All’s Quiet

It’s been a quiet night at work in the ICU. It’s330am, and my senior has been asleep since about 9pm.  A few fluid boluses here and there and the ship has pretty much been running itself. Which means I got to do a little reading at work tonight. I’m about 5 months into this whole being a doctor thing now, and I’m finally starting to get to the point where everything I read, see, do, learn is not brand spanking new, and that’s a really good feeling. I feel like things are starting to connect a little bit here and there. Last night, after intubating a patient, my senior was telling me his personal style for choosing which paralytic agent he uses. Then tonight, I ended up reading about these agents and everything he was saying last night makes perfect sense. Last week I read a paper on steroid use in the ICU for septic patients, and they kept referring to those study subjects that had been given etomidate in the ED as a special group of patients. But now after reading more about these drugs for rapid sequence intubation tonight, I can understand why (etomidate may (or may not) induce adrenal suppression, which would be important when intubating septic patients as adrenal suppression prevents steroid response which limits the bodies ability to support blood pressure, organ perfusion and mobilize defense to fight infection). So yeah, the lattice of my EM knowledge has a vine or two growing on it, slowly but surely, and I’m looking forward to filling the rest.

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on November 8, 2011, in Residency, Uncategorized. Bookmark the permalink. 3 Comments.

  1. I have enjoyed reading your blog and was struck by your post on adrenal suppression. I just had a crisis after anesthesia and have wondered if one of the agents used helped precipitate it (in addition to my history of long term steroid use/HPAA suppression/Steroid Withdrawal/general adrenal wackiness).

    Your endocrine section on your notes is looking a little lonely. There’s a statistic on Medscape that as many as 6 million people are out there with AI, undiagnosed. SAI after steroid use is the most common. By comparison, there are 7 million with GERD. Not so rare after all.

    Oh, and since you are in Emergency, the symptom list for a crisis emphasizes low bp, but at least three of us online (Addison, Cushing’s post pituitary surgery and me) have high bp with crisis.

    Just trying to spread the word.

    M

    • Haha, I will try to fill in a few details of the endo section one of these days. I don’t think I’ve come across a case of adrenal insufficiency in the ED yet. but I’m sure its bound to happen. If you have a normal BP in your crisis, and are not septic, what would make you present to the ED then? Just curious what I should be keeping my eye open for, or at least be thinking about. I wonder if any of the more obvious symptoms like general fatigue, we would ever work up in the ED. I can’t recall anyone ever talking about doing at stim test before they hit the inpatient floor.

  2. PS: I think you are the first med blog I’ve seen to even mention the words adrenal suppression in any manner.

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