Consults- Memorable/Dismal/Ridiculous/Unique

[45408]

Lot of consults are CYA. If something goes wrong while your orthopod is managing DM you can bet the sharks would be all over him. Medicine in general has become so specialized. It makes sense to have someone managing things who does it everyday, not just once in awhile. It's better for the pt and better at keeping the lawyers away. A win win situation really.

Disagree, to some extent. When we get cardiology, medicine and ID involved in the same patient, it gets very complicated for the patient to understand when they have four different services saying "Well, that part is up to so-n-so, I'm just here for this," and then different people have different opinions on when to re-start anticoagulation or blah blah blah.

If you need someone's help, by all means ask for it, but if you've got things under control, then I think it's worse to just load the boat for giggles and thrills. Now, if the orthopod is making adjustments to the patient's outpatient BP/DM medications, that's over his head, but a tweak here or there as an inpatient should not be considered inappropriate.

As a GI attending, having GS housestaff onboard for GI bleeds is generally unhelpful. Patients get CTs they don't need and there is pressure to scope earlier than the evidence supports. The only exception to this is in the one hospital I cover where there aren't hospitalists. In that setting, the GS residents do a much better job than the primary doc of ensuring that appropriate resuscitation occurs.

In general, as someone who works with both IM and surgical services, it is a simple fact of my life that complex patients get better care on surgical services. Sometimes I feel that a couple of hours in the OR getting managed by an anesthesiologist and then getting post-op care from a surgical service is all a patient needs regardless of the indication for surgery. That said, I really want surgeons to operate when I consult.

If someone is grossly underresuscitated, the OR can be a good place to remedy that, because of the very intensive monitoring and medication titration, but for the vast majority of patients, the ICU is as good/better of a place to do that, since the patient isn't getting an inhaled anesthetic with all of its attendant side effects. In my specific hospital, the patient can get a central line or a-line faster in the OR (the lighting, the table, the ultrasound is handy, the tech knows what to get), blood seems to arrive much much faster from the blood bank, and they've got an entire cocktail of drugs sitting right in their cart.

Your username is misspelled.

Must have been a different evening of intoxicated posting.

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[Pir8DeacDoc]

Agree with you.

I don't mean we should be consult overkill. I do feel better having a hospitalist involved. If they think we need GI or cards or whatever so be it. I agree that too many cooks can clutter the kitchen.

 

[Winged Scapula]

What an irritating story. I wonder if the attorney's vindictive behavior is something his/her state bar can do something about. I'd have probably filed a complaint.

While I am loathe to defend him, I'm not sure what was vindictive about his behavior. He was simply doing his job.

Settlement letters are effective and as it has been explained to me, they spend a few hours typing these things up and every now and again, a physician (not realizing the drawbacks of settling) will agree and its over. Or perhaps the malpractice provider will recommend settling (hopefully no one has a policy that allows the provider to settle without your approval) Easy money.

When you refuse to settle, they next try and intimidate you with the threat of reporting you to the Board. That probably works on another group of physicians.

If reporting you doesn't work, then the next step is suit. Well, actually the next step in my case was an attempt at Arbitration, which I was required to attend but refused to accept anything less than dropping of the suit.

So as much as I despised the process, this is "par for the course" and is not considered vindictive.

This book was very helpful to me to understand the process as was this one.

 

[Gastrapathy]

No it isn't. I was apathetic about my military career. Now I'm out of the .mil. Wasn't going for gastropathy. It may be lame but it wasn't misspelled.

 

[balaguru]

Sorry, didn't mean to make you relive it. From your description earlier it had sounded like the pt dropped the suit after the deposition revealed her complaint had no merit. If that is true than a complaint to the state board that is filed subsequent to the pt dropping her suit has no benefit to the patient nor any of your future patients and would only serve in making your life more difficult at very little cost to him or his client--making him/her a dirty SOB.

While I am loathe to defend him, I'm not sure what was vindictive about his behavior. He was simply doing his job.

Settlement letters are effective and as it has been explained to me, they spend a few hours typing these things up and every now and again, a physician (not realizing the drawbacks of settling) will agree and its over. Or perhaps the malpractice provider will recommend settling (hopefully no one has a policy that allows the provider to settle without your approval) Easy money.

When you refuse to settle, they next try and intimidate you with the threat of reporting you to the Board. That probably works on another group of physicians.

