I just finished a long month at a inner city ICU as a senior resident. While there I saw many many sick, sick patients. I could probably create 100+ dedicated posts just to multiple interesting cases that I had while being a senior resident.
A relatively newer common phenomenon that's occurring in the United States today is that the hospitals are becoming so increasingly busy that the ERs are packed full and the ICU and other hospital beds are full and so the sick patients pile on in the emergency room and have to be boarded in the hallways and ultimately stay in the ER for several hours or even days.
As part of all Emergency Medicine training we spend several months working ICUs as junior residents and as senior residents. This past month was my first month in an ICU as a "senior resident". That means that I had the ultimate responsibility for managing the unit. Never fear I had lots of back up, a fellow in critical care at home and an attending physician trained in critical care who was also at home. During the day everyone on the team was there but at night often times it was me and the nurses and a bunch of sick patients with more arriving at all hours. At times it was a little overwhelming but exciting, challenging and fun. I learned more in that month than I could have learned in 1 year of didactic course work.
I want to share one very interesting case that I had while working as the senior resident on the ICU. So one evening when I was on call I was on the floor helping the nurses in putting in orders for 20 different very sick patients we had in the ICU. I was called to one of the rooms because a patient had become bradycardic, with a heart rate in the low 20s. As I entered the room I asked the nurse to prepare some medications and begin to treat the patient. Right in front of my eyes I saw the patient's heart rate completely stop and he flat lined on the monitor.
Immediately we began CPR and resuscitation protocol. I noted that the patient's stomach had become increasingly distended. This patient actually had a feeding tube that was directly connected to his stomach through his abdomen. As I watched his stomach become more and more distended I realized that this was the cause of his problems.
I quickly grabbed some suction tubing and connected it to the wall suction device on one and and then connected the other end to the patient's feeding tube and immediately the distention of the patient's abdomen begin to decrease and the patient took a large breath and his heart beat came back, he was alive. He is still alive and doing well. It was a fortunate save and luckily I saw the stomach / abdomen distention. Air was entering his abdomen and causing the diaphragm to distend which was pushing on his heart / aorta causing the heart to go into abnormal rhythm. As soon as the pressure was decreased and released the heart rate returned to normal. This patient would have certainly died had the pressure continued to build. Fortunately we only had to do 1 round of CPR before fixing the problem. The CPR itself kept the patient alive while his heart was not functioning.
This is a 15 minute look into the ICU. I was there for a total of 20,000 + minutes so you can imagine the stories I have to tell.
