The ICU of the Future

Hola a tod@s, my dear friends.

Yesterday I had dinner with Carles Calaf and Victor Úbeda, and we were talking about the future with a couple of beers. Philosophy of bar and brainstorming: probably the most creative combination.

How will be the ICU of the Future?. As we have thought before, for me is clear: centered in persons and to prevent the disease.

The amazing technological developement is helping exponentially to improve the care of patients. Remember that not so far it was impossible to think that everyone would have a computer in the pocket, appliances and design engineer is enabling health professionals to work in a more efficient way. And there our positions are logically coupled: technology help us and should be at the service of people. The ICU of the future is already here, and we are designing it.



But, what do people want?. The best possible management with the most advanced technology at their service.

Secondly, in times of immediacy, where every year we change our phones simply by being the last, we are served.

What about first? From the IC-HU Project, we see an improvement that should be guided by research ing. Many of our goals are qualitative, so we will have to think how to quantify them so that those results which we hope will also fix managers numbers.

It is no coincidence that in recent weeks we are looking for psychologists to integrate them to the research team, as it is not casual that they are connecting us spontaneously to join the paradigm shift. In fact, multidisciplinary work as in hackathon in medicine is landing.

In any case, you do not believe that we have invented the wheel. Reminded us last week De Tots Els Colors sharing a speech in 1931 by Dr. Edward Bach about how the hospital of the future would be for him, and he was not very wrong:

"It will be a sancturary of peace, hope, and joy. No hurry, no noise entirely devoid of all the terrifying apparatus and appliances of today: free from the smell of antiseptics and anaesthetics: devoid of everything that suggests illness and suffering.

... The patient will seek that refuge, not only to be relieved of his malady, but also to develop the desire to live a life more in harmony with the dictates of his Soul than had been previously done.

The physician of tomorrow will realise that he of himself has no power to heal, but that if he dedicates his life to the service of his brother-men; to study human nature so that he may, in part, comprehend itsmeaning; to desire wholeheartedly to relieve suffering, and to surrender all for the help of the sick; then, through him may be sent knowledge to guide them, and the power of healing to relieve their pain. And even then, his power and ability to help will be in proportion to his intensity of desire and his willingness to serve.


He will have no interest in pathology or morbid anatomy; for his study will be that of health.

He will have to be able, from the life and history of the patient, to understand the conflict which is causing disease or disharmony between the body and Soul, and thusenable him to give the necessary advice and treatment for the relief of the sufferer.

The treatment of tomorrow will be essentially to bring four qualities to the patient:

First, PEACE: secondly, HOPE: thirdly, JOY: and fourthly, FAITH."

Ladies and gentlemen, Tomorrow is now.
What can you do Today? Because things we do now are building the ICU of the Future.

Happy Thursday,
Gabi

How are these cases related?

I saw these two cases on the same day.


This patient had a GI bleed and a massive transfusion:
What is it?


This patient had a history of "frozen shoulders," and had been treated for this elsewhere for quite a while.  He had been seen in the ED 6 days prior for increased shoulder pain, and was referred back to his orthopedic clinic.  He had this ECG recorded because shoulder pain can be a symptom of ACS:
What do you notice?
















The first case has a very long ST segment and thus long QT.  This is classic for hypocalcemia; the ionized calcium was 3.0 mEq/L.  This is a common complication of massive transfusion.  One must be vigilant for hypocalcemia.

The second case shows a very short QT with short ST segment.  The computer measured it at 354 ms.   This was a tipoff to hypercalcemia and so we suspected that this patient had cancer as the etiology of his pain.  A chest x-ray (which we were going to get anyway) confirmed a chest mass.  A chest CT confirmed this and also showed otherwise occult spread to the shoulders.  The ionized calcium was 7.32 mg/dL and the total calcium was 15 mg/dL.


Here was the ECG after normalization of Ca in the second (hypercalcemia) case:
The QTc is now 384 ms