Intensive Care Notes

This week I have been spending every waking moment in the ICU at my VA. It's probably an understatement to say that I love intensive care. I enjoy working on complex cases and assisting the physician with medication-related issues. Today, I helped formulate a TPN for a critically ill patient. We worked together figuring out how much protein, carbohydrates, and lipids should be fed to her through the central line. So far in the ICU this week, I've seen Stevens-Johnson Syndrome, cocaine-induced vasospasms, chronic liver failure that progressed to multiple organ failure, and Clostridium difficile pseudomembranous colitis which resulted in removal of part of the guy's bowel. I also responded to a code...only the code wasn't really a code. One of the nurses got trigger happy and called the code pager for a syncopal episode. At the time we didn't know that, so the physician and I went running to radiology. I was quite nervous, but ready to help all the same. I'm glad the poor guy wasn't dead. It would've been my first code experience. I'm not sure how I will handle that when it occurs. I get emotional very easily. I like to hope in that situation I could seperate the emotional from the mechanical and just be able to run through the steps. The nurses in ICU are amazing. They like pharmacy, and enjoy our participation in the hectic world of the ICU. Today I assisted the nurse with dressing changes on the Stevens-Johnson patient. I will never forget what that looks like, and will never under-estimate the seriousness of the situation. To put it simply, this patient's skin is sloughing off. Large fluid filled blisters cover her body, and when they pop, her skin peels off. It was difficult for me to see the patient in such serious pain and in such grave condition. Tomorrow brings another day in the ICU, and I'm sure some more neat cases. I'm really looking forward to it.