I started my ICU rotation last week and I’m loving it. While I’m way over my head, I’m also learning so much about how to care for really sick people.
In this post, I’m going to share the lessons I’ve learned in my first week of ICU.
Get your COVID vaccine
Despite all our hopes that COVID’s finally at bay, it’s unfortunately still making people really sick. In a 12-bed intensive care unit, three patients are seriously ill with COVID.
Whether I’m seeing patients in clinic or the Emergency Department, I ask people when they got their last COVID vaccine. For the majority of people, their last shot was years ago. Not great, considering the current guidelines recommend getting an updated vaccine every 6 months for adequate protection.
I’m probably preaching the choir, but from someone who’s watching people suffer from lung failure, please consider updating your vaccine and reminding your patients to do the same.
Think twice if someone tanks
One of my patients is a lovely elderly woman who was admitted to the hospital with a UTI. While on antibiotics, she suddenly became so sick she needed full resuscitation for septic shock.
My preceptor judiciously ordered an ultrasound for her belly, where they found a big infected kidney stone. Urology cleared the stone, and when I saw her the next day, she was joking and telling me how much better she felt.
In an ideal world, people should get better if you’re treating the right thing. But if they’re getting worse, it’s vital to rethink the initial diagnosis. My preceptor’s consideration of an alternate diagnosis saved this patient’s life.
Don't be afraid of goals of care discussions
You would be astounded to know how few people have been given a prognosis when they’re diagnosed with a life-limiting illness. This includes diseases like cancer, COPD, heart failure and dementia.
What’s been happening in the ICU is that we talk about goals of care when patients are super sick and families are super stressed. What an excruciating time to make decisions about what to do for a loved one’s treatment.
This week has prompted me to think about when to do goals of care discussions. In a perfect world, they would be done as an outpatient when people are well. That’s the time to make decisions, when the stakes are low and there’s lots of time to think.
I found this PDF from the Ontario Palliative Care Network about how to have goals of care discussions. I’m going to be more conscientious about carving out time to talk to my patients about their wishes and values if they have a life-limiting illness.
I'm hoping these three lessons will stay with me as I head to my next rotation in Emerg.
Stay well friends,
Dr. Kuhnow
Dr. Kuhnow is a family medicine resident physician and former physiotherapist in Ontario, Canada. She writes about healthy habits for healthcare providers on her blog no trophies for perfect. To get healthy habits and practical tips directly to your inbox, sign up for her weekly newsletter.
This post is meant for educational purposes only, and doesn’t replace advice from your qualified healthcare professional.
Great post this week! A lot of this hit home for me— with coworkers dropping like flies, catching covid at work and spreading their illness. And on top of everything pneumonia, colds and an ear infection amongst family at home. Good to have an action plan when ish hits the fan. Lots of good for thought. Keep up the great work!