I was very wise last night, and made no remarks about having nothing to do – didn’t even let the word “bored” cross my mind, and that took some effort. As a result, I got almost no calls, and spent several hours curled up with The ICU Book. After some research, I have finally found a comfortable place to read. The call rooms are impossible: a boardlike bed with a single flat pillow, and an impossible chair, and, if you’re lucky, a metal cart for a desk. (I’m looking forward to graduating out of the intern call rooms.) But I have discovered the closest thing to a comfortable chair, in the same-day section of the recovery room.
Unfortunately, now that I’m actually studying intently, I’m afraid I’m going to turn into one of those people who is always opposing orthodox (traditional) practice on the grounds of “I was just reading about this, and the evidence demonstrates that. . .” I’ve already discovered that one of the senior residents, whom I took for slightly crazy, must actually have read this same book in the recent past.
So far, after just one night of continuous reading, I’ve already learned that: picc lines have no benefit over central lines in the acute setting (no decrease in infection rate, and actually higher rate of complications and cost), nexium is bad for ICU patients (promotes pneumonia, and the GI bleeding it’s supposed to prevent isn’t that big of a danger), blood pressure cuffs are wildly unreliable (even the manual ones aren’t that great, and the automated ones – which are all anybody uses anymore, unless specifically ordered not to – bear absolutely no relationship to reality; and what does that tell you about the diagnosis of hypertension in ~50% of the population?), and that D-dimer and lower extremity ultrasounds are not of great utility in diagnosing pulmonary emboli (ok, that’s not so new). Being as I am, an intern crazy to get my hands on sharp objects, I was particularly interested in the part about picc vs central lines (since the ubiquity of iv team doing these means the house staff do much fewer central lines these days), and went and looked up some literature. I can see where the data was coming from, although there’s some on the other side, too. I printed up some abstracts to show the critical care attendings; one of them is unorthodox enough himself that he might say the book is right. When I rotate in the ICU, maybe I’ll outlaw piccs in my patients.
Oh, and the ultimate bit of heresy: no proven infection control value to masks in the OR. I have to say, I think this one is unproven because no one dares to do a controlled study on it. Anyway, I’m not going to challenge it.