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Baptist Memorial Hospital Memphis

Intensive Care Unit and Emergency Department

03/06/18- 04/6/18. 0645am- 1845pm, 160hrs

Learning objectives;

1 To demonstrate application of strategies for initiating management and plan of

appropriate care intervention.

2 Demonstrate effective communication with healthcare professionals to facilitate and plan

appropriate care interventions

3 Evaluate clinical data to include, but not limited to ventilator data, hematology and

metabolic data findings, as applicable to patient assessment and planning of care.

4 Demonstrate application of airway management techniques, as relevant to insertion and

maintenance of artificial airways

5 Demonstrate the ability to administering basic and advanced therapeutics as relevant to

managing patient’s clinical presentation.

For one month and the half, from February of 2018 to April of 2018, I did my internship at

Baptist Memorial Hospital with my main focus being on critically ill Adults in the Intensive Care

Unit (ICU), Emergency Department (ED) and Cardiovascular Intensive Unit (CVICU). During

the internship rotation, I had the above objectives which I needed to improve my knowledge and

learn a better way to improve patient care, but more importantly, I also had a great chance to

sharpen my skills in a professional working environment. In order to achieve the set goal, I had

to ask question whenever I am wasn’t sure and I also had to focus on one objective every day.

For example, I perform a number of skills per day but my focus for the day was to improve my
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knowledge on initiating plan of care and extubation. The physician explain the importance of

patient assessment to determine weaning, the included the importance of gag reflex, stable

hemodynamic, patient physical appearance, and patients ability to follow command. There are

exception to this protocol for extubating some patients, there was a patient who did not follow

command but was extubated without any problem. This reinforces my knowledge on weaning a

patient who is mechanically ventilated to facilitate extubation.

Perform numerous blood gas sampling per day, also improve my knowledge on the

proper technique of drawing blood from a critically ill patient especially the use of heparinised

syringe the correct amount of heparin and blood is very important to prevent coagulation of

blood and to obtain accurate test results. Patients managed in the intensive care unit (ICU) are

potentially increased risk of difficult airway management, and this is associated with a higher

rate of morbidity and mortality due to reduced physiological reserve.

Patient Assessment, during my internship I learn that patient assessment was the key to

initiate treatment. The assessment included patient past medical history, primary complaints

especially cardiopulmonary diseases that chronic or acute. Documentation is also one of the most

important parts of patient care. “if you did not document it, it means you did not do it” was a

common phrase used, documentation tells you if treatment is working or not and was another

form of communicating with other clinicians to prevent medical errors.

Another important thing which strike me was the reinforcement of the used of heated

humidifiers (HH) and heart moisture exchanger (HME). My intern clinical used mostly used the

HME and the physicians where very clear about the important of keeping all intubated patients

airway humidifier to prevent dryness since the upper airway is by pass and this upper airway

provides natural humidification to inhale gas.

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One of the things that I learn during the internship which I never thought was important is

why clinician use different codes like full, partial codes in different scenarios. We had a patient

was partial code but when this patient was taken for a surgery, the nurse change the partial code

to a full code which got my attention and I wanted to understand why the patient code is change

without their consent. It was explained that, all patients are put in full code when going surgery

so that if anything goes wrong they will get all the care available to keep them alive regardless of

them being in full, partial or DNR codes.

Through the internship, I was able achieve my goals through skilled validation, physician

student interaction, participation in rounds and impromptus quizzes from the preceptors. The

therapists treated me like a newly hired and the will not seat back if they see me do something

wrong, they will ask me questions and criticized me and direct me or some time work me

through the procedure.