Working the ICUs

On my current rotation, I'm working the Surgery and Trauma ICU, Critical Care Unit, Cardiovascular ICU, and Renal floor. Lots of tube feedings and TPNs. I also saw my first Code Blue in the CCU-- a couple dozen people poured into the woman's room to be there if needed. People from outside the unit also came in, just in case, as did a chaplain, who told me that they always respond to a Code Blue just in case they are needed. Luckily, she was not needed--they got the woman resuscitated.

On my first day in the CCU, I saw a man I'd seen over at the cancer center a week before--the man who had really bad mucositis. Turned out, he'd been admitted the day after I saw him with thrombocytopenia. At one point, he'd also been projectile vomiting bile. But by the time we saw him, he was doing "much better." He still looked rough, and he's only at 64% of IBW, with a BMI of 14.8, but he was able to talk and request lemonade. We put him on tube feedings, which will hopefully help him gain some weight and get better.

Today I shadowed the dietitian who does Peds b/c my current preceptor was out sick. As it turns out, there's this equation for calculating REE needs for kids (Schofield) that is written 3 different ways in 4 different resources that the dietitian has. I found a journal article with the correct equation and it turns out that the equation in ADA's pocket guide for Peds is wrong. Of course, I kind of figured that ahead of time since if you follow theirs, you'll feed a 7 year old 11,000 kcal...