Blogs

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

I had the opportunity today to round with another clinical pharmacy specialist, Dr. Kristen Hillebrand, who participates with the cardiovascular critical care team. What a fantastic opportunity! We rounded on patients s/p open-heart surgery and discussed current treatment plans and management, including CORE measures. For example, we happened to see one patient s/p 4 vessel CABG, currently with worsening effusions. We reviewed medication protocols adhering to acute coronary syndrome CORE measures. It was also interesting to gain exposure to critical care management of pleural effusions by aggressive pulmonary toilet, glycemic control transitioning from insulin drips to long-acting preparations.

We also had the opportunity to round on patients in the burn unit. We cared for a 47-year-old male s/p trach secondary to smoke inhalation, with 15 percent of his face and upper extremities severely burned. Unfortunately, he was in a house fire in which most of his family died. We reviewed pain management strategies, specific fluid and nutrition requirements and psychiatric recovery.

By the way, the MICU patient with ARDS is slowly responding to treatment with an FIO2 at 55 percent and PEEP at around 15. His PA02/FI0s ratio is around 150. He was changed to airway pressure release ventilation (APRV) to help improve his ARDS. Despite the awkward prone positioning, he is safely receiving tube feedings.

In early afternoon, I was able to observe how a critical care pharmacist actively engages in education and orientation with new ICU nurses. He provided excellent review on DKA. He discussed the pathophysiology of DKA, metabolic acidosis and an appropriate approach to treatment. He reviewed the importance of fluid and electrolyte replacement and how to appropriately manage the insulin drip (not following standard insulin drip protocols for hyperglycemia).

We also spent time later that afternoon with another clinical pharmacist specialist, Dr. Chris Droege, who discussed pathophysiology and management of arrhythmias.  We reviewed the Vaughn Williams classification. I’m not sure if I’ve ever met someone who gets so excited about arrhythmias!! I think I was getting some serious PVCs during his discussion…just kidding…. Excellent topic review and discussion!! I won’t forget action potentials, what’s happens in depolarization versus repolarization, respective ECG readings and the specific indications for   antiarrhythmic therapy.

Look for my last post, "Day Twelve," which will be posted tomorrow. Also see "Day One" from Aug. 12th, “Day Four” from Aug. 15th, and “Day Six,” from Aug. 19th, and “Day Eight,” from Aug. 20th.  For more information about the Critical Care Traineeship, visit www.ashpfoundation.org/criticalcare. The ASHP Foundation is accepting applications now for the 2014 traineeship.