Blame anesthesia.

[sbhfl]

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2 nursing interactions in past 12 hours--
1. ESRD patient developed hyperkalemia from respiratory acidosis/overnarcosis on the floor. He got 600cc NS intraop. Renal NP is consulted, who writes, "Patient received 600cc LR from anesthesia, which likely contributed to his severe hyperkalemia." Even if it was LR, he would have gotten what, like 2.4mEq of K?

2. Fetus has 1 late decel 45minutes after epidural. BP is 115/60s, mom is asymptomatic. When she was withering in pain, it was 125/60s. Repeat BP is still in 110s, pt has more contractions without late decels. Nurse blames epidural because this is "relative hypotension" and demands ephedrine.

Love the job despite these things.

 

[ScarfTheVerb]

I always use NS in ESRD patients. Not because it’s good medicine, but to avoid conversations like this one.

 

[sbhfl]

I always use NS in ESRD patients. Not because it’s good medicine, but to avoid conversations like this one.

Same here, in this case NS was used anyway.

 

[agammaglobulin]

Agree. NS may even be worse for ESRD patients depending on how much volume you give. NS causes acidosis where, as sbhfl said, potassium from LR is minimal...

 

[deleted697535]

I would definitely find who wrote those things and have a word. I don't mind any questioning but if you write sh1t about somebody on a legal document I think you should have to defend yourself

 

[Aether2000]

OB nurses are the most passive/aggressive people on the planet, and anesthesiologists frequently must deal with their delusions of omniscience.

 

[deleted50478]

2 nursing interactions in past 12 hours--
1. ESRD patient developed hyperkalemia from respiratory acidosis/overnarcosis on the floor. He got 600cc NS intraop. Renal NP is consulted, who writes, "Patient received 600cc LR from anesthesia, which likely contributed to his severe hyperkalemia." Even if it was LR, he would have gotten what, like 2.4mEq of K?

2. Fetus has 1 late decel 45minutes after epidural. BP is 115/60s, mom is asymptomatic. When she was withering in pain, it was 125/60s. Repeat BP is still in 110s, pt has more contractions without late decels. Nurse blames epidural because this is "relative hypotension" and demands ephedrine.

Love the job despite these things.

Give her this. Short and sweet.

Myth-busting: Lactated Ringers is safe in hyperkalemia, and is superior to NS.

 

[Psai]

Why is an np consulted? Not only are they wrong in multiple ways, they are clearly very stupid

The only time I don't use LR is in neuro cases. I give LR with blood, ceftriaxone, zofran, etc. etc. etc.

 

[coffeebythelake]

2 nursing interactions in past 12 hours--
1. ESRD patient developed hyperkalemia from respiratory acidosis/overnarcosis on the floor. He got 600cc NS intraop. Renal NP is consulted, who writes, "Patient received 600cc LR from anesthesia, which likely contributed to his severe hyperkalemia." Even if it was LR, he would have gotten what, like 2.4mEq of K?

2. Fetus has 1 late decel 45minutes after epidural. BP is 115/60s, mom is asymptomatic. When she was withering in pain, it was 125/60s. Repeat BP is still in 110s, pt has more contractions without late decels. Nurse blames epidural because this is "relative hypotension" and demands ephedrine.

Love the job despite these things.

your example points to nurses who obviously have no clue. but this happens all the time with surgeons and even internal medicine docs.

 

[sethco]

Why is an np consulted? Not only are they wrong in multiple ways, they are clearly very stupid

The only time I don't use LR is in neuro cases. I give LR with blood, ceftriaxone, zofran, etc. etc. etc.

I get the blood. What is the deal with the Zofran and Ceftriaxone? Never heard that you shouldn't use with LR. Just "compatibility" issues?

 

[Ronin786]

Absolutely zero reason you shouldn't be chewing out the NP for defaming you in her note.

You're a physician and she's a nurse. I see absolutely zero reason you should let this fly. Who cares about honey.

 

[narcotics999]

You should confront the nurses. Do it once, they will not shxt on you again.

 

[2Fast2Des]

OB nurses are the most passive/aggressive people on the planet, and anesthesiologists frequently must deal with their delusions of omniscience.

