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.