Great jet learning case for my resident colleagues

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jetproppilot

jetproppilot

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So I'm on call this past Saturday.

Pretty busy day...run of the mill cases during the day...hip ORIF, ELAP for SBO, mandatory C sections with labor epidurals mixed in throughout the day....

Thank God I knocked out pain rounds early!

Leave for home around 1530.

As I'm pulling into the driveway my beeper goes off...it says C SECTION AT 1630

S HIT!!!:bang:

Drive back to the hospital, do the C section, home at 1800.

GF has marinated filets already on the grill, garlic mashed potatoes, grilled onions, corn on cob.......yep, I'm a lucky man!

Eat, take a shower, in bed at 2100.

Phone rings at 2330.

Its Mary CRNA.

"Hey Dr Jet."

"Whats up Mary?"

"Just got a call from one of the GI docs. He's in the ICU with a thirty-seven year old lady....she's just outta prison....started vomiting blood earlier today. He gave her versed and demerol but she won't go down. He wants me to come over and give her a little propofol so he can scope her. Says it won't be any more than about fifteen minutes. Whatcha think?"

"Tell ya what," I said.

"Go to the ICU and scope it out and gimme a call back."

"Sounds good," Mary replied.

Less then a minute after we hung up my phone rings again.

"Hello?"

"Hey Bill its John."

John is the GI doc. Nice guy.

"Hey John, whatcha got?"

"Man, I'm really sorry to bother you. I'm having problems scoping this lady. I've given her five of versed, fifty of demerol and she's still fighting the tube. I was hoping..."

He trails off..

"Hey Bill, Mary just showed up! I just need a little propofol sedation so I can get the scope down."

Here I am all curled up all warm and cuddly-like enjoying my sleepytime. GF awakes outta slumber.

"Honey, whats goin' on?" she says.

WHAT DO I DO NOW?:ninja::ninja:
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Ok, so I'm only an MS4 but I figure it cant hurt to check my thinking.

Shes vomiting major blood, an ex-prisioner so possible hep C or other reason for a ciriotic liver. This means I dont know what her VS are but they could crash pretty quick. Also if she starts vomiting more blood it could be a crappy airway pretty fast.

This girl as gotten serious versed and demerol and is still thrashing, who knows how much prop she is going to need.

So you could have the CRNA go do this herself, but if things go to h-ll you're 15 min out. So I say you go back and make sure you're around, worst case you got out of bed; on the flip side worst case you are talking to the lawyers.

jetproppilot said:
So I'm on call this past Saturday.

Pretty busy day...run of the mill cases during the day...hip ORIF, ELAP for SBO, mandatory C sections with labor epidurals mixed in throughout the day....

Thank God I knocked out pain rounds early!

Leave for home around 1530.

As I'm pulling into the driveway my beeper goes off...it says C SECTION AT 1630

S HIT!!!:bang:

Drive back to the hospital, do the C section, home at 1800.

GF has marinated filets already on the grill, garlic mashed potatoes, grilled onions, corn on cob.......yep, I'm a lucky man!

Eat, take a shower, in bed at 2100.

Phone rings at 2330.

Its Mary CRNA.

"Hey Dr Jet."

"Whats up Mary?"

"Just got a call from one of the GI docs. He's in the ICU with a thirty-seven year old lady....she's just outta prison....started vomiting blood earlier today. He gave her versed and demerol but she won't go down. He wants me to come over and give her a little propofol so he can scope her. Says it won't be any more than about fifteen minutes. Whatcha think?"

"Tell ya what," I said.

"Go to the ICU and scope it out and gimme a call back."

"Sounds good," Mary replied.

Less then a minute after we hung up my phone rings again.

"Hello?"

"Hey Bill its John."

John is the GI doc. Nice guy.

"Hey John, whatcha got?"

"Man, I'm really sorry to bother you. I'm having problems scoping this lady. I've given her five of versed, fifty of demerol and she's still fighting the tube. I was hoping..."

He trails off..

"Hey Bill, Mary just showed up! I just need a little propofol sedation so I can get the scope down."

Here I am all curled up all warm and cuddly-like enjoying my sleepytime. GF awakes outta slumber.

"Honey, whats goin' on?" she says.

WHAT DO I DO NOW?:ninja::ninja:
Click to expand...
 
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jetproppilot said:
WHAT DO I DO NOW?
Click to expand...

