Blogs

One participant in the ASHP Foundation Critical Care Traineeship shares what she’s learning

Transitioned into MICU today. This is a different patient population with new and challenging problems. Interdisciplinary rounds ran smoothly with Dr. Neil Ernst as my preceptor in this unit. He has excellent rapport with the MICU staff and really helped explain the dynamics of how things run on this unit, as well as patient care issues and concerns that I may need to evaluate and follow up on during the day.

By the way, my MICU patient who is in the prone-positioning bed is slightly improving – PA02/Fi02 ratio is closer to 150 with better ventilation settings. He continues with low-volume ventilation settings (tidal volume at 6ml/kg), FI02 at 50 percent and PEEP at 15. He is sedated now with Versed drip because of concerns for alcohol withdrawal. Further, he was hypotensive, so we are weaning him off Propofol.

In terms of antibiotics, this patient is on vancomycin and piperacillin/tazobacta for positive blood cultures for MSSA and Klebsiella respectively. We successfully de-escalated to Rocephin based on culture and sensitivity results.

I then met with my primary preceptor, Dr. Eric Mueller, and Malar (my fellow trainee) over lunch to discuss the residency program at the hospital. Both Malar and I wanted to understand the dynamics of UC Health’s PGY1 residency program, particularly the types of activities included in their critical care rotation and preceptor involvement. Dr. Mueller was extremely insightful, describing their critical care rotation and what they do to create a great learning experience for their residents. Great stuff we could consider with our own residents in their ICU rotation!

We then spent time in the afternoon in a teaching session on mechanical ventilation, another topic that Malar and I had requested. This was an excellent discussion with Dr. Neil Ernst, who reviewed key concepts of ventilation, parameters to evaluate, the difference in various vent settings, concerns with specific disease states (ARDS, VAP and MDR pathogens). In addition, he addressed the many questions and concerns we had related to our hospitals. Extremely informative and good review!

I must say that our afternoon teaching sessions (hemodynamic monitoring, shock states, ventilation, ARD and MDR pathogens) have been excellent, with good discussions of topics.

Look for my next post, "Day Eleven," which will be posted on Aug. 22nd. Also see "Day One" from Aug. 12th, “Day Four” from Aug. 15th, and “Day Six,” from Aug. 19th.