I spent the last two weeks in the coronary care unit (CCU) as part of my first elective. Although the CCU is an ICU, the patients are much more “medical” than surgical, and therefore, present different challenges compared to what I saw at the beginning of my fellowship.
I worked with the team to diagnose the etiologies of shock (distributive, cardiogenic, hypovolemic, and obstructive), and in many cases, had to deal with several types of shock in the same patient. We used bedside echo to guide some of our therapy, multidisciplinary rounds to focus on all aspects of patient care, and I had so much fun teaching the interns many of their “firsts” (ie, central lines, ultrasound-guided arterial lines, bedside heart/lung echo exams, etc.)
Going into a cardiothoracic anesthesiology fellowship next year, it was also nice to reacclimate myself to patients with mechanical circulatory support devices like ECMO and Impella, valve replacements, CABGs, heart transplants, and the like. 🙂
I’m heading back to the combined surgical, trauma, and burn ICU for the next two weeks, but hope I can do another elective in the CCU down the road!