Tell him to hand the phone to Mary. :)

Really need more info about this patient, and the CRNA's more likely to know, notice, or seek out what we care about than this GI guy. I got a page eerily similar to this on call a couple weeks ago, except the GI guy just wanted us to "sign off" on some procedural sedation to be provided by the ICU nurse.
 
get out of bed , go back to the hospital, do the case under GA with rapid sequence induction, leave it not to the CRNA unsupervised, go there see the patient , control the airway.
it sucks but everything else is bound to go wrong and you have to go back to the hospital under much less controlled circumstances....
my $0.02 , fasto
 
mstudent12345 said:
Ok, so I'm only an MS4 but I figure it cant hurt to check my thinking.

Shes vomiting major blood, an ex-prisioner so possible hep C or other reason for a ciriotic liver. This means I dont know what her VS are but they could crash pretty quick. Also if she starts vomiting more blood it could be a crappy airway pretty fast.

This girl as gotten serious versed and demerol and is still thrashing, who knows how much prop she is going to need.

So you could have the CRNA go do this herself, but if things go to h-ll you're 15 min out. So I say you go back and make sure you're around, worst case you got out of bed; on the flip side worst case you are talking to the lawyers.
Click to expand...

Thats a nice post, Dude.:thumbup:
 
pgg said:
Tell him to hand the phone to Mary. :)

Really need more info about this patient, and the CRNA's more likely to know, notice, or seek out what we care about than this GI guy. I got a page eerily similar to this on call a couple weeks ago, except the GI guy just wanted us to "sign off" on some procedural sedation to be provided by the ICU nurse.
Click to expand...

Mary said its a tiny girl, sporting about a buck-five body weight, alert, anxious about the procedure, polite, asking how long the procedure is gonna take.

BP 100/68 HR 110.
 
jetproppilot said:
Mary said its a tiny girl, sporting about a buck-five body weight, alert, anxious about the procedure, polite, asking how long the procedure is gonna take.

BP 100/68 HR 110.
Click to expand...

Jeez, I'm not asking the CRNA to do an H&P, just fetch some data. Surely this polite, cooperative ICU admit has some recent lab data and history?

If no more information is forthcoming, here's my take. A non-opiate/benzo-naive jailbird, possibly intoxicated right now, with who knows what comorbidities (liver & coags probably aren't normal), GI bleed of unknown severity/duration, unknown HCT, tachycardic. Slugs of propofol would not be my technique of choice. Barring a need to transfuse/resuscitate her now, she ought to get an RSI and a tube if GI man thinks she needs a scope. I wouldn't assign a CRNA to the case here, so I guess I'd go in and do it myself.
 
What's her airway like?
 
pgg said:
except the GI guy just wanted us to "sign off" on some procedural sedation to be provided by the ICU nurse.
Click to expand...

Huh? WTF? Is that how it's usually done at your place?
 
jetproppilot said:
Mary said its a tiny girl, sporting about a buck-five body weight, alert, anxious about the procedure, polite, asking how long the procedure is gonna take.

BP 100/68 HR 110.
Click to expand...

Report to hospital.
RSI.
Return to snugglytime.

It's Saturday night. This does not bode well for her planned sedation.
 
I'm an MS4. I like doing cases, so here it goes:

This sounds like its gonna be a huge can of worms.

We are making assumptions about the nature of her GI bleed. Now, given her lifestyle history, its likely its related to varices, ulcers, or gastritis, but we can't be certain. I mean, for all we know, it could be a Dieulafoy lesion.

Her pressure is stable, but she is 110bpm. It could be because she's nervous. It could also be because she's hypovolemic.

I'd get all the usual blood/urinework ordered up over the phone before I got there and a Type and cross. I'd also scrounge up some O- blood(lawsuit prevention) and FFP and hit her with some NS 1L bolus. I'd make sure she has some 12 gauges in both arms too. The blood goes in depending on the crit and symptoms. The FFP goes in with the blood if her coags suck (which they likely do).

How's her EKG?

I'd also strongly recommend that everyone involved in her care wear face and eye shields.

I wouldn't touch her with propofol. If she ends up hypotensive, there's nothing we can do to reverse the effects of the propofol. I'd rather have her in a more stable environment.

Its clear that the benzos and opiates aren't working. I'd consider booking an OR and doing the scope under general. We'd have better control of her airway, and she would be anesthetised in a controllable fashion. Also, should things go sour enough to require surgery, she's already set up for it.

I'm curious what Bill means about her "fighting the scope". Is she grabbing it with her hands?

I'd also ask what medications she's been treated with already.
 
