another competency involves putting in an art line. Again, we are to be entirely sterile. If you accidentally bump anything you fail. Seriously. (Except that I did accidentally bump anything and still pass - mostly because this teacher and I had already gotten into an argument because he is an ignorant homophobe... So I really actually think that is why he passed me and my partner). My preceptor was asked to insert an artline into a patient (a patient that was health maintenance only - no intubations, no CPR - so I'm not sure why she needed an artline). We got the bucket of supplies ready and headed into the room. My preceptor put on a gown, and I put on gloves. Yes that was the extent of the protective gear. One gown, one set of gloves. And then we did a mildly invasive procedure.

Why do we waste so much time being stressed out about these things in school, when NO ONE cares in the hospital. I know, I know - best practice.

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