Last week I did 4 night shifts on ICU. It was definitely worth doing as ICU seems to be a place where a lot of things happen at night. Having said that the first night on was pretty quiet and nothing particularly exciting happened while I was there. I left around 1am and apparently a few minutes after I left someone on the ward was recognised to have a pneumothorax and so a chest drain was inserted.
The next night was really useful for me - one of the registrars was putting in a central line and an arterial line and asked me if I wanted to have a go at the art line. He talked me through it step by step and then I put in the art line which I was pleased about - it was made much easier by the fat the patient was unconscious during the procedure. It was good to have a go at finding the radial artery and feeding a guide wire through. Then the registrar showed me how to suture it in as well which is a skill that has eluded me up till now! Other than that there was a 30 yr old lung transplant patient who had been admitted for respiratory failure who went into SVT at about 170bpm. She was given IV adenosine which casued the AV block showing underlying p waves so she was in sinus tachycardia. She was then given esmolol which is a very short acting Beta Blocker to slow the rate while listening carefully to her chest incase she had a wheeze. Her chest was clear so she was then given metoprolol to slow her rate down which was successful.
On the third night, there were 2 fairly urgent intuibations carried out in quick succession. The first one was for a was a guy in cardiothoracic ICU who had been admitted post mitral valve replacement. While seeing him on the ward round he had increasing confusion, dropping oxygen sats and his CXR showed extensive consolidation on his left lower zone - so had worsening pneumonia. He was intubated and put on mechanical ventilation to stabilise him. I got to put on the cricoid pressure as he was intubated - this compresses the oespohegus which helps to prevent reflux up the oesophegus that can lead to aspiration. It was good to get involved with the procedure which was succesful. Then the second case was a guy with a weeks history of diorrhea, fevers, rigors who devoloped a cough. On his CXR there was complete white out of his left lung indicating a severe pneumonia. His blood gases showed normal pH but low CO2 and low bicarb - due to metabolic acidosis with bicarb loss in diarrhoea, then hyperventilation leading to lowered CO2 and correcting the pH. He was stuggling to breathe with Bipap non invasive ventilation and was hyperventilating at a rate of 40 breaths per minute. Therefore it was decided that he should be intubated to relieve his difficulty breathing - again I put the cricoid pressure on during the procedure. After this guy was intubated, the reg put in a central line and I catheterised the patient which was good practice.
The final night wasnt as interesting - saw one of the registars admit a patient who was in septic shock and had not responded adequately haemodynamically to 7 litres of crystalloid over the preceding few hours. He then put in a cental line and an arterial line.
Yesterday was my last proper day in ICU. I was with the external team who go and see patients recently discharged from ICU and check up on their progress. All patients with tracheostomies are followed up unti lthey are taken out. It was interesting to see patients out of the ICU setting and was great to see how much better some of the patients looked - the guy with pneumonia hyperventilating at 40 breaths/min and then intubated was now practically ready to go home. Then, today I did a presentation at the ICU teaching seminar. I presented a case of lady who had a sub arachnoid haemorrhage after rupture of an aneurysm. I then talked a bit about one major comlication after SAH which is cerebral vasospasm which is a major casue of ischaemic neurological defecits and looked into some of the evidence behind various treatments used to treat vasospasm. I think it went ok!