I figure I'd put a few things I learned from my intern year regarding pages and dealing with nurses while an intern.
If a nurse pages you in the middle of the night and says that the patient "doesn't look right or looks ill, etc.", ask for details (What specifically makes the pt NOT look well? Pallor, diaphoresis, ill-looking, is the patient in pain, N/V, etc. , ask for Vitals and if they've changed (if you're cross-covering). If the patient is hypoxic, ask the nurse to provide O2 (in whatever manner you think is appropriate), if the pt is complaining of chest pain --> ask nurse to get an ECG, makes sure that there's a good IV and consider asking for nurse to give SL Nitro. Then GO and see the patient. Even if you know that 99.9% of the time, it will be OK and pt will not need anything to be changed in the current management, you still should make sure that the pt is OK and stable. Then ALWAYS document that you were call (mention what the nurse told you) and what you found when you saw the patient. Never lie or it WILL come back to hurt you.
If you get a page about a change in vital signs, I usually did the following:
If call is for elevated BP ---> ask what the pt's baseline has been (if you're cross-covering), then if it's not critical ask the nurse nicely to recheck the BP and give some sort of parameters... i.e. "check BP again please and ONLY call back if it's >160 SBP. Always consider pt's current problem when accessing whether to treat an elevated BP... i.e. If they've just had a stroke for example, a BP of 180/110 does not need to be critically lowered or lower at all. But a person without a stroke and the same BP, will need to have action taken.
If you get called by a nurse for a decreased O2 sat... ask if pt is COPD and what is person's baseline and if they're on O2 currently. This will help to access to what action you will need to take. If no COPD and no O2 currently, ask nurse to give patient O2 (this depends on what the % is) and then go see the pt---> consider getting an ABG and/or CXR in order to access why pt is hypoxic.
If you get a call about tachycardia, ask about pain, presence of fever, recent surgery or procedures, agitation, what's the BP and other VS... then access if treatment is necessary based on the answer to those questions. If pt is on telemetry and you get a call about a pt having a string of VTach... ask "how many beat in a row" or "for how many seconds consecutively"... If VT lasts for >30 seconds in a row ----> sustained VTach ---> get your ass to the patient right now and treat it immediately (if cardioversion if unstable, meds if stable)
if non-sustained VT ---> check on the pt, check pulse Ox and last K levels as this might be a sign of low K and hypoxia.
If you get a call about a fever --> ask the nurse if pt is getting any kind of transfusion, if so --> consider the possibility of a transfusion reaction and treat... if pt is getting a transfusion then stop it and access the pt. If no transfusion, see if pt had cultures taken in past 48 hours... if so, you can safe with just giving Tylenol and consider getting a CXR and urine cultures on the pt. If pt does not have any recent cultures --> Give Tylenol and then get CXR, Blood Cx x 2, urine cx and possibly Sputum cx (although this is not a must especially in vent pts--> low yield and often have contaminants). The answer is NEVER... "just give the pt tylenol" and hang up... you must address this and then sign it out to the in-coming team.
If you get a page about hematuria in a pt with a foley (for example)... go to the pt and access it and then see if pt is taking ASA, Plavix, anticoagulation, aggrenox and consider d/cing them for the time being and sign out to the next team to follow-up on the foley and restart if hematuria resolves.
If you get a page about a low BP---> ask what the other VS are, what the pt's reason for being there is (any trauma, recent surgery any reason to believe that they're septic, volume depleted), if they're on an drugs that can drop their BP (i.e. Betablockers, vasodilators, optiates, etc.) and if they've been given recently. Go see the pt and examine them for signs of shock, hypovolemia, internal bleeding, etc. and act accordingly. If you think pt is bleeding, send a stat CBC and type and screen for 2 units and consider doing a rectal if you suspect pt has bleeding in his/her intestinal tract (ie. post op, mesenteric ischemia. Check for peritoneal signs if you're suspecting of intraabdominal bleeding and/or perforation.
If you get paged about tachypnea, ask about pain, associated symptoms, O2 sat and if pt is on oxygen... see pt if it's severe and do ABG.
If you get paged for agitation ---> see what is the patient's comorbidity and age as this will change the treatment that you give. If you feel that pt needs treatment... Avoid benzos in Elderly as they can become even more agitated from benzos. You can elderly a low dose of Haldol if you feel they need treatment. Consider 1:1 watch and/or restraints. Also avoid benzos in Chronic Liver disease pts as it can cause their liver disease to decompensate. Consider Lactulose in ESLD pt's with agitation as it might be secondary to hepatic encephalopathy. You can give haldol to these patients as well. Consider possibility of EtOh withdrawal if pt is alcoholic and a day or two from his last drink. Then use benzos.
Try to write for specific parameter for when to "call MD" in your orders so that you don't get bothered as much.
If you get paged for FSBS of <50. Go see the pt and give pt 1 amp of D50 and ask nurse to check FSBS in 30 minutes after dose given. Always try to assess pt's insulin coverage and why pt has such a low FSBS and adjust accordingly.
That's all I can think of for now.
