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February 21, 2006
Why I Love the SICU, by Maggie
So, today was an awesome day.
It started out hard cause my mean lady who has bounced back two times now, and who once told me that I was "too high and mighty and holier than thou to ever make a good doctor" (no kidding, her words), when I left yesterday her pulmonary status was tenuous, I was asking if we needed to consider intubating her, it looked like she was throwing up coffee ground emesis into her ventimask (coffee ground emesis = vomiting old blood, = bad). ANYWAY, she was intubated last night around six...after that they put an orogastric tube in and immediately 2.5 liters of coffee ground fluid came out (=bad). A few minutes after that she dropped her BP to 50 systolic (I know, I have two readers, neither of whom are medically inclined but this is neato stuff for me). Her arterial line that I beautifully put in yesterday stopped transducing pressure at that point, they got her pressure up with neosynephrine and ended up putting an A line into her femoral artery.....she got a swan-ganz cathetar, her cardiac function is shitty (near heart failure range shitty when I got in this morning, better now). SO, her new complication is that her right foot (the one that has the a line in the groin) is now cold. This morning it was "cool" and with doppler I was able to find both her DP and PT pulses. A few hours later her foot was "cold" and I was not able to get her DP pulse on doppler.
THE OTHER THING TODAY
41 year old female in car accident at high speed head on. Took an hour to get her out of the vehicle. When she got to UH she coded and was getting compressions for 20 minutes, she got 2 chest tubes, was found to have blood in her belly, went to the OR had her spleen out, and went from the OR to the SI. In the ED she had gotten 2 trauma caths (giant IV's) in her femoral veins and an a line in her right femoral. We needed "better" access, so the fellow told me to get the kit to put a central line into her subclavian. I looked at him and asked if he was messing with me. And he said "no, she has bilateral chest tubes so you can't mess it up," so I said "are you messing with me, seroiusly" and he said "no." So I go and get the central line kit, and start to set up, and I am told by the fellow not to do it. GAA!! So, blah, and then they decide to change out one of the trauma caths to a large triple lumen over a wire. I did something similar with a crappy resident last week (changing a triple lumen to a swan over a line) and it went VERY poorly. So, I was excited to do this so that I could do better than before. And save for starting to try to change it out while the other ID was still sewn in and having to reconnect the IV fluid then cut the 2 stitches out, it went very smoothly. My sewing was a little slow still, but much better. I think it went pretty well...so that was exciting. AND PART OF THE REASON IT WENT WELL, the resident who was sterile with me stood aside and just handed me what I needed, she didn't hover and take shit out of my hands!
ANYWAY, it was a neat day. However, I have a feeling that some interesting shit is going to go on tongiht, when I am not there...someone coded the other night, and I wasn't there for it. Which made me sad. The woman survived.
Posted by Maggie at 5:37 PM | Comments (6)
February 12, 2006
wedding planning
is a pain in the ass.
neal made this big deal about wanting to be involved in decision making and the what not, but he hasnt helped at all, which is frusturating. then he gets pissed when i nag him about things.....
finally decided on which china to register for.
mom had her 2nd knee replaced on tuesday, she is doing ok, harder than last time.
SICU is awesome. i think i very well may do a fellowship.
i am starting to worry about matching, i will be glad for it to be over with.
Posted by Maggie at 5:33 PM | Comments (1)
February 2, 2006
SICU
so yesterday was my first day in the SI (surgical intensive care unit). i was on call my first day...which was a little overwhelming. i got about an hour and a half of sleep over the 31 hours that i was there...
the residents / attendings / fellows are pretty nice.
people are really fucking sick, interesting injuries and sicknesses.
will share more about it later.
but it is neat, and i very well may want to do a fellowship in critical care!
Posted by Maggie at 8:12 PM | Comments (1)