Week 5- ICU

This week I'm working in the small animal ICU. It's very different from the other services in the hospital because there are all kinds of patients there and they have varying levels of treatments/care required.  It can be a little rough at times-- we've already had 4 animals euthanized this week (it's only TUESDAY!) and there are a few others with poor prognoses. On the other hand, we've also discharged several patients that have recovered and are going home with a good prognosis. Wahoo!

Some of the patients that come to ICU are not emergencies but have just come out of surgery, so they require closer monitoring than what they would get on a regular ward. They are monitored for signs of pain and signs of surgery related complications (signs of internal bleeding, dehiscence of an incision, regurgitation before the patient is fully recovered, etc, etc). Often, these patients are also continuing to potent pain medication intravenously along with regular fluids.  All of these things have to be monitored along with the standard stuff like temperature, pulse, respiration rate, catheter patency, whether the catheter is still properly placed, urination, defecation and apparent mental/emotional status. That's just for a standard post-op recovery patient! Patients that have critical conditions often require a lot more attention.

All ICU patients, post-op or otherwise, have a specific chart that shows what treatments need to be given or diagnostics need to be done each hour.  So, for example, we have a dog that's been in the ICU for a few weeks who has been getting regular blood transfusions due to severe anemia. We'll call her Gertie. Gertie is on a plethora of medications that are given at various intervals, one may be every 8 hours, every 12 hours, once a day and so on.  Also, because we are concerned about her anemia, we need to do regular blood tests to evaluate how effective the blood transfusions are and how/if her body is making an effort to counteract the anemia. We run a group of tests called "quats", this is a group of four tests that can be done from a single blood sample of only about 1 ml or so.  The four tests are blood glucose, packed cell volume (PCV), total protein/total solids and lactate. With Gertie, we are most concerned about her PCV because it tells us the percentage of red blood cells that make up the blood and therefore can indicate the severity of her anemia. For a dog, the normal range is 37-55%. Gertie's PCV when I did it this morning was 18%, which is about where it's been hanging out.  The blood transfusion are being given in an attempt to keep her PCV up as high as possible while it is determined what exactly is causing the anemia. At this point, it is believed that she has some form of cancer that is causing a lack of red blood cells in her body, but we won't know for sure what the cause is until some diagnostic tests come back. My point here is, it's important for Gertie's quats to be done at regular intervals in order to monitor her status and it's also important for her vital signs to be monitored at regular intervals and medications administered at the appropriate times so we know if her status is becoming more severe. So, every hour, an ICU tech specifically assigned to her goes through her chart and ensures that every thing that needs to be done that hour is done. It's imperative to note any changes or trends that are occurring with critical patients because it may aid in determining a definitive diagnosis or be a sign of deterioration...or improvement!

ICU is definitely a hands on kind of rotation. There's plenty of med administration, fluid administration, physical examination, blood and other body fluid evaluation, catheterization and beeping fluid pump aggravation! (and so returns the nerdiness...) Anyway, it's been great experience so far. I shall keep all of you in my ever growing audience up to date as the week progresses.

PS- Good luck to all my pre-clin pals on your first mini-CPE next week! You'll do greaaaaaat!