One of the OB nurses calls me anesthesia person and tells me to take pictures of the new parents and their wrapped burrito as if I have nothing better to do while the patient is bleeding and the OB is taking their sweet time to close. This is in an all MD practice so they know who we are but no respect still

 

[sbhfl]

Absolutely zero reason you shouldn't be chewing out the NP for defaming you in her note.

You're a physician and she's a nurse. I see absolutely zero reason you should let this fly. Who cares about honey.

I called her, put on a nice voice and she changed the note. Chewing her out would have been cathartic, but you've got to pick your battles.

 

[DirtDocMD]

A call to the hospital’s risk management officer will often nip this sort of behavior in the bud.

 

[caligas]

I called her, put on a nice voice and she changed the note. Chewing her out would have been cathartic, but you've got to pick your battles.

Well handled with desired result. If she was obstinate then you take it up a level.

 

[AdmiralChz]

I called her, put on a nice voice and she changed the note. Chewing her out would have been cathartic, but you've got to pick your battles.

This is EXCEEDINGLY important, especially for us young guns out there. Many of us were in programs that were fairly dictatorial and hierarchical, so through that osmosis many would respond with yelling and teeth gnashing... that doesnt help build good relationships. There are definitely problems with personalities, laziness and knowledge gaps around but one has to play the game.

 

[jwk]

One of the OB nurses calls me anesthesia person and tells me to take pictures of the new parents and their wrapped burrito as if I have nothing better to do while the patient is bleeding and the OB is taking their sweet time to close. This is in an all MD practice so they know who we are but no respect still

But did you take the picture? 😉

 

[2Fast2Des]

But did you take the picture? 😉

I told her I was busy taking care of things. I don't get why we're turned into the de facto photographer when the OR nurse is figri there. It's hard to fake excitement everytime to take a picture. Rinse repeat

 

[deleted162650]

I told her I was busy taking care of things. I don't get why we're turned into the de facto photographer when the OR nurse is figri there. It's hard to fake excitement everytime to take a picture. Rinse repeat

Take the pic, run it through an IG filter or 2, then give Mom your card with a link where she can download photos for the low price of $49.99.

 

[Twiggidy]

One of the OB nurses calls me anesthesia person and tells me to take pictures of the new parents and their wrapped burrito as if I have nothing better to do while the patient is bleeding and the OB is taking their sweet time to close. This is in an all MD practice so they know who we are but no respect still

Either...
A) I don't know how to use this thing (even if it's an iPhone)
B) I'm an anesthesiologists not a photographer. I say the same thing when they say something about the music playing. I"m not a DJ, and if I were, I'd probably be getting paid more and having much more fun

 

[kidthor]

A call to the hospital’s risk management officer will often nip this sort of behavior in the bud.

Too bad the hospital risk manager is an RN, JD.

 

[chocomorsel]

One of the OB nurses calls me anesthesia person and tells me to take pictures of the new parents and their wrapped burrito as if I have nothing better to do while the patient is bleeding and the OB is taking their sweet time to close. This is in an all MD practice so they know who we are but no respect still

And you take this because......? I tell the nurses my name is not anesthesia. It's Dr. Choco

 

[Psai]

One of the OB nurses calls me anesthesia person and tells me to take pictures of the new parents and their wrapped burrito as if I have nothing better to do while the patient is bleeding and the OB is taking their sweet time to close. This is in an all MD practice so they know who we are but no respect still

Why do you let yourself be a doormat? "It is doctor 2Des to you and you can feel free to take pictures for the family."

 

[okayplayer]

You guys must get along great with the RNs in your hospitals.

 

[Twiggidy]

You guys must get along great with the RNs in your hospitals.

I love my OR nurses. The OB nurses?

 

[2Fast2Des]

Still used to being a new attending, when as a resident keeping your mouth shut was the best way to stay out of the principal's office. We are always just anesthesia. Still feel weird to be called Dr.,

 

[coffeebythelake]

if you're intimidating as **** that even some of the surgeons are afraid of u, this **** doesn't happen

 

[MirrorTodd]

if you're intimidating as **** that even some of the surgeons are afraid of u, this **** doesn't happen

So be as swole as possible and wear a scowl at all times?

 

[DocVapor]

So be as swole as possible and wear a scowl at all times?

