On my most recent placement in ICU there was a great deal of information i had to absorb when assessing and treating a patient. Not only were there the usual stuff but also the ABG's, Blood count, ECG and central venous line measurements, patients fluid balance throughout the day and the effects of that, not to mention learning all the drugs they were on and the effects they might have on their system as well as all the usual objective measures and PMHx, HPC things to absorb. I was a little worried about remembering all the drugs at first because my memory isn't great at the best of times but it was kind of important to remember what drug a person was on because sometimes it would have an affect on the treatment planning.
One drug in particular, nitric oxide, works by breaking down a blood clot (i.e. when you have a pulmonary embolism). This drug however will break down a blood clot in the preferentially ventilated lung. So on ICU when people are ventilated the preferentially ventilated lung is the opposite of normal and is the more superior lung. This is important because if you want the nitric oxide to work at its best and the patient has a pulmonary embolism in their left lung you should place them in right side lying for the full effects of the drug. By placing them in right side lying it also means that majority of the perfusion will be going through the right lung, which is then diverting blood away from the blockage where the PE is.
I couldn't believe how smart this drug seemed to be! Amazing! I was even more amazed when another student i was on prac with commented that they overheard an intern asking a registrar about what nitric oxide did and the registrar commented "oh it's just a bronchdilator". Perhaps they meant a vasodilator but even that doesn't explain the intricacies of how this drug works.
It just embedded the fact that it is so important to have a further understanding of drugs. Not only did we not learn very many drugs in uni but it really does effect what we do as physio's. In the future, even though it may take me a little longer to look up the drugs, i will make sure i have a full understanding of the patient, including their medications prior to treating them. This experience has taught me how important a broad understanding of each patient is.
2 comments:
Hey Erin,
I was also recently on a ICU cardio prac and didn't realise how important it was to firstly remember the important ICU based drugs, and secondly how we had to as physios, relate them to or treatment - especially with respects to the CNS and CVS.
In an acute setting, where most patients are mechanically ventilated and are unable to communicate to you their concerns, drugs they are on, how they are feeling etc, it is very important to gather as much information as you can for subjective and objective from other sources, especially the patient's nurse.
This means that you have the required information to make a valid and informed decision about the proper treatment of your patient.
Hey Erin,
Thanks for the post, i found it veru interesting, especially not worked in an ICU setting. I only worked on the respiratory medical ward.
I also found that it is really important to know the drugs the patients are on. Every prac, the supervisors keep telling me to check the drugs.
Even though there are lots of drugs, sometimes if you remember the "ending" of a drug can help to determine what they are ie. "....pril" or "....prol".
And you're right, there's so much to remember already for a Rx for a patient let alone remembering the drugs! What i found help was to become really nice to the pharmacist on the ward :p
Thanks for the post, i learnt soemthing from it!
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