This week I've been on the adult ID ward. Overall, my time here has been an incredible learning experience, but this week I really felt like I've been able to contribute to the team in a significant way.
The team I'm working with, which is responsible for about 40 patients, has two interns and, like the rest of the hospital, severely lacks enough nursing staff. Because of the lack of nursing staff, dosing decisions for medications are adjusted under the assumption that doses of medications will be missed. For example, for treatment of presumed or confirmed bacterial meningitis, which is probably 25-50% of the patients, they give double the normal dose (2 grams, twice a day) so that if the patients only get one dose they still get the "full" recommended dose.
The severe shortage of interns and nursing staff means that visiting students, residents and nurses can really be a significant help in taking care of the patients. Yesterday I did several blood draws (including my first femoral), 4 lumbar punctures (only 1 successful), hung bottles of IV fluids and placed urinary catheters from 8 AM to 7 PM. It was really the first time since I've been here that I appreciated how much anyone with some fundamental skills can help out here. And because the patients here are often very sick (to the point where in the US they would be in the ICU), getting things done in an expedient manner feels like it might make a difference.
This morning, one patient, who is HIV positive (like most of the patients) with a CD4 count of 10 who is essentially not responsive (likely due to meningitis suspected tuberculosis, cryptococcal meningitis, syphilis etc) had a blood pressure of 75/55, heart rate of 130, a respiratory rate of >30 and a sodium of 168. This patient would likely be in the intensive care unit in the US but here that's not an option so we just hung a bottle of IV fluids, which even with the line fully open was not going fast enough to catch up. We tried to put in another IV line but failed and the team went on to the next patient. I would be surprised if she's still in the ward tomorrow as she looks sicker than a lot of the patients that I saw one day and were gone the next.
On a lighter note, the teaching on the adult ID service has been excellent. The SHO (senior house officer) that I've been working with constantly elicits the students' opinions both to teach but also to guide treatment.
That's all for now.
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