DAY IN THE LIFE OF A DOCTOR: EMERGENCY INTUBATION (Intensive Care Unit)

DAY IN THE LIFE OF A DOCTOR: EMERGENCY INTUBATION (Intensive Care Unit)

November 17, 2019 100 By William Morgan


Hey guys, I’m Siobhan a second-year medical resident. It’s 6:30 in the morning and I’m heading to the ICU So today I want to really show you things I’ve never shown you in the hospital before and give you a sense of how cool it is that we work in teams To save some of the sickest patients in the hospital when working in the ICU ok, just got to the hospital do you guys remember last year when I did a vlog with Carol? She’s my second year She’s my senior. Now, that’s my role. Although there are no other first-year residents. So I’m still kind of like the most junior doctor On the team so it doesn’t feel like too much has changed, but still I’m moving up in the ranks The day starts with an hour of formal teaching which is great because as residents were still Learners and unless teaching is prioritized. It can easily get forgotten when the day gets super busy It was febrile intraoperatively hypotensive in the operating room a right subclavian central venous line was inserted It’s now been removed in the recovery room Next we meet with the exhausted resident who was on call overnight to get handover Which means we hear about update and what happened overnight. Hey Sandra, how was the night? It was good. It was good night Yeah, yeah, we didn’t have much going on which was nice. We did have a couple of abnormalities so patient upstairs we’ve had an abnormal breathing pattern and a patient down here who had a bit of abnormal blood work and Looks like he might be bleeding a little bit. We don’t know exactly why so we’re gonna do some scans to figure that out So that’s organized for today. Okay, we’ll get the rest of handover when without the patient confidentiality bit Okay. So now we start rounding which means we literally go around the ICU as a team seeing each patient and making a plan for their care so when I say team I mean the doctors and medical students bedside nurse the pharmacist the respiratory therapist and dietitian and Depending on the patient situation. We may also be joined by a spiritual care provider or the physical therapist I can’t imagine how we would manage to take care of such sick patients without an amazing team like this So for each patient, we review all their medications lab work in imaging then we discuss the patient’s active issues so an issue might be weaning down a patient’s sedation so that they can wake up for treating an infection or Determining why their blood counts are low Then we write a progress note that explains the plan that we’ve come up with and write any doctor’s orders Which is basically a prescription that’s actually used in the hospital So rounds just gone interrupted. We have a new patient coming to ICU who needs to get intubated now At a time like this the team jumps to action getting ready to insert a breathing tube as soon as the patient arrives Preparation is key because every minute every second counts when it comes to an airway It’s a matter of life and death. This is what the intensive care unit is all about and Just like that. The emergency is under control and we can head back to rounds now that the patient is stable a Big part of rounding is hearing an update from the bedside nurse So when the team comes around to our patients room, we kind of discuss and go through our own head-to-toe assessment from the morning What we do is we discuss their neurological status their cardiac status Respiratory function all the way down to their toes And what we do is we discuss any outstanding issues that need to be addressed in the team Yeah, which is super helpful So actually I remember now that you need a an aural gastric tube Right that goes into the mouth and goes down to the stomach to give Medications through the mouth. So actually I should look let’s just do that now Okay, sounds good Okay, so let’s go find the og tube that we need to put in I Think it’s just down here Yeah, so This is the one that we thread down to their stomach Now I just let me grab the rest of the supplies It’s way more Pro to have all the supplies in the room before you start rather than asking a nurse to keep running in and out to get You things that you forgotten when you’re holding a tube in place? So it’s 12:45 just finished with rounds and now it’s time for some lunch I’m actually doing the keto diet right now Not as challenging as I thought it’s actually been pretty good So I brought some chicken to dip in mayonnaise and I got a salad as well So I want to keep that up and then meet the rest of the team Okay, I said it’s been easy on the Keo diet, but actually that’s I’m too weak since I’ve gotten used to it but honestly the reason I’m doing it is mainly because I think I’m like actually addicted to carbs and to sugar especially over naive alcohol and then the next day when you know I want a treat and I’m tired. So I’ve decided I just need to stop this cycle So it’s always tough when I’m going to a CAF mixing my favorite treats though alright, so we’re just heading back to the ICU had some lunch, which is really nice and Now, what do we do? Yeah mol kind of catch up Okay, so back in the ICU now during rounds I kind of make it to do list on my patient list about all the things I need to check up on in the afternoon. So Kind of divided and conquered you’ve got a big team and so we’re each checking up on different things And otherwise I kind of just wait to see what comes up in the afternoon if we gotta do procedures If we need to admit a new patient Put in lines any of that kind of stuff and then if nothing else is going on Then we actually get more teaching which is awesome So one patient has a white out of part of their lung meaning like one of their lungs looks totally white on x-ray So we’re trying to figure out what is causing this we’re gonna use ultrasound to go and do that now Ultrasound is really cool because we can use it to detect different things and you do on x-ray So in this case we can figure out if the patient’s lung is filled up with fluid Or if it’s collapsed and we can do that right at the bedside So that was great We were able to figure out that it’s a whole bunch of fluid looks like a big pneumonia and now we can treat it So super helpful So it’s 5 p.m the end of the day thank you to the team for letting me show what the actual team in IC was like by participating in this If you want to see a crazy video about me on call for 24 hours Check out this video if you want to see me like hooked up to an ECG scene and EEG machines will see my brain waves while I’m playing the violin and check out this video. Anyway, I’ll talk to guys next week. So bye for now