If reporting you doesn't work, then the next step is suit. Well, actually the next step in my case was an attempt at Arbitration, which I was required to attend but refused to accept anything less than dropping of the suit.

So as much as I despised the process, this is "par for the course" and is not considered vindictive.

This book was very helpful to me to understand the process as was this one.

 

[Winged Scapula]

Sorry, didn't mean to make you relive it. From your description earlier it had sounded like the pt dropped the suit after the deposition revealed her complaint had no merit. If that is true than a complaint to the state board that is filed subsequent to the pt dropping her suit has no benefit to the patient nor any of your future patients and would only serve in making your life more difficult at very little cost to him or his client--making him/her a dirty SOB.

No apologies necessary..I live everyday in a very litiginous field, and expect to be sued again. I am blessed that I had the opportunity to learn about the process with such a case, rather than one which was indefensible.

This was the order in which the process occurred:

1) Request for Settlement ---> Denied
2) Complaint to AZ Medical Board ---> Independent Expert found no Breach of Duty/No censure or license action taken
3) Subpeona/Suit Filed
4) Videotaped Deposition (mine)
5) Arbitration ---> Refusal to Settle/Admit Breach of Duty, Damages or Culpability
6) Deposition (plaintiff)
7) Another Request for Settlement (much lower amount) ---> Denied
8) Dropped with Prejudice

 

[mimelim]

1) Consult from transplant team comes in for CRS (team 1)
2) Intern looks up and sees that another CRS (team 2) has seen this patient 5-6 times in the past as an inpatient and tells transplant team that they should consult team 2.
3) Transplant team consults team 2 who tells them that the patient doesn't need an operation and should follow up as an outpatient.
4) Transplant team calls team 1 and asks for a second opinion.
5) Intern from team 1 sees patient, becomes pretty clear that there is no reason to go to the OR now.
6) Transplant team calls team 2 and tells them that team 1 is seeing the patient.
7) Team 2 calls transplant team and lets them know that they will operate tomorrow, on Good Friday so they don't lose the business.

 

[45408]

Can't team 1 just refer the patient for the same outpatient follow-up? seems like some bad intra-department blood if they can't save a patient for their partners.

 

[mimelim]

Can't team 1 just refer the patient for the same outpatient follow-up? seems like some bad intra-department blood if they can't save a patient for their partners.

Team 1 and team 2 are different, competing CRS practices. We would have told them exactly what team 2 said and told them to follow up with them as an outpatient. This was at least in my opinion the transplant team bullying someone else into operating. I've seen it before where patients that don't even come close to meeting the criteria for IVC filters or Nissens end up getting them because the primary team simply wants them and will doctor shop until they get a surgeon who will do it.

 

[Pir8DeacDoc]

What complete BS. Sad that's what it takes for some practices to stay in business.

 

[TrustMe]

I'm totally late to the game but thought I would share in the misery/comedy. I was an intern doing a month rotation in the ED working the night shift. 20-something year old dude gets sent from his nursing home/group home for nausea/vomitting. H/o DD/V-P shunt/CP/etc. Vitals normal, exam is at baseline according to staff that brought him (non-verbal, non-ambulatory, etc.), abdominal exam is totally benign. Labs normal, KUB normal, CT head and shunt series normal. Decide to send him back to nursing home now at 2 a.m. My ED attending insisted on me calling neurosurg "just to let them know he was here". Me: "Even though everything was normal and he's going back". Attending: "Yes. They put in his shunt, they should know he was here." When the neurosurg resident called back I should have said, "Before I tell you the story, please come down the the ED and punch me the face so you won't hate me as bad afterwards." He surprisingly did not berate me on the phone, even though I could tell that I had woken him up for that "notice", and he had every right to be pissed.

 

[Bostonredsox]

I'm totally late to the game but thought I would share in the misery/comedy. I was an intern doing a month rotation in the ED working the night shift. 20-something year old dude gets sent from his nursing home/group home for nausea/vomitting. H/o DD/V-P shunt/CP/etc. Vitals normal, exam is at baseline according to staff that brought him (non-verbal, non-ambulatory, etc.), abdominal exam is totally benign. Labs normal, KUB normal, CT head and shunt series normal. Decide to send him back to nursing home now at 2 a.m. My ED attending insisted on me calling neurosurg "just to let them know he was here". Me: "Even though everything was normal and he's going back". Attending: "Yes. They put in his shunt, they should know he was here." When the neurosurg resident called back I should have said, "Before I tell you the story, please come down the the ED and punch me the face so you won't hate me as bad afterwards." He surprisingly did not berate me on the phone, even though I could tell that I had woken him up for that "notice", and he had every right to be pissed.

