After working in the ICU only about 6 months now, it strikes me that one of the main differences between the ICU and other units isn't that the patients crash more so much as that nobody panics. This occurred to me the other night when a patient next door to mine went into an SVT. I was helping the nurse in the room get the patient back to bed when I noted how calm and work-a-day she was. Then I noticed that I, too, was experiencing no adrenaline rush. Who is this person, I wondered? Let's compare PCU me and ICU me:
Progressive Care me: Heart rate suddenly in the 140s-160s??!! OMG, OMG, OMG, whatkindofrhythm is that? OMG,OMG,OMG, okay it's narrow compelx... OMG,OMG,OMG, what do I do?! OMG,OMG,OMG, okay I need an EKG... OMG,OMG,OMG,where do we keep the EKG machine?! Wait, should I get a BP first or get the EKG machine?! OMG,OMG,OMG...
Intensive Care me: Rapid A-fib? sweeeeet... MAP of 132??? Hmm... No way... anybody got a manual cuff... oh, and... yaaaaawn... can somebody find the EKG machine, too? Thanks...
Maybe this is just experience, but I think part of it is setting the boundary of your "normal zone." On PCU, other than an actual code, a rhythm change is about as edgey as you get. In ICU, it's like a little speed bump on the way to end of shift.