Last edited:
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fastosprintini said:
get out of bed , go back to the hospital, do the case under GA with rapid sequence induction, leave it not to the CRNA unsupervised, go there see the patient , control the airway.
it sucks but everything else is bound to go wrong and you have to go back to the hospital under much less controlled circumstances....my $0.02 , fasto
Click to expand...


Dude, thats pretty direct, huh?

Nutmegs was direct too.

As were others.

You guys were right.:thumbup:

We do MAC scopes all the time but the little birdy in my head was warbling "DANGER!! DANGER!!"

I'm on the phone with the GI guy.

"Dude, I don't think its a good idea to just sedate this girl. I know you're ready to go but ya gotta wait. I'll be there in twenty minutes."

I arrived at the ICU and the patient was alert and oriented, tiny stature, conversive. I explained to her what we were gonna do and off we went.

RSI intubation with propofol 80mg and sux 100mg. Plans to bump with propofol for the 15-20 minutes planned for the case.

GI dude puts his scope in and her belly is FULLA BLOOD.

He's working along, everyone is chatting it up when all of a sudden, probably 10 minutes into the ordeal blood starts flowing outta her mouth. Cups and cups of old blood.:eek::eek:

"Man, I'm glad we didnt do a MAC," I said.

So was everyone else!

Had the GI guy not had us involved he wouldda been in a heap of trouble with certain aspiration. Insufflation just pushed alot of the old blood upwards and out.

He was extremely thankful.

Mallory Weiss tear was the diagnosis so he did his GI stuff and we were done.

Another point is if you walk into something in a foreign environment (read: not in the OR) don't assume anything. As soon as I saw all the blood in her belly I glanced to the IVs...she had 2 20" sukky IVs with those little pigtails attached....a unit of blood was hanging but thats about all it was doing...hanging there.

"We got more blood?" I inquired,

"One more unit downstairs," an ICU nurse said.

Remarkable how content all these critically care trained nurses are with small IV catheters restricted more with the tiny pigtails, with the unit of blood hanging dripping like a KVO line.

We sent for the other unit, ordered more, and remedied the IV situation....as far as rescuscitation this lady needed to be treated like a trauma case....and everyone in the room had missed that boat.

So there it is.

Two big points:

1) Don't do a MAC on someone who could potentially have a stomach fulla blood, even if its near midnight and you're home curled up with your hottie.


2) Don't assume someone else has already thought of steps that need to be taken.

Nice case.

Hope all of you enjoyed it and learned something along the way.
 
not even going into anesthesia and found this to be very interesting

you guys have a good forum going on here
 
jetproppilot said:
Another point is if you walk into something in a foreign environment (read: not in the OR) don't assume anything. As soon as I saw all the blood in her belly I glanced to the IVs...she had 2 20" sukky IVs with those little pigtails attached....a unit of blood was hanging but thats about all it was doing...hanging there.

"We got more blood?" I inquired,

"One more unit downstairs," an ICU nurse said.

Remarkable how content all these critically care trained nurses are with small IV catheters restricted more with the tiny pigtails, with the unit of blood hanging dripping like a KVO line.
Click to expand...

This point is pure gold. No matter how much we or other physicians know, if the situation is not assessed and the limitations to our potential interventions removed...the patient's f'ed.

This is what Jet showed, and I think one of the real strengths of anesthesiology training. Too bad the ASA cannot brand and sell this to the public.
 
MS1 here, it's still a bit Greek to me but I really enjoy these cases. Thanks for the write-up! :thumbup:
 
I understand the diagnosis, but if VSS and shes AAO in NAD, is there a contraindication to waiting to do this case till the am? I probably don't know enough about the complication rate of the mallory tears, just asking if its possible to wait till the am.
 
ozzie20 said:
I understand the diagnosis, but if VSS and shes AAO in NAD, is there a contraindication to waiting to do this case till the am? I probably don't know enough about the complication rate of the mallory tears, just asking if its possible to wait till the am.
Click to expand...

Most GI guys I've met don't like doing things at 1130 pm on Saturday unless they have a good reason.
Vomiting blood--> airway badness, plus he's already d1cked around with the scope, her coughing and bucking could have another bleeder on deck ready to burst

Coming from prison--> hep c/etoh=bad liver=not a friend to the goose (esopha-Goose that is)

mild tachycardia--> in this scenario has a high likelihood of being secondary to some big ole blood loss

I've heard too many stories of GI guys trying to cowboy through a scope in someone like this only to have anesthesia arrive as part of the code team, when its usually game over.
 
