More of day three

One of the Resident physicians getting a first hand experience of what it's like to breathe on the vent.

Patti teaching the VAP prevention bundle 

Connor at the grease board with Lisa and Kacie teaching integrated case studies on trauma, sepsis and respiratory failure 

The care here is fascinating.  Because of the limitations of resources they have to pick their battles.  A 50 - 60 year old in respiratory failure is not a viable patient to expend resources on.  They would rather expend them on the young.  Sean and Cameron both visiting ED physicians from the US expressed their frustrations with the constraints.  I'm in awe of all the good these physicians are doing.  There is a 60 year old woman who has necrotizing fasciitis that has ascended from her legs to her abdomen.  She is in the ICU on comfort care.  In the US her leg would be amputated but here, she is only afforded the opportunity to simply die with dignity.  There have been two other recent cases of the same necrotizing fasciitis.  They aren't certain of its origin and asked the ICU physician if they can ask the family if she used some sort of folk medicine because the Dr's. Have never seen anything like it before.  It's scary.  One coded and died last night.  The other came to the ER with an advanced stage and he died in the ED.  Patients are held and treated in the ED  for days, sometimes 8 days then discharged to home from there because they just don't have the staff to care for them in the ICU or med surg unit.  It's fascinating to see the people in gurneys and chairs and all waiting to be treated or being treated and awaiting eventual discharge.