The continuing saga of the Mr. Hackencough.

We finished our sim lab experience yesterday--I presented the story of the guy I had interviewed (and, though we didn't give as much feedback as we had before with other people, it seemed to go over really well) and we discussed what we knew about acid/base levels and their relation to respiratory problems.  We also discussed/learned how we can adjust these kinds of problems with ventilator settings. We then got to troop ourselves into the Sim lab, where Mr. Hackencough was replaced with a simulator dummy hooked up to a ventilator.  Our sim dummies are pretty cool--basically, they look like CPR dummies, but they're computerized to the point that they breathe in oxygen and out carbon dioxide, they bleed, they have heart and lung sounds and pulses in the right places, and when we give them drugs, they react appropriately.  They also tend to be hooked up to monitors so that we can follow their vitals (heart rate, blood pressure, pulse-ox, etc.).  

The guy I had to "intubate" last week was presented to us with respiratory acidosis, and we basically went through the actions of fixing his vent, then watching him go nuts again (he developed further acidosis and uremia), fixed that, then he got better, and then he got worse again.  We "fixed" him a total of I think three or four times.  I love things like this, mainly because the doctors that work with my group did a really good job of letting us make the decisions and talking us through them, rather than essentially telling us what to do and letting us fake our way through the procedure.  I can't say that I feel like I would be able to handle a ventilator patient all on my own now, but I do feel confident that if I walked onto the wards tomorrow, I would at least have a basic idea of how it works and what to adjust to effect certain changes.  I also managed to remember all of the causes of anion gap metabolic acidosis (of which there are many--the mnemonic we were given to help remember was A CAT MUDPILES, with each letter representing a different possible cause, and some letters representing two), which pretty much made me feel like a badass in front of the attendings who were helping us.  

As I told D this morning, days like this are so incredibly re-affirming.  I am deeply, deeply satisfied with choosing medicine as a career, and things like this just reinforce that.  I'm sure I would probably be a bumbling idiot if you suddenly threw me into third year right now, but I feel confident about my abilities to take a history, present the pertinent information, and answer questions about the basics of the problem.  Of course, this should (hopefully) only improve next year with path and pharm.  We shall see.