Substance said:
I'm an MS4. I like doing cases, so here it goes:

This sounds like its gonna be a huge can of worms.

We are making assumptions about the nature of her GI bleed. Now, given her lifestyle history, its likely its related to varices, ulcers, or gastritis, but we can't be certain. I mean, for all we know, it could be a Dieulafoy lesion.

Her pressure is stable, but she is 110bpm. It could be because she's nervous. It could also be because she's hypovolemic.

I'd get all the usual blood/urinework ordered up over the phone before I got there and a Type and cross. I'd also scrounge up some O- blood(lawsuit prevention) and FFP and hit her with some NS 1L bolus. I'd make sure she has some 12 gauges in both arms too. The blood goes in depending on the crit and symptoms. The FFP goes in with the blood if her coags suck (which they likely do).

How's her EKG?

I'd also strongly recommend that everyone involved in her care wear face and eye shields.

I wouldn't touch her with propofol. If she ends up hypotensive, there's nothing we can do to reverse the effects of the propofol. I'd rather have her in a more stable environment.

Its clear that the benzos and opiates aren't working. I'd consider booking an OR and doing the scope under general. We'd have better control of her airway, and she would be anesthetised in a controllable fashion. Also, should things go sour enough to require surgery, she's already set up for it.

I'm curious what Bill means about her "fighting the scope". Is she grabbing it with her hands?

I'd also ask what medications she's been treated with already.
Click to expand...

You got a lot of that right-on and had good differentials for the stuff you were seeing, thought ahead well. I would just add one thing to your future career: it will serve you well to always treat tachycardia in an otherwise "good-looking" patient with a blood-loss story as hypovolemia/blood loss until proven 6 ways otherwise.
 
Great post, I am constantly amazed how terrible most other parts of the hospital are at BASIC resusication.

Our ER. The multiple stab wound victim who has 2 great 18g IVs in the with the Pedi-tiny-ass T pieces attached so they drip like 5cc/hr. "Oh ya, one of the stab wounds may have hit the liver, but that doesnt bleed much right?"

OUR OB. The post partum hemmorrage patient who looks like death that has gotten methergine q15 min, tons of carboprost, but nobody figured we should hang a blood set, GIVE HER SOME FLUID or GOD FORBIBD PUT IN AN IV bigger than a 20 in one of her dozen monter-pipe veins.

OUR ER again... Incarcerated hernia x6 days at home, NPO x5 days, obtunded, febrile to 39.2, Tachy to 142, with a BP of 90/50. And that foley they put in 2 hours ago is bone dry. "hey we gave a 500cc bolus and hour ago, she ready for the OR"

Our OB again.....well just imagine any nightmare mixed with incompentence and we got it.

These are all from my friday and sunday of call by the way.
:D
 
Magnus67 said:
Our ER. The multiple stab wound victim who has 2 great 18g IVs in the with the Pedi-tiny-ass T pieces attached so they drip like 5cc/hr. "Oh ya, one of the stab wounds may have hit the liver, but that doesnt bleed much right?"
Click to expand...

You get 18s out of your ER? Wow.

At least our "ER Special" antecubital 20g is half of a RIC.
 
well, i had an old lady in the ER with septic shock come in with a BLOWN 20g in the forearm. Atleast she got some of the 1L crystalloid in her forearm. She looked like popeye the sailor man.
 
Thanks, Jet...

As usual, we once again are reinforced that--

SOMETIMES YOU GOTTA STEP UP TO THE MIKE WITH MICATIN.
:thumbup:
 
fakin' the funk said:
This point is pure gold. No matter how much we or other physicians know, if the situation is not assessed and the limitations to our potential interventions removed...the patient's f'ed.

This is what Jet showed, and I think one of the real strengths of anesthesiology training. Too bad the ASA cannot brand and sell this to the public.
Click to expand...


As a licensed pilot (as is Jet) I think flight school drills situational awareness into your psyche. It does grow extra eyeballs onto the back of your skull along with the necessary 6th sense to interpret what you perceive. It also trains you to plan ahead and consider contingencies before they happen ... you can't just pull over at 10,000 feet to change a flat tire. NASA has some great stuff on it as well.
 
jetproppilot said:
Dude, thats pretty direct, huh?

Nutmegs was direct too.

As were others.

You guys were right.:thumbup:

We do MAC scopes all the time but the little birdy in my head was warbling "DANGER!! DANGER!!"

