ICU Experience

Last day in Istanbul today! I'm back in Canada tomorrow. Not sure how I feel about that. It will be good to see people but I'm sad for the adventure to come to an end. I think I'd be more excited about returning to start residency. Somehow four more months of classwork just isn't appealing!

While finalizing other posts, I was reminded I hadn't written about my ICU experience! Here it goes.

ICU Experience

I spent 3 days in ICU at the end. It seemed to work essentially the way CTU at home does: meet quickly in the morning for handover, disperse and follow-up on patients, afternoon walking rounds with the attending. I haven't done a true ICU rotation at home, but from my surgical ICU experience this seemed quite different. Of note: the ICU attendings changed daily instead of weekly.

Cases were interesting: a 65% burn patient, a patient with unexplained muscle weakness (?ALS), a case of Naegleria fowleri, a couple traumas, a couple myasthena gravis crises (first presentation of myasthena gravis with respiratoryr distress), and several septic cases (perforated bowel, pneumonia, etc.). Unfortunately the septic patients nearly always succumbed.

One patient stood out for poor management. The initial diagnosis was brain trauma plus alcoholism (fell 10' onto his head while drunk). He had surgery appropriately and was recovering reasonably well after 10 days of ICU admission. When I was there he was diagnosed with delirium (for non medical: patient is essentially not himself. Could be aggressive, sleepy, self-harm, etc.). He was being managed with antipsychotics and physical restraints, despite the underlying cause not being investigated. The list of potential reasons for his delirium is long: direct result of the brain trauma, alcohol withdrawal (though 10days later), ventilator acquired pneumonia, catheter acquired UTI, disorientation secondary to ICU admission, etc. While the one ICU attending (Dr. Acharya of NCCDF) identified these and recommended  he be discharged to the floor for improved sensory stimulation etc., the others focused on medicating him with antipsychotics. It was heartbreaking to see a man that seemed quite with it struggling against physical restraints. (for non-medical: correct management of delirium is to treat any possible causes first, and then medicate only as a last resort).

* disclaimer: I wasn't sure about his mental status since I didn't see him at night, and couldn't talk to him. He seemed quite lucid, logically pleading with me through eyes and gestures for being released from his restraints.