Monday, April 8, 2013

PRP Week 24 & 25 - Clinical (ICU)

ICU a.k.a Intensive Care Unit is where the most critically ill patients are admitted. Some conditions are life-threatening which requires them to be closely monitored. So, for the final two weeks in clinical department, I was attach in ICU. Although there are only 12 or less patients in ICU, however the treatment is far more complex than any other wards. The medications are usually given in high dose and some patients were on expensive antibiotics because apparently they are many microorganisms had become resistant to the common antibiotics. The emergence of MRO (multiple-drug resistant organisms) is very worrying in hospital setting.

Like usual, in the morning I will clerk case in ICU, updating the CP2 and then follow specialist round. I'm not sure why, but the specialist kept on changing day by day. It's confusing some time. Here, specialists from other teams such as medical, surgical, or ortho will also do their rounds around the same time. So which one to follow? Follow the anaes team. Usually there are around 3 HO, 1 MO and 1 specialist. Some staff nurse will follow the round as well.

Common cases in ICU include MVA, severe sepsis, acidosis, hypertensive emergency and many patients were transferred in from another ward because the need of ventilation and support. Post-operative patients who are in critical conditions are placed here too.

During my attachments here, there were paediatric patients as well. One with nosocomial pneumonia, one with dengue fever and another one I forgot already. 

Some patients were admitted for one or two days only in ICU, which they will be transferred out when their conditions improved.

Important point in becoming ICU pharmacist:
1. check the renal adjustment dose, because many ICU patients has deteriorating renal function
2. remind the doctor about the antibiotic frequency and the proper day to off it
3. suggest dose adjustment if required
4. answer inquiries especially which drugs are available in the hospital and the dosage form
5. drug interactions, whether any drugs should be stopped and removed from the treatment
6. some doctors will even ask about drug price

I already presented the ICU case this week, the case is about necrotising fasciitis or also known as flesh eating infection. The bacteria involved are sure very nasty one.

Me in ICU.. untuk kegunaan hospital sahaja.. lol

A very useful reference.. can download online too.. 

Sanford Guide

Were bored listening to talk

It was raining one day and the hospital form a swimming pool on the roof top.. :D

Everolimus, a drug used in cancer patient..

Alhamdulillah, out first Oovoo video conference since came back to Malaysia..


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