Reflections on Residency & Learning

PICU reflection

This was both a challenging and exciting rotation with honestly some of the best preceptors I have encountered to date. I had encountered some fairly interesting patients, practiced my patient work up presentation daily and practiced critical appraisal often. Overall, I felt like some things “clicked” at the end of this rotation, and more of my work up began to feel second nature.

My rotation specific goals included:

  • To create an appropriate treatment and monitoring plan for critically ill patients with fluid, electrolyte disturbances, and acid/base disorders
    • Nearly all of my patients had some kind of electrolyte/fluid or acid/base disturbance and so I became much more comfortable in creating treatment recommendations and monitoring plans for these patients. Specifically I practiced a fair deal in my understanding of when to add diuretics vs. supplement with K or Na and when to do both.
  • To compare and contrast the commonly used vasopressors in regards to their pharmacokinetics, pharmacodynamics, and toxicities, as well as their role in the treatment of critically ill patients.
    • Roxane provided us a great talk about this with the medical residents. However it wasn’t until our very last day when we had a ?septic shock patient come in and I could apply the information taught to me to my patient. Although I do not feel well versed in vasopressors/inotropes yet, I do feel like I have the skill set to be able to apply their nuances to a patient.
  • To be able to describe the effect of drug deposition and PK in plasmapheresis and dialysis
    • Although we did not have any patients on plasmapheresis, I did have one patient on peritoneal dialysis, so I was able to dose adjust for their medications. Moreover, we were provided with a good topic discussion about CRRT and ECMO and the drug deposition effects in these two systems.

My thought process specific goals were:

  • To be thorough in my thought process with a focus on therapeutic alternatives.
    • This was a great month to really work on my therapeutic alternatives. I attempted to include anything feasible (and then some) and I found this made me successful in coming up with a recommendation that was logical and defendable.
  • To be able to proficiently prioritize DTPs and patients in a rapidly changing critical care area
    • I was pleasantly surprised that critical care DTPs were not particularly challenging for me to ascertain which took highest priority. It usually boiled down to which of the following is most likely to harm my patient first and most severely.
  • To ensure my follow up of my patients is systematic and thorough (and to potentially try some new monitoring forms to aid with this)
    • New monitoring form employed – and I don’t even remember why I used anything but this new form. It has made my monitoring so much easier, as I’ve incorporated a head to toe ROS and med changes to the monitoring form which made it much more intuitive to follow along with my patients.

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