Mission: Healing August 23, 2011

PGY 39, Day # 54
Back into they recovery phase. It always takes a few days for me to take care of loose ends and to catch up on my sleep ... to restore "normal bodily functions" after a week in the ICU.
This week was busy as usual, but not brutal as was my last week in the ICU. My team included two very bright fourth year medical students, a mid level surgery resident, two PGY 2 anesthesiology residents, a mid level OB resident and a surgery intern. Performance was quite good despite the fact that we had, as usual, some very sick patients. Aside from some some routine administrative nonsense (that needs to be eliminated) capacity was not exceeded at any time, as best I can tell. It is still trauma season, and the students are now back in town, so we can get slammed at a moments notice.
But, this week, we had time to talk ... and my focus was on The Healing Mission: Specifically Healing in the ICU. From my perspective Critical Care means Patient resuscitation, prevention of accident or further injury, and protection & preservation of Life, Limb and Organ Function. From that big picture view, I brought the students down into the gritty world of Patient & Family, organism, limb and organ injury and preservation ... then down into the level of cell and molecule ... damage, pathogenesis of injury, opportunities for intervention and the need for precise, rapid intervention. And, I gave them my STOMPP(TM) check lists to help them StepWisely(R) & stay on target in this world of chaos we call patient care.
Key points of discussion included, distractions from the mission and how to stay on target, advanced directives, reasons why families interfere with advanced directives, reasons why families interfere with care, reasons why providers interfere with advanced directives and patient care, team development, including the family in the care team. Then, we dropped down to specific patient and organ injury and injuries, primary injury, secondary injury, progressive injury, prevention of progressive injury, brain preservaion, the vaue of hypernatremia, spinal cord preservation, perfusion and its importance, prevention of complications, cardiac protection and prevention of myocardial ischemia, treatment of acute myocardial injury and MI, renal protection and preservation, ADH, DI, Cerebral Salt Wasteing ... and on and on. Generally, I take a tutorial approach based upon the real patients in the unit, but this week there was enough time for me to give my lecture on respiratory failure. This included, diagnosis, treatment options, prevention of progressive respiratory failure by using non invasive airway management therapies. Then we went on to invasive airway therapies, endotracheal intubation, methods and optimal intubation strategies, early management after intubation, early ventilator management, analgesia and sedation after intubation and prevention of self extubation. I am sure that the students (and the intern) were overwhelmed ... but that is not bad at this stage, because they always work with supervision.
So, now, I take care of loose ends and R&R for a few days ... part of which includes writing this blog ... and other assorted moments of reflection.
Ciao for now,
Dr. Mike