The ICU

Some of you may be aware of my dislike for the Intensive Care Unit (ICU) in the States. I am not a big fan of the high intensity with multiple patients on the brink of death. I have discovered that I probably wouldn't mind the ICU here - it is NOT high intensity.


I had my first real encounter with the ICU team this week when I wanted them to come see a patient on our team. The patient arrived on our team around 10 AM as we were going about our morning rounds. We stopped to assess the new patient because he looked quite sick. After a quick examination we found that his extremities were cold, he had no peripheral pulses, and we were unable to get a blood pressure or oxygen saturation. He was on oxygen and was clearly having difficulty with his breathing.

It was clear that this patient was not adequately perfusing his organs and he would quickly die if we did not get him to the ICU with some type of pressor support. On rounds we discussed this and the plan was to call the ICU and cardiology to come see him. After we saw the patient I noticed that no one was calling the ICU or cardiology. I asked my intern and he said he would call after rounds (rounds are an average of 3 hours long). I told him the patient wouldn't survive that long, so I called both consults myself.

I was pleasantly surprised when cardiology showed up 20 minutes later to see the patient. They agreed that he needed to be transfered but thought it might be too late to help him. I continued to wait for the ICU team to arrive. The patient died at 1pm and the ICU team showed up to see him around 3pm.

I was extremely frustrated with this but I learned that the ICU works a bit differently here. They take all the consults they recieve and go around seeing the patients. They may have 1-2 beds available so they try to find the patients they feel might have a chance at surviving. The others they turn down and the patients remain on the wards to be managed.

I guess my patient did not fit into their "possible recovery" category as he was unable to survive long enough for them to come see him. There is absolutely no urgency here in patient care.