Morning guys. I'm Siobhan, a 3rd year medical resident. Right now
I'm heading to the hospital to start a 26-hour call shift in the ICU.
So we're going to be dealing with the most critically ill patients in the hospital and I'm gonna be telling you all about it.
Each morning in the ICU
we meet in the conference room and then meet with the doctor who was on call to find out what happened overnight.
Then we gather as a team to see each patient together.
We stand with our portable computers and desks, discussing every aspect of patient care.
Today our team includes the bedside nurse, pharmacist,
dietician, respiratory therapist, 4 residents and the attending physician.
These are the sickest patients in the hospital.
Often they're hooked up to life support with breathing tubes, which is why we spend so much time with each patient. These discussions on rounds are
fascinating, but to be honest it takes a long time and it could become pretty exhausting and even a little bit painful standing for so
many hours. Okay, so it's 2 p.m. and we just
finished rounds.
Like this was seeing 14 patients over like 5 hours.
We're all exhausted. I'm so hungry. I really wish I'd eaten breakfast this morning, so now I definitely need to get lunch. I'm starving!
Okay, so the rest of the afternoon has been pretty relaxed actually.
We had some teaching, we went over some new big trials that have come out in the IC literature,
we finished up our notes, chatted as a team. So nothing major.
But now it's 8 o'clock
and guess what?! We go on rounds again.
Which means that we're gonna go walk around, see all the patients again and see what's happened throughout the day. Have there been any changes?
These are some of the sickest patients in the entire hospital, so things change quickly. Which is why we actually
see patients frequently, many times per day.
Evening rounds are a lot faster.
We're mostly following up on tests that have been done during the day, ordering
bloodwork for the morning and then trying to anticipate any issues that might arise over night and trying to deal with them early.
Now we're done with that, so it's time to find the ICU call room.
And we've got anything that we might need: a fan,
computer,
flashlights for emergencies, Saudi Journal of Medicine
2017 very up-to-date and
of course the bed, which I really hope gets used tonight.
Hey, this is Siobhan from ICU returning a page.
Hi Mary. And how much oxygen right now?
I'll come up and meet you. We will see the patient together and then figure out what to do.
So I was just paged by one of the CCRT nurses, that's the critical care response team.
So these are very highly trained ICU nurses who respond to patients who are sick up on the ward. And the
idea is that they can identify who probably needs to come down to the ICU early, so that they can get the care quickly
and then hopefully getting better.
So I've been called because there's a patient who is very hypoxic, meaning they're not getting enough oxygen.
I'm going up to see them right now in the ICU. I'm always worried if
someone isn't getting good oxygen in, do we need to put a tube down their throat? Do we need to intubate them?
We're gonna find out.
Walking into the room I can see the patient is receiving high flow oxygen and she's clearly feeling short of breath.
Her heart rate is a bit elevated at 120 beats per minute, but luckily her blood pressure is normal.
I'm ordering a stat chest x-ray and blood work now. I'm also gonna see if one of the nurses can put in another IV,
so that we can easily give medications today. So this patient is really not doing well.
They're on 100% oxygen, so we can't give any extra oxygen. She's using all of it at this point and
the x-ray looks like there's a collapsed lung, so you can imagine she's not even able to get very much air in.
So at this point we definitely need to bring her down to the ICU and I'm gonna call my staff physician at home as well
as the ICU fellow on call to be able to consider the next options, which may be something called bronchoscopy.
So actually taking a camera, going down into the lungs... Not me, like that is not something that I'm
qualified to do, but I will watch tentatively and then trying to figure out what's blocking
that lung. By the time the patient was transferred down to the ICU, the staff intensivist had already come in from home.
We prepared some of the sedating medications for the procedure and then got started with the bronchoscopy.
So putting the camera into the trachea and then down into the lungs we were able to see that there was a lot of thick,
white mucus and that had plugged up her lung. So we were able to suction it back and then help her breathe a lot better.
This is likely related to infection, probably a pneumonia. So we're starting up antibiotics and then watching her really closely overnight.
It's so funny in medicine people always say: ''Oh, is the patient sick?'' And you think: ''Uh, they are in the hospital. Aren't all patients sick?''
But this idea... There's this idea of like sick or not sick that you kind of develop in medical school
that is so incredibly important and I mean, I'm sure I'm still figuring...
Page. Okay, let's do this. Hi, this is Siobhan from ICU returning a page.
Oh yeah, I did hear he was coming. I just didn't know what time the OR was gonna finish.
Great.
Yeah, I'll be right there.
Okay.
So this is the patient who's just coming out of the operating room and they need to come to the ICU
here to be monitored overnight.
So the
anesthesiologists and the surgeons should be just rolling in now with the patient,
so I'll meet them at the room and be able to get all the details from the surgery.
I'm greeted by the general surgeon who explained that they repaired a bowel perforation in the operating room.
The OR apparently went smoothly and there was really minimal blood loss.
I then chat with the
anesthesiologist, who warns me that the patient has a difficult airway.
Meaning it's really difficult to intubate them because of his anatomy.
So that's definitely something that I'm going to be passing on to the morning team.
For now I'm gonna continue his IV fluids, antibiotics,
give him some pain medications and then overnight we'll be watching for any bleeding and make sure that his urine output is good.
Don't think I realize how incredibly thirsty I am until I actually started drinking water on call. My kidneys will thank me.
Oh my gosh, I'm actually so tired at this point and I'm so convinced that the pager is gonna go off.
I'm like dreading it.
So... Okay, positive thoughts. I'm gonna try and get a little sleep and hopefully I won't be seeing you guys until the morning.
Okay.
So I just got paged about a patient who's in the
emergency department who apparently needs to come to the ICU.
Sounds like they're in septic shock right now,
which is really dangerous. So do I see them right now?
This patient came to the emergency department feeling generally weak. The emerge doctors found
his blood pressure was dangerously low, yet a high white blood cell count and a fever.
So first thing is to try giving IV fluids to bring up that blood pressure
and the emergency physicians did that. They gave him almost 3 liters of IV fluids, but his blood pressure is still low.
That's why they called the ICU. So at this point we're going to start a new medication called Levophed.
Which will help to bring up his blood pressure by causing constriction of the blood vessels.
It's now 7:30.
So I'm gonna get up and look at morning blood work before the team gets here, print out some lists.
But when my alarm went off I had no idea where I was. So much more different than having the pager going off.
I was so confused.
It feels so good to be home.
Can't wait to get into my pajamas, curl up in bed, sleep for as long as I can without an alarm and no pager.
Anyway, if you guys find that the ICU is exciting or you have more questions about it,
I actually have a whole playlist for the past 2 years when I've done ICU rotation.
So take a look at that and then leave comments. I'd love to hear from you guys and
otherwise, I'll be chatting with you in the next video. So bye for now!