Rotation at the Emergency Department
At the beginning of rotations that started this semester, I was a intern in ICU. However, after having served as a novice in that unit for one week, I was required to take the work outside at the inpatient setting of the emergency department due to shortage of doctors there. There are huge differences between the inside and outside of the Intensive Care Unit. In the Unit, I was faced with uncountable tests results such APTT+PT, Complete blood cell count, Artery Blood Gas analysis, Biochemical Analysis and Bacteria Culture in the sputum, urine, stool, etc. Of course, because patient in the intensive care unit usually have severe heart disorders, like congestive heart disease, or even tachycardia and ventricular fibrillation (I saw several patients die due to it), ECG is also one of the most exams done in the unit. Two things that impressed me deeply are the ventilators and the unconscious patients. Quite a lot of patients who had been admitted into this unit do not know what is going on around, they have little or no awareness of people, things(disorientation). they can not breathe effectively which means in severe conditions, only with ventilator can they survive. But even with ventilator and other high technology equipments, most of them died at the end with MODS.
So, in my mind, several things you have to prepare before your rotation at the ICU starts. The first one, knowing what will happen in that unit, and be familiar with CPR skills. Because, in the intensive care unit, patients are really dying, and one of the things that you are doing every day in this unit is seeing people dying. The second, be familiar with the normal scales of the routine tests such as those mentioned above. One of the important issues I want to point out here is you have to know the balance of electrolytes and the analysis of artery blood gas, because in this unit, attendings will surely test you on those issues as soon as you step into this unit. There is no excuse, for latter on, you will find how important the balance of electrolytes and oxygen and pH are for a dying patient. Also, you should be familiar with at least the presentations of acute myocardial infarction on the ECG .(four phases: phase1: peaked T wave；phase 2: peaked T wave as well as ST elevation; phase 3: ST elevation plus reverted T wave; phase4: abnormal Q wave as well as reverted T wave ). I was asked by the consultant Qi Wenshen during my first week rotation at ICU about ECG changes in a patient with AMI, and happily I got that score. But for another question asked by him simultaneously, I lost that score and got laughed by those senior doctors there. That question was about the right treatment to a sudden onset of ventricular tachycardia. It is an easy question, but I just got uneasy at that time and gave the consultant a stupid answer.
After one week rotation at ICU, this week, I have shift out to the emergency ward being faced with nine patients with coronary artery disease. So, I think tomorrow, I will review something related to angina pectoris that you will probably meet or have already met in your department. Can you guess what MONA has Hep B mean? It is a easy way to help you remember the protocol for angina pectoris and MI. detail will be addressed tomorrow.
