ICU Rotation in Nanaimo March 22nd to April 16th
Week 1
During my first week I was able to attend rounds and work up 4 new patients (made recommendations on-dose of Vit K to lower INR, dose of heparin for DVT prophylaxis, antibiotic in pneumonia etc.). I also was able to watch 3 procedures in the ICU (a bronchoscopy, an insertion of a central line and an insertion of a pulmonary drain) and learn about ventilators from a Respiratory Therapist. I also answered some drug information questions; I found references in regards to the changes in loading doses of Plavix prior to ACS patients getting PCI. I highlighted key points of the articles and calculated the NNT and NNH to help with the physician’s evaluation. My first week was busy but a great way to start to this rotation!
Week 2
This week was another great week for learning opportunities. I continued to attend rounds and work up 3 new patients. This week I learned about the management of cardiac arrest, pulmonary embolisms, seizures and septic shock by assessing drug therapy, making recommendations and watching procedures (estimated bladder pressure to determine if patient was “third spacing”). I was also given the opportunity to facilitate journal club this week and involved other pharmacists in a group discussion about when to continue or discontinue dual antiplatelet therapy after implantation of drug eluting stents (see below for article and handout).
Dual Antiplatelet Therapy Beyond 12 months? Journal Club Handout
Week 3
During my third week I continued to attend rounds and work up patients with Septic shock, aspiration pneumonia and pneumonia. This week I also continued to follow Phenytoin levels and became more comfortable with when to hold doses and how to adjust levels for low albumin. I also assessed a patient with MRSA, calculated an initial starting dose of Vancomycin and will follow their levels next week. I also got some experience with dosing of vasopressors and activated protein C this week and will continue to learn more about both of these kinds of medications through readings and my case presentation. Finally, on Friday I worked in the ICU on my own and found this to be a really good experience, I was able to help solve dispensary issues and make suggestions in rounds. I look forward to next week when I do my case presentation and continue to try and work as independently as possible.
Week 4
During my last week I did a case presentation on a patient with Septic Shock on activated protein C (See PowerPoint below). I also was able to work up two patients with meningitis and continue to follow my other patients from last week. I was also able to follow vancomycin and gentamicin levels and try and target a trough for a patient with MRSA on vancomycin and look at peak and troughs for a patient on synergistic gentamicin. I also attended a therapeutic talk on diabetes and a Journal Club on Dabigatran versus warfarin in atrial fibrillation. Finally, I was given two drug information questions where I was asked to find out the evidence of using methylnaltrexone for opioid constipation in the ICU and the evidence of using LMWH versus heparin for DVT prophylaxis in ICU patients.
