The ICU part 1

Monday was my first day in ICU. I was assigned to 2 patients and then went on my own to do the H&P/SOAP note. I was excited about the cases, but as soon as I looked at the charts and the labs and all the caution signs on the patient's door, I started to feel very lost & overwhelmed. A lot of the patient's are on drips or ventilators. My first patient has been in the ICU for a while and just returned from surgery for debridement of large hemorrhagic bullae on both arms (final dx - necrotizing cellulitis and fasciitis) due to an infection from eating raw oysters. btw, can you guess which bug would cause this?
hint: the patient has liver disease which makes him more likely to get infected. He also went into septic shock and developed acute renal failure from hypoperfusion of the kidneys.
As interesting as it sounds, I was like, how am I suppose to come up with a plan for this patient?

My 2nd patient was actually in the CCU (cardiac care unit) which was on the same floor. That patient was more straightforward and only had atrial fibrillation (with a hx of a. fib), but he became bradycardic from taking beta blockers (used to control his heart rate). They just took him off the BB and observed him to see if it helped improve his HR. And it did. He was transferred to the "floor" the next day since he was doing fine.

Rounds was at 11 am and I was worried about how to present these patients since I didn't have time to talk to the residents about them. I spent a lot of time on the first patient and too little time on the second patient. They were busy also because the ICU was full. It turned out that I didn't have to present them and the residents went ahead and did it.

Later, that afternoon, they went to the patients I saw and explained what was going on and what they were planning to do each patient and teaching me about the ICU. They even read my SOAP note! I never really had someone critique it and felt a little nervous for a moment while watching them analyze it. But it turned out to be a good thing because the resident showed me what things to add and how to write the A/P part for each patient. The residents were very good about asking me what labs to order in certain patients and why (just to make sure I understand everything). They are very nice about it too.

The ICU is definitely a lot more challenging and it's all about getting the patients stable so that they can be moved to the "floor". Any patient who has to be on a ventilator has to go to ICU. Also, every patient who presents to the ER with DKA goes straight to the ICU. The rooms are less private with one wall being made of glass so that the nurse can see you more easily. There's a cabinet on the bottom of the wall which, when you pull one of the cabinet doors down, it's a toilet. This is so that they can keep track of your output.

So far, all the residents are very nice and helpful and so are the nurses. The nurses will usually inform me of any changes about the patient. Also, they don't mind if I ask them about stuff like "what's that tube? or what does this say/mean?"

Btw, the director will regularly meet with us to make sure that we are treated okay, if we have a problem with other students/residents/attendings, and if we are getting a good learning experience. She also asks if we are having any car trouble or problems with housing. They try to help us out as much as possible since we have busy schedules.
As far as the residency program goes, something I learned about this program is that it's family-oriented friendly. Many female residents are pregnant (or male resident's wife) because the hospital insurance is really good and they have 24 hour daycare in the hospital. Something to consider when looking at residency programs.

book recommendation: The ICU Book by Marino. very easy to read, a couple of residents recommended it, I would just read it at the library.