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Department of Anesthesiology

Day in the Life: PGY-1 at TICU (Pediatric Step Down Unit)

Master
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Emily

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By Emily Bruner, M.D.

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As an intern at Baylor College of Medicine we do three total months of ICU rotations. One month each at Ben Taub, St. Luke’s and Texas Children's Hospital. Each is a very unique experience with different patient populations and responsibilities. My first and favorite ICU rotation was the TICU at Texas Children's. The TICU is a very unique ICU experience (only a few like it in the country!) where we care for patients who have complex medical needs and are often technology dependent. Patients often end up staying for months at a time before they are ready for discharge.

You will work with a pediatric resident and split the 14 patients. There will be a pediatric critical care fellow and an attending supervising. The morning starts at 6 a.m. when you receive sign out from a pediatric intern who was on call overnight. They update you on any changes to your patients as well as tell you about new admissions from overnight. You then chart check for overnight vital signs, review morning labs/images and touch base with the nurses about any concerns they have or orders they need. Then, most importantly, go see your patients and be ready to round at 8:30 a.m.

Rounding in the TICU was a great learning experience. Rounds are multidisciplinary meaning we round with the bedside nurse, respiratory therapist, pharmacist and even parents on all of the patients. We also round with the transplant team on patients who are post-transplant. The attendings I worked with were invaluable resources. One of my attendings was an expert on sepsis and helped develop the sepsis protocol at TCH and another specialized in pulmonary hypertension and showed us the app he developed to help manage patients with pulmonary hypertension.

A unique feature of the TICU is that the majority of my patients had tracheostomies. The goal for many of the patients in the TICU is to wean their ventilator settings to as minimal of support as possible before they go home. Part of our lecture series required that we complete a simulation during which we had to troubleshoot a tracheostomy that had to be replaced. Becoming comfortable with tracheostomies, weaning respiratory support and interpreting blood gases were important skills I developed during my time there.

Lastly, I really appreciated the relationships I made with the families of my patients. They were a great source of knowledge because they are used to taking care of their medically complex children by themselves at home. I had several patients who I got to know very well because I took care of them the entire month I was there. One of my favorite memories was on Halloween when we got all the kids dressed up in costumes and "reverse trick-or-treat" with the therapy dogs to pass out toys to them in their rooms. I had a great introduction to pediatrics through this rotation and cannot wait to go back to TCH for anesthesia!