ITU was my last placement of F2. I had gone into the placement with the hope of gaining an understanding of what happens in ITU so that I can confidently pursue medical training and become a diligent medical registrar with a solid grasp of which patients are in need/are suitable for ITU-level care.
I ended the placement wanting to specialise in ITU.
Having completed my MRCP Part 1 and 2, I felt pretty confident in my medical knowledge and would generally feel relatively comfortable on most wards. ITU, however, was different. All the patients have lines coming out of various parts of their body, there were numbers everywhere, acronyms I didn’t recognise and extremely unstable patients pickled in a variety of drugs. These first few days were overwhelming and I was dreading 4 months of cluelessness and fear.
To my relief, I began to enjoy it more and more as the weeks went by. I found that ITU was actually far more relatable than it may seem at face value, especially to medical students. At medical school, you learn a lot of physiology and, though it may be interesting, it can sometimes seem a little abstract and detached from real life patient care. In ITU, you are able to see physiology in action being measured by the various monitors that are attached to the patients.
There are a handful of intimidating topics that, once you have a basic understanding of them, you can start to fully appreciate what happens in ITU.
- Mechanical Ventilation
Ventilators are obviously an important part of ITU care but the settings can be incredibly confusing. The wording of various ventilator settings can vary depending on the brand, but the principles are always the same. This concise document provides a brief overview of mechanical ventilation.
Renal replacement therapy is another essential aspect of ITU care that is often shrouded in jargon. You hear a lot about ‘level 3 filters’, ‘citrate filters’ and ‘filter holidays’, but it may not be particularly apparent what any of these terms mean. I’m sure you’ve all heard of dialysis, but haemofiltration and haemodialofiltration may not be terms that you are familiar with.
Fortunately, Make a Medic has a YouTube video on this exact topic!
- Inotropes and Vasopressors
Whilst the primary condition that led to the ITU admission is being treated, a variety of drugs are used to optimise a patient’s physiology. Much of the time, patients will need blood pressure support which is achieved using inotropes and vasopressors. You may have heard of some of these drugs in passing and may have a general understanding of why they are given, however, ITU doctors employ an intimate understanding of the pharmacodynamics of these various drugs to optimise the patient as best as possible.
Here’s an article that provides a succinct introduction to inotropes and vasopressors.