I'm on the phone with the GI guy.

"Dude, I don't think its a good idea to just sedate this girl. I know you're ready to go but ya gotta wait. I'll be there in twenty minutes."

I arrived at the ICU and the patient was alert and oriented, tiny stature, conversive. I explained to her what we were gonna do and off we went.

RSI intubation with propofol 80mg and sux 100mg. Plans to bump with propofol for the 15-20 minutes planned for the case.

GI dude puts his scope in and her belly is FULLA BLOOD.

He's working along, everyone is chatting it up when all of a sudden, probably 10 minutes into the ordeal blood starts flowing outta her mouth. Cups and cups of old blood.:eek::eek:

"Man, I'm glad we didnt do a MAC," I said.

So was everyone else!

Had the GI guy not had us involved he wouldda been in a heap of trouble with certain aspiration. Insufflation just pushed alot of the old blood upwards and out.

He was extremely thankful.

Mallory Weiss tear was the diagnosis so he did his GI stuff and we were done.

Another point is if you walk into something in a foreign environment (read: not in the OR) don't assume anything. As soon as I saw all the blood in her belly I glanced to the IVs...she had 2 20" sukky IVs with those little pigtails attached....a unit of blood was hanging but thats about all it was doing...hanging there.

"We got more blood?" I inquired,

"One more unit downstairs," an ICU nurse said.

Remarkable how content all these critically care trained nurses are with small IV catheters restricted more with the tiny pigtails, with the unit of blood hanging dripping like a KVO line.

We sent for the other unit, ordered more, and remedied the IV situation....as far as rescuscitation this lady needed to be treated like a trauma case....and everyone in the room had missed that boat.

So there it is.

Two big points:

1) Don't do a MAC on someone who could potentially have a stomach fulla blood, even if its near midnight and you're home curled up with your hottie.


2) Don't assume someone else has already thought of steps that need to be taken.

Nice case.

Hope all of you enjoyed it and learned something along the way.
Click to expand...



Nice case jet. Whoever admitted this pt to the ICU violated the first rule when dealing with GI Bleed.. Two BFIVs.
 
jetproppilot said:
1) Don't do a MAC on someone who could potentially have a stomach fulla blood, even if its near midnight and you're home curled up with your hottie.
.
Click to expand...
ill further expound on that. IF you look out the window and it's dark outside, everyone gets an endotracheal tube. PEriod. No LMAS ,NO MACS, NO EPIDURALS. Maybe spinals.
 
maceo said:
ill further expound on that. IF you look out the window and it's dark outside, everyone gets an endotracheal tube. PEriod. No LMAS ,NO MACS, NO EPIDURALS. Maybe spinals.
Click to expand...

sucks for your L & D patients.
 
Good learning case for sure I had one of these patients with Gastric cancer that started to hemmorhage in the ICU at about 3am with a difficult airway. The bougie saved her life as I could only make out an epiglottis swimming in pool of BRB.
 
I would only add one thing: you need a stat surgical consult.

I had a lady in the MICU with a GI bleed when I was an intern. She blew-out a gastroepiploic. The surgery is the only thing that saved her life that night. Of course, she died a week later in the SICU.

-copro
 
Hockeyguy said:
Good learning case for sure I had one of these patients with Gastric cancer that started to hemmorhage in the ICU at about 3am with a difficult airway. The bougie saved her life as I could only make out an epiglottis swimming in pool of BRB.
Click to expand...

Blah. I had my first pulmonary hemorrhage code intubation the other night, which had always been one of my fears. As I was using the Yankauer as a spatula to spoon out clots, two white balls starting bouncing up and down in there to the beat of the compressions. My friends the arteynoids!! I sunk it and won. The patient did not. But I thanked him in my mind for letting me do it so that next time if the person is not so far gone at the beginning they might get a chance.
 
Magnus67 said:
Great post, I am constantly amazed how terrible most other parts of the hospital are at BASIC resusication.

Our ER. The multiple stab wound victim who has 2 great 18g IVs in the with the Pedi-tiny-ass T pieces attached so they drip like 5cc/hr. "Oh ya, one of the stab wounds may have hit the liver, but that doesnt bleed much right?"

:D
Click to expand...

Dudes, I'm amazed and worried at the same time how ubiquitous this practice has become.

I mean, WTF?

Who's teaching the nurses to do this kinda s hit?

Its a dramatic SNAFFU from every angle appreciable!

And yet I see it frequently on emergency patients in dire need of resuscitation.

