Rotation #2, week one: Critical Care

My second clinical rotation is actually two rotations in one. They decided this year to combine the Emergency and Critical Care rotations into a single two-week block instead of two separate blocks, because so often the animals that come into Emergency end up in the ICU. The two services work so closely that students often end up working on both anyway. Last week, I spent my time on Critical Care.

The Small Animal Intensive Care Unit is a hodge-podge of all sorts of cases. The ICU is where animals go as they are recovering from surgery. It's often where animals who are seen on ER end up as they recover or wait to stabilize enough to go to surgery. The Internal Medicine service often has ICU patients, like when a pet who comes in to be assessed for increased frequency of urination gets diagnosed with diabetes and needs time to get stabilized and started on insulin. The animals in the ICU are usually not far from some sort of impending crisis, which is why they need to be monitored so closely and need to be close to lots of people who can act quickly if something bad happens.

In the past week, I saw my first grand mal seizure in a dog (terrifying). I've learned how to take blood pressures using a Doppler, learned how to set up a CRI (constant rate infusion), watched a classmate remove fluid from a dog's abdomen, and saw my first case of pericardial effusion. I saw a dog who got put on a ventilator to breathe for her after meningitis caused his brain to swell to the point that he lost control of his respirations. We made a lot of sad diagnoses (cancers mostly, or poor outcomes following surgery), but also got to send a lot of our patients home after they made it out of the woods. I helped take care of a litter of kittens post-C-section, and got to send a tiny puppy patient home after he recovered from a pretty major head trauma.

Critical Care is a place where the swing between hopelessness and miracles occurs 10 or 20 times a day. Sometimes all the monitors, tubes, medications, and blood tests seem so invasive and pointless... but then there are cases where your patient looks a hundred times better after receiving a liter of fluids, or that one EKG tells you that your patient is turning the corner, and it all suddenly makes sense.

I'm still not sure that I'm built to handle the wild swings between elation and sadness that come with Critical Care, but I will say that the feeling of getting a hug from a client who gets to take their dog home after five long days in the ICU is worth a million bucks.