SICU/CTSU

WakeMed SICU

It has been unusually slow since I started at SICU, however, when I came back from weekend, it became a trauma unit on Monday. Therefore I need to assess all the patients, evaluate their needs, even before surgeries. My preceptor said to me: Welcome to my world. It was not bad on Monday, I finished on time, learned for trauma patients especially head/neck trauma, we need to push medical team to know of their nutrition needs, and important for their prognosis.

We had tele-seminar on nutrition support for ICU patients. APEN guideline for EN and PN just came out recently. There are a lot of things differ from what we learned in class! Such as:

1. Obese patients need to be hypocaloric feeds in ICU (22-25 kcal/kg of IBW), however, Protein need is much higher compared to normal size patients, (Patient with BMI over 40 even need 2.5 g/kg protein of their IBW).
2. For EN: it has been widely accepted Tube feeds should be on hold if residuals over 200 ml, however, from this seminar, it is not good indicator for GI tolerance due to other input, gastric volume, lying position etc. Paper said TF may be on hold for residuals over ~450 ml. It is not what they practice in clinical setting.

I have been working independently from last week, which I really want to do, I appreciate my preceptor trusts and it gave me more room of learning and practice.

There are only two weeks to go for summer; time goes fast than I image. I will start to do staff relief from tomorrow!