So for four weeks I'm covering the surgical highcare unit (SHCU) - a 10 bed collection of the sickest surgical patients that aren't quite sick enough for ITU but too sick to be on the wards, or those patients with high risk of post op complications who come straight from theatre.
My day starts around 0745 with a handover from the sister. Around 0800 the entire colorectal team rock up to see their patients so I ward round with them, attempting to interject with useful information gleaned from my handover. The trick is to sound as if I know all about each of the patients from their latest blood results to what volume they vomited overnight, their own individual nutrition plan, what antibiotics they're on, whether their bowels have been open and what pain relief regimen they have.
Once the colorectal team leave I have to triage furiously, doing my own ward round beginning with the sickest patients, examining all the patients, going through their investigation results and acting on anything unusual, while also completing any jobs generated from the ward round such as referrals to other specialties. During this time any of the other surgical teams (or indeed any random consultant, or microbiology, or the nutrition team) might appear to see any of their patients that have landed in SHCU and I'll have to ward round with them. It is nearly impossible to see everyone before the anaesthetist turns up between 1300 and 1400 to start the anaesthetic ward round during which they see every patient themselves and I see them all again.
It is quite satisfying (if a strain on my organisational abilities) having 10 sick patients all to myself, if they're not frankly unwell they're just really complicated. One day last week I had three patients in fast AF by mid morning, and one in pulmonary oedema so I was juggling digoxin loading doses and furosemide. There's a guideline that suggests starting with a beta blocker for fast AF but all three patients were hypotensive so I held off.
Another day I had three hypotensive patients that were clinically dehydrated and one in SVT so I was fluid bolusing one end of the ward and getting the other end to blow continually into a syringe (valsalva manoever which can induce a return to sinus rhythm) while phoning the med reg and trying to collect jobs from the ongoing ward rounds, of which there were three happening simultaneously.
I had another day with two patients that were frankly septic and one having a large fresh PR bleed (which was unexpected given that he had had a panproctocolectomy (removal of colon and rectum) so shouldnt really have had anything to bleed from.
Today I actually managed a lunchbreak! All the patients were stable, and there was no anaesthetic ward round so had a chance to relax.
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