That's an easy one. Just start that convo with "dude I know your sleeping and I'm trying to send this guy home but my attending insisted I call you guys...." And then roll it out. The buck stops with your attending you can't deny them. But you can, between residents, Through them under the bus if its bull****. We have a weak hospitalist that calls cardio for almost every chest related complaint. I text the attending cardiologist...hey man I'm sorry to give you this crap but attending X, whom is known for this, wants you to see this pt. the response from him is usually no problem ill take care of it. I always make it known to my consultants why I am consulting them, especially if my attending is forcing it. They generally understand the residents situation.

 

[45408]

It's always less painful if someone acknowledges that it's weak, but their attending/patient/family wants it anyway. Also helps you gauge what kind of response they want from you.

 

[blue2000]

It's always less painful if someone acknowledges that it's weak, but their attending/patient/family wants it anyway. Also helps you gauge what kind of response they want from you.

I can remember having to consult ortho as an intern on a guy who was 400 lbs, s/p recent gastric bypass, who had 8 YEARS of knee pain. He was a difficult patient in many ways (I'll never forget walking in to his hospital room, where he was watching porn and had his hand in his open infected wound) and I think the attending was just trying to do everything to get him out of the hospital. I called the resident on ortho and started with "Dr. X asked me to call you about...." which covered my bases, especially because Dr X was a really wonderful person and very supportive of residents.

 

[skiz knot]

I can remember having to consult ortho as an intern on a guy who was 400 lbs, s/p recent gastric bypass, who had 8 YEARS of knee pain. He was a difficult patient in many ways (I'll never forget walking in to his hospital room, where he was watching porn and had his hand in his open infected wound) and I think the attending was just trying to do everything to get him out of the hospital. I called the resident on ortho and started with "Dr. X asked me to call you about...." which covered my bases, especially because Dr X was a really wonderful person and very supportive of residents.

My reply would be "send him to clinic" followed by the the phone hanging up.

 

[Instatewaiter]

Apparently lawsuits have dropped significantly in the state because of the high rate of physician triumph; however, as my attorney tells it, that means that those who are still in practice suing doctors, are especially hungry and will take any two-bit case that comes along.

The whole process was *very* enlightening.

Why not pay him back in kind? Report him to the Az bar. If nothing else it will cause him the same worthless hassle he caused you. You could sue the plaintiff for damages for a clearly frivolous lawsuit It is rare but it happens.

Now, if the orthopod is making adjustments to the patient's outpatient BP/DM medications, that's over his head, but a tweak here or there as an inpatient should not be considered inappropriate.

Seems most orthopods don't agree with you.

If someone is grossly underresuscitated, the OR can be a good place to remedy that

Haha, I have found they "remedy that" even when the patient has a wedge of 30. Nothing better than having a cardiomyopathy go from compensated to shock because 3 liters given during of a routine surgery.

 

[VisionaryTics]

Bump.

One of the funnier moments of intern year so far: dermatology as primary on an inpatient.

"Hi, ENT returning a page."
"Hi, this is Dr. Skin with dermatology. We have a consult."
"Okay, what's the name and MRN."
"Uh, Mrs. Johnson."
"MRN?"
*Sound of fumbling papers*
"Nevermind, room number?"
"Bed 7."
"Bed 7 where?"
"Inpatient."
"...what floor?"
"Ah, 10th floor."
"So, 1007, which bed?"
"Uh...7?"
"Okay, what's the problem?"
"We think she has EM major and we want to do an oral mucosa biopsy and we would like you there for hemostasis."
"...uh, can you just use some silver nitrate sticks?"
"We would feel more comfortable with you there."
"We do oral biopsies in the clinic all the time. Just hold a silver nitrate stick on there for a couple of seconds."
"Where can we get silver nitrate sticks?"
"The ED usually has some."
"Where is the ED?"

 

[Pir8DeacDoc]

The funniest part is that derm was primary on a pt. Wow

 

[dpmd]

Bump.

One of the funnier moments of intern year so far: dermatology as primary on an inpatient.

