Georgetown End of Week 3

I saw three more procedures, all in the ICU!

1) a bedside FEES (Fiberoptic Endoscopic Evaluation of Swallowing) - the pt came in with respiratory distress, and was on a trach and receiving nutrition via PEG. They were trying to evaluate whether it was appropriate for him to eat PO yet, but unfortunately he's not. As he swallowed applesauce, some of it was dropping back towards the airway before the airway was able to fully close, therefore putting him at high risk for aspiration. They will reevaluate next week.

2) a "Bronch" or a Bronchoscopy - they were checking for any abnormalities in the airways, then inserted and drewback some fluid, which they are going to test (I dunno what they are looking for) to determine whether a biopsy is needed. I think this is a lung cancer pt.

3) a Thoracentesis - this man was fluid overloaded, with buildup of fluid in the pleural space which further worsened his ability to breathe. So they removed it by basically poking a hole in his upper back and draining it through a syringe. this procedure yielded about 1.5 liters of fluid! The doctors said the pt usually feels better immediately, and is able to breathe much more easily. It was interesting to see this because during medical rounds, the residents asked me if I could further concentrate his nutrition in order to reduce fluid intake, and now I see exactly why they wanted me to do so!

I really enjoyed working in the ICU during week 3! I especially like that Georgetown is a teaching hospital, because everyone is learning. On this floor, the RD, pharmacist, and nurse attended medical rounds with the primary team (attending, fellow, 3-4 residents, and an intern), which is so helpful for learning about all of the pts in the unit, their current status, and what needs to be done.

Also, since the RD for this rotation, Molly, attends rounds, everyone seems to know and respect her, and she gets a lot more done! She is actually very proactive, and while the team is rounding she'll write her orders in the chart, and ask the MDs to sign it right then.