?? for the experts..again!

April04

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    Cristagali said:
    I'm doing a MICU roation next month. If a pt is admitted from another floor due to acuity, is that pt a "new" pt and do I need to do the H & PE all over again? sorry :confused:


    at my hospital we do the H&P over again, or a critical care consult (as the case may be). however, why are you worrying about this stuff now?
    I would just ask the fellow or senior resident on MICU how they do things at your hospital.

    good luck and have fun on the rotation, i think you will really enjoy it.
     
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    irlandesa

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      kinetic said:
      No. The patient just needs a transfer note.

      the transferring team in question should write a transfer note IMO; in my MICU experience, we wrote an abbreviated Hx explaining very briefly why the patient was originally admitted to the Gen Med floor with "please refer to GMS admit H+P for further details", and then went into the hospital course and why they were transferred to the MICU. ALWAYS do a full physical and ascertain the patient's code status, regardless of their condition on transfer. As long as you're not at a hospital with notoriously malignant residents, you should have a great time and learn a lot. I actually ended up liking the MICU better than the GM floors; it was really cool to watch patients who came in intubated at death's door get better.
       

      carol ann

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        irlandesa said:
        it was really cool to watch patients who came in intubated at death's door get better.

        Or alternately, in my experience...watch the stroke patients come in, watch them get intubated and progress through brain death until days later when family finally is able to hear the message from the team and d/c's the vent.

        I did see other people's patients get betterish though.
         

        irlandesa

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          carol ann said:
          Or alternately, in my experience...watch the stroke patients come in, watch them get intubated and progress through brain death until days later when family finally is able to hear the message from the team and d/c's the vent.

          I did see other people's patients get betterish though.

          yeah, I got relatively lucky on my MICU rotation in that respect, as did our patients. However, judging by some of the MICU patients I've seen on my current consult rotation, I have no doubt I'm going to get hit with a dose of harsh reality during intern year. One patient was an elderly man who underwent 5 cycles of agressive chemo for an incurable, got pancytopenic (platelet ct of <10K), developed urosepsis, DIC, ARF, had to be intubated, developed aspiration and inoperable bowel perforation during the intubation and NG tube placement, etc.. His wife wanted to keep him on hemodialysis even though several vent weaning trials and numerous platelet transfusions failed and he was completely unresponsive to all stimuli. He was also a convicted felon, and required 2 cops to sit and guard his bed all day in the very likely event that he woke up and escaped from the hospital.. Fortunately for him, he died before anyone could do any further damage to him.
          hopefully, you'll get an experience more like mine at Faulkner than the one I just described.
           
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