Theres gotta be some ER studs out there reading this.....so ER studs....

WTF????:confused:
 
ca-chunk-ca-chunk-ca-chunk-ca-chunk-ca-chunk........(say it quickly in your head)..................

that's the sound of the IV pump going at 999 after you order a liter bolus in a crashing patient. Followed by...can we put the LR in a pressure bag instead?
 
coprolalia said:
I would only add one thing: you need a stat surgical consult.

I had a lady in the MICU with a GI bleed when I was an intern. She blew-out a gastroepiploic. The surgery is the only thing that saved her life that night. Of course, she died a week later in the SICU.

-copro
Click to expand...

GF's a surgeon so if I needed it all I had to do was pick up the BAT PHONE and she wouldda been there likkity split, albeit dreary eyed.:D
 
Green912 said:
ca-chunk-ca-chunk-ca-chunk-ca-chunk-ca-chunk........(say it quickly in your head)..................

that's the sound of the IV pump going at 999 after you order a liter bolus in a crashing patient. Followed by...can we put the LR in a pressure bag instead?
Click to expand...

This is the practice that came the closest to me getting in a out and out fight during intern year. "We can't run it off pump". The **** you can't! It's SALINE. The object is for the WHOLE BAG to go in. Why in God's name do you need a pump????
 
nutmegs said:
This is the practice that came the closest to me getting in a out and out fight during intern year. "We can't run it off pump". The **** you can't! It's SALINE. The object is for the WHOLE BAG to go in. Why in God's name do you need a pump????
Click to expand...

At this precise moment in my intern year, I had to go stand in the corner and chant "Serenity Now" for like five minutes before I could move on with life. Mindboggling.
 
Many of the nurses where I'm training ask for central lines the second a patient looks like they are going to need a lot of fluid. No matter how many times I explained that two large bore PIVs are better for fluid resuscitation than a central line (unless it's a big honking shiley), they still don't get it. Also, the pump set to 999 is the fastest we can get fluid into a patient. Really bugged me when we had a similar case in the MICU - patient vomiting lots and lots of BRB. Two PIVs with LR running at 999 each.


Cool case.
 
You see what I mean, people? YOU SEE WHAT I MEAN?

This is precisely what I was alluding to on the other thread!

There are times when you want to scream at them, "I don't want your f***ing opinion on what I can and cannot do right now. Just f***ing do what I tell you!" (Of course, you can't do that without getting written up.) :laugh:

Seriously, I've learned that the best way to handle such conflict in life-or-death situations like this is to say out loud so the whole room hears you, "Now is not the time to discuss why. I take full responsibility for [THIS ACTION]. We can discuss my reasons later. Please just do what I ask. Or, give it to me and I'll do it."

That has worked for me the vast majority of the time. And, what else has helped is being familiar to the staff. Now that people know me and understand that I'm competent, they don't question when I ask for something during a code (for example). Likewise, if I'm out of ideas, I say so and open the floor, so to speak, to other suggestions.

-copro
 
I am having a hard time not commenting on some of the BS and unrelated crap that some people insist on throwing at us.
I just don't want to be accused of hijacking Jet's thread.
 
coprolalia said:
You see what I mean, people? YOU SEE WHAT I MEAN?

This is precisely what I was alluding to on the other thread!

There are times when you want to scream at them, "I don't want your f***ing opinion on what I can and cannot do right now. Just f***ing do what I tell you!" (Of course, you can't do that without getting written up.) :laugh:

Seriously, I've learned that the best way to handle such conflict in life-or-death situations like this is to say out loud so the whole room hears you, "Now is not the time to discuss why. I take full responsibility for [THIS ACTION]. We can discuss my reasons later. Please just do what I ask. Or, give it to me and I'll do it."

That has worked for me the vast majority of the time. And, what else has helped is being familiar to the staff. Now that people know me and understand that I'm competent, they don't question when I ask for something during a code (for example). Likewise, if I'm out of ideas, I say so and open the floor, so to speak, to other suggestions.

-copro
Click to expand...

:hijacked:
 
jetproppilot said:
Who's teaching the nurses to do this kinda s hit?
Click to expand...
Do you see the older more experienced nurses doing this, or is it maybe just the young'ns? It seems like there's such a shortage of nurses EVERYWHERE, that they just throw nurses fresh outta school into acute areas like ICU and ER now. I don't think that's necessarily an excuse, but maybe it's a reason. Any nurses out here who can explain?
 
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