ICU at Manipal

I had my ICU shift the other day. They have 12 MICU beds, 4 CCU beds, 8 NeuroICU beds all on the same wing of the hospital. The first thing that you'll notice is the guard that sits at the door. I'm not completely sure of his function as I never saw him stop anyone. Maybe its for those rare cases of family upsets?

Entrance to ICU wards

Looking back at the ICU ward entrance. CCU and Neuro ICU on right, MICU on left.

The next strange thing was that everyone has to take their shoes off and change into these blue slippers. All nurses, docs, pts, pt families. I think its for infection control or part of their general custom of taking your shoes off before entering someone's home, but I'm not sure. Especially since they don't seem to wear gloves on a routine basis. And they don't seem to stress the importance of infection control or isolation. 

Change your shoes before entering the unit

The main MICU is pictured below. The cases are very similar to what you see in the US including: severe alcohol DTs, GI bleeds, urosepsis, COPD exacerbation, ischemic CVA, hepatic encephalopathy, sepsis from pneumonia, AMS, pancreatitis (not sure why that was an ICU case), ect. They do not use non invasive ventilation strategies except for in the neonatal ICU. So pts either breath on their own, or they get intubated. The ICUs are the only unit with ventilators and at the moment, only one pt was on the ventilator in the ICU. The nurses say that the average length of stay is about 5 days in the unit and they always seem to be full. If there is a pt who needs ICU admission and there are no beds, the pt is transferred by vehicle to Katmandu (7hrs) or in rare cases is flown by helicopter. The nursing ratio is 2 pts per 1 nurse. As far as doc staffing goes, they have a similar call schedule as we do in the US.There is a night intern and a night resident who stay on duty for 24 hours and take turns taking naps when they can. The rest of the interns and residents arrive in the morning. Interns take 1 or 2 pts to pre-round on, and around 9am, the attending comes for morning rounds. Typically the night resident presents all of the cases both old and new. After rounds, the interns and the resident do the tasks for the day then go home. Afternoon rounds happen at 4pm with the on call team. 

Vent and IV pump

Supply area

They do pinning and counter-traction here. You can see the nurse/doc station in the back

Permission given by pt. This pt was admitted for urosepsis and pyelonephritis. She as a RIJ CVC in place and from the morning rounds, it appears they do follow EGDT protocol for sepsis here. They measure the CVP every morning off the line. This pt was also on low dose levophed, and thats why she has the pump going. Most of the time, the nurses count the number of drops of med per min to calculate the correct flow rate. 

Needless to say, I survived my ICU shift. There pts did not seem nearly as complicated as our ICU pts in the US can be, but maybe it was an off day. They have no IMU status here, so the only other place for these pts to go is to the floor without monitoring. 

This is the waiting area for family members. 

They have their own calendar and numbering system that confuses the heck out of me... year 2069? huh?

This is the coffee shop in the main entrance area that has some pretty awesome coffee if you ask me!

And one last fun picture from my night shift in the ED... it was pretty quiet and there were barely any pts but this is a picture of a resident suturing a forehead lac. Notice the sterile dead grasshopper in the tray?

Permission from staff and pt. Notice the dead grasshopper in the tray? I supposed he was sterilized in there?