"Hi, ENT returning a page."
"Hi, this is Dr. Skin with dermatology. We have a consult."
"Okay, what's the name and MRN."
"Uh, Mrs. Johnson."
"MRN?"
*Sound of fumbling papers*
"Nevermind, room number?"
"Bed 7."
"Bed 7 where?"
"Inpatient."
"...what floor?"
"Ah, 10th floor."
"So, 1007, which bed?"
"Uh...7?"
"Okay, what's the problem?"
"We think she has EM major and we want to do an oral mucosa biopsy and we would like you there for hemostasis."
"...uh, can you just use some silver nitrate sticks?"
"We would feel more comfortable with you there."
"We do oral biopsies in the clinic all the time. Just hold some a silver nitrate stick on there for a couple of seconds."
"Where can we get silver nitrate sticks?"
"The ED usually has some."
"Where is the ED?"

The most remarkable part of this is that derm had admitted a pt at all.

 

[VisionaryTics]

The most remarkable part of this is that derm had admitted a pt at all.

From my conversation on the phone, I'm not sure they had ever personally called a consult in.

Actually, the funny part was they consulted OMFS and then called ENT because they though we were the same specialty.

 

[filter07]

I had a consult recently for an acutely cold hand. They first paged the wrong number, then paged the attending instead. I go see the patient, and lo and behold, pulses are normal, doppler signals to the arch and digits. Warm, well perfused.

No big deal, sometimes this kind of thing happens, some of these cold hands are self-limited. I advise the patient to keep his hands warm and out of the cold. I communicate my findings to the primary physician.

As I go to the chart to write the note, I notice the consult was made to the wrong specialty. In addition, there is a paragraph saying how they disagree with my diagnosis, and proceeds to quote a junior surgical textbook regarding the epidemiology of a SYMPTOM, which by the way has a bunch of different etiologies. The final insult is that the plan is exactly the same as mine.

This consult got everything wrong. Page the wrong person, incorrectly assess the acuity of the situation, place a consult for the wrong service, then write a passive aggressive note quoting a junior surgical text that only serves to demonstrate their own superficial understanding of the topic. If you are going to consult a specialist, don't be a douche. Don't say you disagree but since I'm the specialist you will go ahead with my plan. YOU are their primary physician, either give up responsibility and shut up, or speak up and make your own decisions.

 

[sublimaze]

i've read most of this thread and thoroughly enjoyed myself.
as an anesthesiologist, we usually don't get consulted for anything other than emergencies (code/intubations) or pain managment.
sometimes, we get called for IV placement since we are (supposedly) deft with needles.
this was probably my most unfortunate IV consult as a resident, courtesy of L&D.

(phone call at 0300)
me: dr. sublimaze, OB anesthsia, how can i help you?
nurse: hi, we need help with a difficult IV stick in room 534 - we've tried multiple times with no luck.
me: sure, I'll swing by. (gather IV supplies, get ultrasound, walk to pt's room)
(pt has HIV but otherwise normal, normal BMI, great veins, single bruise on left AC from unsuccessful stick - pt super cooperative, I get an 18g easily)
me: she was actually pretty easy - you sure you guys really tried more than once? she only had 1 bruise...
nurse: oh, she has HIV so I was worried about getting stuck so I called you guys.
me: ??? so let me get this straight, you didn't want to get stuck but it's OK if I do?
nurse: .... (blank stare)...

i'm ok with laziness because I've come to expect it, but this flagrant dishonesty was something new.
waking me up at 3 am to secure IV access is OK - crash section without an IV is a disaster - but lying through your teeth is completely unacceptable.
I actually reported her to the nursing manager not out of spite but because I was genuinely concerned that she lacked the necessary number of properly firing neurons to do her job.
interestingly enough, when i was back on ob anesthesia 3 months later, she was no longer employed. karma is truly a full circle.

 

[mercaptovizadeh]

It was the ED-- the med student in question was on her ER rotation. I know the attending very well and yes, he absolutely would. "Just page transplant, they're always in house."

Interesting that he thought you - and not med onc or BMT - were the first person to discuss GVHD.

 

[dpmd]

Necrobump because it's almost July !!

And I'm even going to comment on a page 1 gem from 2009:



That's what you call a lazy HPB chief. I want to see panc masses as an inpatient because then I can expedite the workup and often convince the staff to squeeze them in on the schedule. This is why I make friends with the GI fellows.

Easy consult and leads to MOAR WHIPPLES...

You say that like it is a good thing

 

[DoctwoB]

Is an ostomy "appliance" like the bag that you stick on there? Don't the nurses just put that back on? Honestly, I wouldn't know what to do with it either. I would guess that ortho guy asked the nurse, who faked it and said that she didn't know if she was supposed to touch it. Hence the call to you.

