I keep telling myself I should blog more often so that I have a record of things that have happened, so that I can look back and see what I’ve learnt. Maybe I’m worried about breaching patients’ confidentiality. Or maybe I’m just being lazy.
Anyway, I’ve taken a break from ED and I’m currently working in ICU. To be honest, it was all quite daunting at first. I’m looking after the sickest patients in the whole hospital. I’m dealing with complex patients with multiple issues. I’m managing the continuing care of patients when I was used to fixing the immediate problem and handing the rest over to the inpatient teams. I’m now on the receiving end. Don’t even get me started on how disappointed I’ve been in some of my ED colleagues.
2 months in, there is still heaps more to learn, but at least I’m a bit more comfortable in this environment. I’ve picked up lots of procedural skills along the way (art line, CVC, vascath, ultrasound-guided peripheral IVs), and also turned on my physician brain to think about issues such as acid-base balance, fluid balance etc. I’m really thankful for the fantastic support by the other registrars, the consultants, and the nurses.
I remember the first MET call that I attended. I guess I knew what had to be done to treat the patient, but I was definitely very uncomfortable being the one in-charge and making the decisions. However, as I attended more of them, I began to build more confidence and learnt to trust myself whilst seeking advice when needed. It also helps that I know most of the med regs by now (and they, me), which makes it easier to work together.
The first Code Blue that I attended didn’t go very well. Both ICU regs were there, and my co-reg who has some anaesthetics training took charge of the airway while I was helping with CPR. She was sort of running the code, but the whole situation was quite chaotic and on hindsight I felt that I should have stepped up to be the leader so she could have concentrated on what she was doing.
The next Code Blue was a paediatric one that I attended with the senior reg, and we didn’t do much because the paeds reg was happy managing it himself. Then there was one where it was someone who had just been discharged from ED and had collapsed along the street. He was fine by the time we got there and was brought back to ED. At the next one my consultant came up not too long after I had arrived so he took over. The following one was in ED so it was run by the ED senior reg.
It wasn’t until yesterday that I had my first experience at a Code Blue as THE team leader. My co-reg is an anaesthetics trainee, so she headed straight for the airway. This time I clearly stated to everyone there that I was going to be in charge. It was nice that I knew the names of the residents, the med reg & the anaesthetics reg; it’s so much easier to assign tasks directly when you can actually call the person to your attention. Despite a bad outcome for the patient, I think we did well as a team and tried our best to maintain some sort of control over the chaos. Stepped out to call my consultant after 30 mins and when he asked me what I thought was going on, I was kinda at a loss for words. I think he was trying to prompt me to go through the 4Hs & Ts, which we kinda did, albeit a bit haphazardly which resulted in us not thinking about 1-2 possibilities. By then, despite us trying to reverse what we could based on the first VBG, the repeat VBG showed a worse result that was probably incompetent with life. 45 mins in, a collative decision was made that any more resuscitative efforts would be futile. Had a debrief with my co-reg & the anaesthetics reg and I think we all felt that we managed this pretty well. Of course, there is an art to all this and I hope I’ll get better with more experience! Although obviously I’m not hoping for more patients to arrest.
A few different people have asked me if I would do ICU. Perhaps it’s a bit premature to tell, having only done this for 2 months, but I think I still prefer ED for the fresh start at each shift, for the wider variety of procedures, and for the lesser degree of intensity/complexity. I still have 4 months to go, so we’ll see!