Busy Day in ID

Today started off pretty busy.  I was at my morning rounds at 8:30 as is routine, and I wrote down the overnight reports of the patients.  One of them caught my attention as being a patient who had been downstairs on the normal inpatient floors.  We have been caring for two patients with Clostridium difficile infections and one of them wasn't looking to good and the other was looking better.  Unfortunately the one who was looking better yesterday ended up in the ICU overnight and was basically circling the drain.  It was really sad because he looked like he was getting better there, and he had been alert and talking and fine the previous day.

Right as my preceptor and I gowned up and went in to our decompensating patient's room, he told me to go to the room two doors over - that the guy had just coded and it would be a  good observational experience.  So I took off the gown and watched them go through all the Advanced Cardiac Life Saving procedures that I had trained in - they were doing a PEA (Paroxysmal Electrical Activity)/Asystole procedure, where the patient has flatlined and they are doing chest compressions, rescue breaths, and injections of Epinephrine every 2 minutes.  It was surprisingly by the books, no one was panicked, but there were definitely a lot of people.  There were imaging people in the hallway waiting to come in and do ultrasounds or x-rays of the heart/chest when anyone got tubes placed, and the defibrillator was ready.  You don't shock a flatline though, so they were basically going through the cycles of compressions and injections.  

By the time the code finished, I turned around to join my preceptor and we ran into the whole family of our C. diff patient, and we discussed his condition, and the family wanted to take him off life support.  It was pretty clear her was fading fast - his blood pH was down to 6.85, and the normal range is 7.35-7.45.  So, in a very short amount of time two ICU patients in the same area both essentially plummeted.  

The rest of the day was spent checking out our other patients and we discussed AIDS regimens and Pneumocystis jiroveci pneumonia.  This weekend I am going to check out the infectious disease society website and look up treatment protocols for a few things.  We have a fourth year (from my school?) joining us on Monday, so that should be interesting - maybe he will have some helpful hints for rotations and preparing for residencies.