Every hospital I've been to has enterostomal or woundcare or ostomy nurses that handle such things. It's pretty common.

 

[Winged Scapula]

That's what you call a lazy HPB chief. I want to see panc masses as an inpatient because then I can expedite the workup and often convince the staff to squeeze them in on the schedule. This is why I make friends with the GI fellows.

Depends on the environment. Many private payors will not reimburse for inpatient workup. In hospital consultations typically pay less than when seen in the office. Hence the recommendation for outpatient office visit and further workup if the surgeon involved is not a hospital employee.

 

[VisionaryTics]

I really just laughed about this one. The resident in question still owes me a beer. To his credit, they had flipped the patient after a prone case and it came off, and stool was getting everywhere. They just didn't know what to do.

At the VA, I once got a panicked call from a radiology resident down in nuclear medicine. Our patient with a colostomy was getting a tagged RBC scan to find the source of a GI bleed. He had also gotten oral contrast earlier for a CT scan.

"Oh my God, the bag fell off, there's **** everywhere, it's all full of contrast, he's covered in contrast, our room is covered in ****, oh my god, it's terrible, the scan is cancelled, we can't do anything, there's **** everywhere, please come get your patient."

 

[sanityonleave]

"Oh my God, the bag fell off, there's **** everywhere, it's all full of contrast, he's covered in contrast, our room is covered in ****, oh my god, it's terrible, the scan is cancelled, we can't do anything, there's **** everywhere, please come get your patient."

I almost aspirated my coffee. I can just see the poor rads resident rocking back in forth in a dark corner of the reading room - "They told me I'd never have to smell that again!"

As an ER resident, I've called some truly awful consults to my surgical colleagues, and I'm sorry about those. They're almost always because my attending can't figure out WTF to do with a patient and in academia they're not the ones calling in the BS, so they don't have to defend it over the phone. As a poster above said, if it's a consult I think is garbage I've already tried to talk my attending out of it and I'll tell the consultant as much.

As an aside, though, if it's not a garbage consult, giving me grief over the phone doesn't help anyone. I get that you're tired and overworked and the ER to you is full of miserable cockups who can't figure out which way to pull the zipper so they can pee. If you have a legitimate reason you don't think it's justifiable to see a consult, please let me know - I'm all for learning and you may change my mind.

There are some that can't be dodged, though. I don't know why you guys opened the gastric bypass clinic in tandem with the fibromyalgia and chronic lyme disease clinic, but if you operated recently on the part that hurts, your ass is coming in to see them. Sorry.

On the plus side, I'm switching to anesthesia, so no more BS consults. Though I do have to spend more time with surgeons...

 

[Slack3r]

I almost aspirated my coffee. I can just see the poor rads resident rocking back in forth in a dark corner of the reading room - "They told me I'd never have to smell that again!"

As an ER resident, I've called some truly awful consults to my surgical colleagues, and I'm sorry about those. They're almost always because my attending can't figure out WTF to do with a patient and in academia they're not the ones calling in the BS, so they don't have to defend it over the phone. As a poster above said, if it's a consult I think is garbage I've already tried to talk my attending out of it and I'll tell the consultant as much.

As an aside, though, if it's not a garbage consult, giving me grief over the phone doesn't help anyone. I get that you're tired and overworked and the ER to you is full of miserable cockups who can't figure out which way to pull the zipper so they can pee. If you have a legitimate reason you don't think it's justifiable to see a consult, please let me know - I'm all for learning and you may change my mind.

There are some that can't be dodged, though. I don't know why you guys opened the gastric bypass clinic in tandem with the fibromyalgia and chronic lyme disease clinic, but if you operated recently on the part that hurts, your ass is coming in to see them. Sorry.

On the plus side, I'm switching to anesthesia, so no more BS consults. Though I do have to spend more time with surgeons...

Why the switch?

 

[dpmd]

I always appreciated the residents who started out saying i know this is bs but my attending wanted it. Lets you know you can take a little time if you need before seeing it.

 

[MediCane2006]

At the VA, I once got a panicked call from a radiology resident down in nuclear medicine. Our patient with a colostomy was getting a tagged RBC scan to find the source of a GI bleed. He had also gotten oral contrast earlier for a CT scan.