No, just on your first day take down the biggest, baddest Ortho you can find. After that you're good to go.

 

[deleted162650]

No, just on your first day take down the biggest, baddest Ortho you can find. After that you're good to go.

No, you walk straight up to the highest ranking clipboard RN you can find, rip the clipboard outta her hands, and smash it over her head into a thousand splinters. Then pull off your bouffant cap and let it slowly fall onto her unconscious body as you walk away without saying a word. It sends a message.

 

[MoMoGesiologist]

... you shouldn't have to hit people or put them down to get respect...

And @2Fast2Des , I definitely agree that anesthesia residency trains you to be everyone's doormat (to your attendings, surgeons, nurses, IV pole, trash can, etc). I wonder if other residencies are like that...

 

[Twiggidy]

Plain and simple. Know what battles to pick. Don't let anyone walk all over you but also don't have a "reputation".

 

[nimbus]

No, you walk straight up to the highest ranking clipboard RN you can find, rip the clipboard outta her hands, and smash it over her head into a thousand splinters. Then pull off your bouffant cap and let it slowly fall onto her unconscious body as you walk away without saying a word. It sends a message.

Ironically the clipboard brigade banned fiberboard clipboards in our operating rooms. We now have aluminum clipboards which do not splinter.

 

[thegenius]

Give her this. Short and sweet.

Myth-busting: Lactated Ringers is safe in hyperkalemia, and is superior to NS.

My guess is 1L of any standard crystalloid, LR, NS, normosol, etc won’t do anything or measurably change any level of any electrolyte or acid base status ever. 1L is just not a lot of fluid, let alone 600 cc.

 

[deleted547339]

Ok a related note, I don’t know what the appropriate thing to call you guys is when it’s an emergency and I don’t know your name. I’m at a big academic center with anesthesia residents and attending a falling over each other. I’m EM and CCM, so if you’re involved, it’s usually already a goat rodeo.

I usually say “hey anesthesia, sorry I dont know your name, please <insert request>“ then introduce myself once the situation has calmed down and thank them.

Am I’m making my colleagues see the inside?

 

[Twiggidy]

Ok a related note, I don’t know what the appropriate thing to call you guys is when it’s an emergency and I don’t know your name. I’m at a big academic center with anesthesia residents and attending a falling over each other. I’m EM and CCM, so if you’re involved, it’s usually already a goat rodeo.

I usually say “hey anesthesia, sorry I dont know your name, please <insert request>“ then introduce myself once the situation has calmed down and thank them.

Am I’m making my colleagues see the inside?

What’s wrong with “Doctor”?

First of all everyone should be wearing a name
badge and all you have to do is see those 2 letters that say MD after their name.

So yeah, “hey Doc. Can you help me with this?” That seems pretty simple

 

[RedPhys]

And @2Fast2Des , I definitely agree that anesthesia residency trains you to be everyone's doormat (to your attendings, surgeons, nurses, IV pole, trash can, etc). I wonder if other residencies are like that...

Literally the first thing an anesthesia resident told me when I was in 3rd year rotations, "Anesthesia is great, but you need to know you won't ever be the alpha-male, and you have to be okay with that." I wasn't a fan of the wording, but sounds like it rings true

 

[DM27]

You basically need to be a beta with the capability to "go alpha" if needed. There are the occasional occurrences where you need to be able to step in and take charge, often because you're the only one aware a problem is happening or you're the only person in the room capable of managing it. The rest of time you are basically the great facilitator for the ORs.

 

[deleted547339]

What’s wrong with “Doctor”?

First of all everyone should be wearing a name
badge and all you have to do is see those 2 letters that say MD after their name.

So yeah, “hey Doc. Can you help me with this?” That seems pretty simple

Doctor doesn’t work when there are 6 doctors in the room...it’s typically trauma bay or an “all hands on deck” type of situation. Is “anesthesia doc” better?

 

[Psai]

Doctor doesn’t work when there are 6 doctors in the room...it’s typically trauma bay or an “all hands on deck” type of situation. Is “anesthesia doc” better?

Id rather be called hey dude

 

[MoMoGesiologist]

Ok a related note, I don’t know what the appropriate thing to call you guys is when it’s an emergency and I don’t know your name. I’m at a big academic center with anesthesia residents and attending a falling over each other. I’m EM and CCM, so if you’re involved, it’s usually already a goat rodeo.

