ICU

This last week, I started my intensive care sub-internship at San Francisco General Hospital. It is an open surgical ICU meaning we act as a consult team but not a primary team. We handle all pain, sedation, ventilator, and access requirements for patients in the ICU. We can suggest to the primary team what else they might want to do, but they make the ultimate decision whether or not to take our recommendations. Being in this capacity is kind of fun; we don't have to worry about the day-to-day management of these patients and don't get paged for anything except sedation and airway problems. The surgical ICU takes mostly trauma and neurology patients, but we also take the occasional pediatric or ob/gyn patient.

The service is big; we've had about 20 patients all week. Many are victims of car accidents, falls, gun shot wounds, and strokes, so it's an interesting mix. Nearly all our patients are on ventilators and propofol, fentanyl, and/or lorazepam drips. They have invasive lines such as central venous catheters and arterial lines. We start early in the morning with radiology rounds; we look at all the new films for all the patients (nearly all of them get a daily chest X-ray to look at their pulmonary status and the positioning of lines and the endotracheal tube). Then we do bedside rounds which can take several hours, discussing and seeing all the patients. Each day, we have a lecture on an ICU-related topic. Then the afternoon is composed of admitting new patients and doing work on the olds, changing lines, adjusting ventilator settings, transporting patients. Since trauma can come in any time, admissions are unpredictable and since patients are sick, we need to see them immediately. It's very different from my medicine rotation last month.