"Oh my God, the bag fell off, there's **** everywhere, it's all full of contrast, he's covered in contrast, our room is covered in ****, oh my god, it's terrible, the scan is cancelled, we can't do anything, there's **** everywhere, please come get your patient."

This made my morning, thank you.

 

[DoctwoB]

Had a patient this week (operated on at another hospital) get sent from a pcps office to the ER and then a surgical consult because a drain stitch snapped.

 

[TallScrubs]

Ugh. Sounds like the Gen Surg variant of our least favorite patient.

Me: "So what happened to your cast?"

Teenager: "It got wet."

Me: "Get caught in the rain?"

Teenager: "No, I went swimming."

Me: "You know casts can't get wet, right?"

Teenager: "Yeah. But I wanted to go swimming."

Me: "...but now it has to get cut off and a new one put back on. And the bones may come out of alignment. And you might have a skin infection."

Teenager: "Yeah. But it was hot, and I wanted to go swimming."

Me: "... okay. I'll go get the cast materials."

Mother: "Is this going to take much longer? We've already been here three hours!"

Teenager: "Can I get a black cast this time?"

Me: "Sorry, all I've got is pink."

You know, this begs for the creation of monetary penalty system for varying degrees of non-compliance.

 

[TallScrubs]

It would probably not be outside the standard of care if we told the ER, "Sorry, that's an office visit, not an ER visit" and made the parents miss a day of work. But of course we don't do that...

I'm talking gross negligence by patients--I'll forgive anyone ignorance, but not gross negligence. Your patient actually just pissed me off as well

 

[Dr.LeoSpaceman]

Can I complain about IR for a second? Nothing like getting a "consult" for a bleeding TDC that was placed by IR in the afternoon. I don't blame the FM resident, since I know that isn't something they're used to handling. But it irks the hell out of me that the response of the IR fellow to the FM resident's call is "Give some FFP and hold pressure...I'll be in at 6am."

 

[Pir8DeacDoc]

Can I complain about IR for a second? Nothing like getting a "consult" for a bleeding TDC that was placed by IR in the afternoon. I don't blame the FM resident, since I know that isn't something they're used to handling. But it irks the hell out of me that the response of the IR fellow to the FM resident's call is "Give some FFP and hold pressure...I'll be in at 8am."

Fixed it for you.

 

[Winged Scapula]

Can I complain about IR for a second? Nothing like getting a "consult" for a bleeding TDC that was placed by IR in the afternoon. I don't blame the FM resident, since I know that isn't something they're used to handling. But it irks the hell out of me that the response of the IR fellow to the FM resident's call is "Give some FFP and hold pressure...I'll be in at 6am."

Frustrating on so many levels not the least of which is that IR should know that a family medicine resident is out of their comfort zone with something like this and to leave them without any help, knowledge or the skills and resources to manage this problem is pretty unprofessional.

 

[Dr.LeoSpaceman]

Frustrating on so many levels not the least of which is that IR should know that a family medicine resident is out of their comfort zone with something like this and to leave them without any help, knowledge or the skills and resources to manage this problem is pretty unprofessional.

I sent a measured email to my staff, who is going to forward it on to the IR attending of record. More important than being annoying for me, it's a patient safety issue. As proceduralists, we should absolutely be on the hook for managing our complications. It's one thing if the IR fellow comes in and calls me because it's something he thinks they can't handle. But to not even come in? Unacceptable.

On the other hand, it did give me a chance to pass on some knowledge to the FM intern, so that was good. "Doctor pressure" (i.e. not through 7 layers of 4x4s), ddAVP in a bleeding renal failure patient, and why giving FFP to someone with an INR of 1.7 isn't likely to help. Not to mention to not be afraid to start calling up the chain when the "1st Call" isn't returning your call.

 

[VisionaryTics]

I think it's surgeon pressure > doctor pressure >>> nurse pressure.

You could add a couple > between surgeon and internist.

When our on-call resident arrived 20 minutes into a coding carotid blowout, the team of medical residents were calmly working through ACLS while the cardiac output was quietly being pumped out of the patient's neck onto the bed. The on-call resident literally saved the guy's life by applying two fingers of pressure.

 

[Dr.LeoSpaceman]

I had a fun one when a ENT patient started bleeding out from a free flap. Interns were wigging out. I just applied pressure where I knew the anastomosis was until the ENT residents showed up.