I usually say “hey anesthesia, sorry I dont know your name, please <insert request>“ then introduce myself once the situation has calmed down and thank them.

Am I’m making my colleagues see the inside?

I don't get why people get butt hurt when they get called anesthesia by random people. The person calling you anesthesia obviously is not trying to offend you on purpose, they just don't know your name among the hundreds of people you work with at the hospital. They are just asking you for help. Is saying to a random person "hey nurse" or "hey janitor" offensive when you are in a code or emergency situation? Someone didn't address you as doctor so now you feel small? I think that's more a reflection on you than them. Me being called anesthesia doesn't take away the respect I have in myself or my skill set. It doesn't somehow make the MD after my name invalid. I think who cares?

Now if you work with someone consistently and they refuse to learn your name, that's another story.

 

[Mman]

... you shouldn't have to hit people or put them down to get respect...

And @2Fast2Des , I definitely agree that anesthesia residency trains you to be everyone's doormat (to your attendings, surgeons, nurses, IV pole, trash can, etc). I wonder if other residencies are like that...

also trained me to make more money than them so I'm cool with it.

But on a serious note, I'm nobody's doormat. I will kick in and do whatever is necessary to get the cases done as quickly and safely as possible. If helping push a bed or move a patient over is what I can do at the moment, than that's what I will do. If swinging from the OR lights to get the proper angle to intubate a patient that nobody else can get is required, I will transform into Tarzan. The only people that ever call me "anesthesia" are the ones that haven't met me yet.

 

[pjl]

also trained me to make more money than them so I'm cool with it.

But on a serious note, I'm nobody's doormat. I will kick in and do whatever is necessary to get the cases done as quickly and safely as possible. If helping push a bed or move a patient over is what I can do at the moment, than that's what I will do. If swinging from the OR lights to get the proper angle to intubate a patient that nobody else can get is required, I will transform into Tarzan. The only people that ever call me "anesthesia" are the ones that haven't met me yet.

The rest call you “Tube Monkey?”

 

[rakotomazoto]

Also a recent grad, I am also navigating how to use my new superpowers like 2Fast2Des. It sure is nice to have the training wheels removed. In different situations, I find myself channeling my favorite attendings, "what would Dr. XYZ do/say in this situation?" Grateful for all of the good and bad examples that I saw for the past 4 years. Fortunately, I am at a much smaller hospital than the one I trained at so navigating the environment and various personalities is actually overall much easier. Everyone learned my name quickly and most of the RNs and staff call me Dr. Rakotomazoto, even though at first I was telling everyone to call me by my first name since it sounded so weird to be "Dr. Rakotomazoto" all the time.

Personally I prefer it when people just say, "Hey" or "Excuse me" or "Doctor" rather than "Anesthesia" if they can't remember my name. I haven't been bold enough to correct anyone, though. I also learned not to rock the boat during medical school and residency, that is one of the fundamental pillars of the hidden curriculum.

 

[GlowInTheDark]

The rest call you “Tube Monkey?”

“That’s Dr. Tube Monkey, thank you very much.”

 

[GlowInTheDark]

Pre-op nurse referred to me as a CRNA to the patient this morning.

Patient corrected pre-op nurse immediately, “This guy ain’t no CRNA, I’ve got a doctor doing my anesthesia.”

Yea, dude totally got some extra “happy juice” for that one.

 

[2Fast2Des]

Pre-op nurse referred to me as a CRNA to the patient this morning.

Patient corrected pre-op nurse immediately, “This guy ain’t no CRNA, I’ve got a doctor doing my anesthesia.”

Yea, dude totally got some extra “happy juice” for that one.

Extra? He should remember how he got back, not more amnesia😉

 

[MetaPhysicianBlog]

No, just on your first day take down the biggest, baddest Ortho you can find. After that you're good to go.

I personally like to say 'surgery table up' when I am intubating to establish dominance in the room from the get go.

 

[partydoc]

I personally like to say 'surgery table up' when I am intubating to establish dominance in the room from the get go.

If you really want to assert dominance, ask for cricoid and then criticize their technique.