DB Week 6

MICU

The MICU was a nice change from the CCU especially because the staff was exceptionally friendly.
I usually avoid patients on contact isolation but since most patients were on, I gowned up with the team. I realized that I felt much more comfortable gowned and gloved because I look like less of an outlier to the patient. One of the Interns was very nice and let me and Lina listen to patient's hearts and feel for pitting edema (when a patient has so much swelling that pressing on the skin leaves a dent which takes time to resolve). Interacting with patients makes rounds much more immersive.

Lina and I saw a patient who survived the holocaust and who received a pacemaker on Friday.

Patients with heart problems in the MICU are interesting. It's clear that the MICU staff isn't as comfortable as the CCU. Makes sense, but it's still funny to see someone looking up basic info on heparin. There was actually an issue where a patient didn't get the proper heparin dosage because someone on the night shift didn't know to bolus in addition to continuous delivery, probably an extreme example.

CCU

I continue to learn from CCU even though I've been there many times. However, I've noticed that the skill of the person presenting a case makes all the difference in terms of following the patient and being interested.

One case this week, a women in her 40s with tachycardia. When we rounded on her, she seemed okay, but 30 minutes later she was throwing up and in ventricular tachycardia. Vtac is basically when the ventricles start pumping quickly while the rest of the heart is like slowww downnn.  It's usually a prelude to vfib, at which point your blood flow has basically stopped and your heart is about to arrest. (My 4x CABG patient was a good example of this progression after his surgery.) A fellow and a PA cardioinverted her, a procedure in which the patient is shocked with electricity, essentially "defibrillated,"  but to prevent fibrillation, not terminate it.