Week 5

This week has FLOWN by so fast I just realized that I have failed to blog in quite a while! There are a few things that I wanted to share!
First, last week I went with the other intern and the RD with whom she was rotating to see a bedside PEG placement in the Surgery/Trauma ICU. The other intern is about 4 weeks ahead of me, so she's in a more acute setting but I was so glad that they invited me to come and witness. We were ready to watch the PEG placement when the MD told the other intern to put on a gown and mask and gloves because she was going to help! The RD and I stood back and watched, and the MD tried to get her to puncture the abdomen but she refused (still not sure if he was serious) but he let her pull the tube through the skin once he had gotten it through and then plug it up! She then cut the tube to fit! It was really cool that he was so adamant about her having that experience (not that she will ever do it on her own!) but she was pretty excited about it. She even kept the scissors that came in the kit and had him sign them for fun. I am kind of hoping that he doesnt get me to help out when I'm in the STICU, but it would be a really cool experience. It was really interesting to see the placement because they use a scope in the throat to get the tube down there so we got to see the inside of the throat and stomach. we even found an ulcer in the guy's stomach.
For this week...
CMC has a lot of ICU's since its such a large hospital, and so I started out my time in ICU this week in the Progressive ICU, which is the least acute of them all. I learned a lot this week for sure. One thing that I felt really un-knowledgeable about was trachs and vents. To go to Progressive, the patients are no longer vent-dependent (though some of them have to go back on it while they are in there) so mostly a lot of Trachs are in the ICU. I was really curious about Trachs and how they affect the person nutritionally, how much they assist the person in breathing, and what it's all about so my RD thought my questions would best be answered by walking around with a Respiratory Therapist today, so I got to pick his brain and he showed me all of the machines and we visited patients with Trachs and Trach collars. I really recommend it, particularly if you are interested in critical care!
Also, Ive started working on my case study! When I was with the transplant RD, she let me do a transplant eval on a lady who was being evaluated for a liver transplant. I was going through all of the documents that I could before meeting her and I found the ridiculous list of herbal supplements that she was taking, as well as 2 weight loss pills. The liver team had not yet pinpointed the cause of her fulminant liver failure, but it was suspected to be supplements. They have now decided that it is definitely from her supplement use, weight loss pills, or NSAID use or some combination of the 3. She was still potentially going to go home fine at the point that I first met her, but by the end of last week her ammonia levels had gone up to 149 and she was encephalopathic and went to the MICU. They started her on NutriHep and her ammonia levels decreased and now shes back in a normal room and eating normally, though shes still restricting because shes "dieting" and she is also still slightly encephalopathic. Shes at the top of the transplant list they are just waiting for the right liver to come in, though there is still the possibility that she could walk out with her own liver (though its a slight chance). I've been doing some research on weight loss pills and their effects on the liver...very interesting...and also herbal supplements. I am really excited to follow her and hopefully either she will walk out with her liver, or I will get to witness her walk out wiht a new liver before my internship is up. I wish ya'll could see how jaundiced she is! I went through all of her labs today, and her bilirubin levels are crazy! (and for those of you who know, I want to name my dog Bilirubin one day, so it has a special place in my heart!)
Ok from now on I'll try to blog before the end of the week so its not so long and crazy! Have a great week everyone, and look for our Diabetes camp stories next Sunday!

Elizabeth