Satisfying. The other common one is the bleeding AV fistula. ED physicians on the phone: "THERE IS SO MUCH BLOOD!!!" Roll in, 1 finger on the anastomosis and everyone is amazed.

 

[Pir8DeacDoc]

You could add a couple > between surgeon and internist.

When our on-call resident arrived 20 minutes into a coding carotid blowout, the team of medical residents were calmly working through ACLS while the cardiac output was quietly being pumped out of the patient's neck onto the bed. The on-call resident literally saved the guy's life by applying two fingers of pressure.

20 minutes? That's a helluva long time to bleed out.

 

[dpmd]

I had a fun one when a ENT patient started bleeding out from a free flap. Interns were wigging out. I just applied pressure where I knew the anastomosis was until the ENT residents showed up.

X marked the spot?

 

[VisionaryTics]

X marked the spot?

Prolene stitch marked the spot

 

[metalmd06]

Here's a good one:
STAT consult to rule out compartment syndrome. Consulting team felt that the patient's thigh was dangerously tight during assessment with diminished pulses. When I examined patient the pulses were bounding and the thigh was soft. Patients was actively having a tonic-clonic seizure when being examined by the primary team

 

[Winged Scapula]

You could add a couple > between surgeon and internist.

Seriously.

One of my most memorable events as the SICU Chief was leaving the off-service EM intern to hold pressure after removing a IABP. Apparently he thought my instructions about the length of time and degree of pressure to hold were a tad dramatic and that he knew better. Not more than 10 minutes after I left, I got a measured panic call from the RN; apparently he'd left after he'd decided he'd held hard enough and long enough. It wasn't.

 

[KHE]

As an optometrist, I rarely do hospital based work but in the past I have taken call for a small local ER and I had a few consults for complete loss of vision in patients where the diagnosis ultimately was that the patient was not wearing their glasses or contact lenses.

I've also had two cases where the ER reported sky high eye pressures in one eye and when I went in, they were taking pressure readings on a prosthetic eye.

 

[dpmd]

Seriously.

One of my most memorable events as the SICU Chief was leaving the off-service EM intern to hold pressure after removing a IABP. Apparently he thought my instructions about the length of time and degree of pressure to hold were a tad dramatic and that he knew better. Not more than 10 minutes after I left, I got a measured panic call from the RN; apparently he'd left after he'd decided he'd held hard enough and long enough. It wasn't.

Hmm. Long ago as a nursing student in the army i was tasked to hold pressure after some kind of cath was taken out (was a long time ago but probably a cardiac cath sheath). I was told to push as hard as i could for 10 minutes and i was very obedient and watched the clock as i pressed so hard my fingers were useless for a few minutes afterward. It boggles my mind that an intern would be so much less compliant with instructions.

 

[Winged Scapula]

Hmm. Long ago as a nursing student in the army i was tasked to hold pressure after some kind of cath was taken out (was a long time ago but probably a cardiac cath sheath). I was told to push as hard as i could for 10 minutes and i was very obedient and watched the clock as i pressed so hard my fingers were useless for a few minutes afterward. It boggles my mind that an intern would be so much less compliant with instructions.

It does boggle the mind doesn't it?

We frequently had issues with the off service rotators on trauma. It was never the surgical subspecialties but almost invariably the EM guys. IIRC this particular intern also complained about the work hours and overnight call. We didn't have an emergency medicine residency program based at our hospital at that time. He came to us from a smaller community program that had relatively little trauma and perhaps he wasn't used to having a (female) surgical resident telling him what to do.

I always liked holding pressure on those balloon pump removals as an intern. It was the only time I got relieved of my pager for an entire hour!

 

[Slack3r]

It does boggle the mind doesn't it?

We frequently had issues with the off service rotators on trauma. It was never the surgical subspecialties but almost invariably the EM guys. IIRC this particular intern also complained about the work hours and overnight call. We didn't have an emergency medicine residency program based at our hospital at that time. He came to us from a smaller community program that had relatively little trauma and perhaps he wasn't used to having a (female) surgical resident telling him what to do.

I always liked holding pressure on those balloon pump removals as an intern. It was the only time I got relieved of my pager for an entire hour!

Well, when the primary draw of your specialty is "shift work" and being "off when you're off", are you that surprised?

 

[dpmd]

Well, when the primary draw of your specialty is "shift work" and being "off when you're off", are you that surprised?

Explains bitching about work hours and stuff but not the inablity to follow simple instructions. Maybe my prior military service has skewed my expectations in term of following orders.