Did you read prior to beginning residency?

[dr.evil]

Well, as 4th year progress on, I lose more and more of the little knowledge I once knew. I was wondering how many of you residents out there took some time at the end of 4th year to read/brush-up on your particular field of choice. I'm usually not to anal about these things but I actually had my first dream last night of being killed in M&M. <img border="0" title="" alt="[Eek!]" src="eek.gif" />

I must be subconsciously (and now consciously) stressing. Thanks a lot.

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[Voxel]

I guess it all depends on how much time you have left. Maybe (and this is a big maybe) try doing your last rotation as fourth year in general surgery (your specialty of choice, right?). Sounds kinda brutal, but hey, no better way to jog your memory. On the other hand if you just want to review things for a PGY-1 general surgery intern, I'd suggest you read up on pre and post-op medical management of your patients since you probably won't be in the OR much as a PGY-1. Best of luck to you. Mistakes will happen and surgical M&M will always be a grill session no matter what you do.

 

[Winged Scapula]

I did a little bit but frankly it didn't help. Get used to losing some of that precious fund of knowledge. All of us here complain about getting dumber and dumber by the day - sure we're learning stuff, but we're also forgetting medical school information at a phenomenal rate.

If you have some time, sure go ahead and read but the yield will be low. I'd frankly recommend you simply rest and enjoy the waning days of your freedom!

 

[wbd161]

Ms Cox: which surgery textbook do you prefer reading- Schwartz or Sabiston?

 

[Winged Scapula]

We actually use Greenfield here (lots of faculty are chapter authors) and I also like Cameron. I haven't used Sabiston extensively and although I own Schwartz don't care for it much either.

 

[Voxel]

How about just enjoying life while you still have one. I second that thought. Good luck with general surgery residency.

 

[dr.evil]

Well, my immediate surge of stress has disappeared. My true self has come back and I think I'll stay away from the books. I think a little traveling, hiking, and being a gym rat will suffice for the next few months. I'll just take my beating in M&M like many before me.

Enjoy your prelim year Voxel. After that, it will be smooth sailing in radiology. It is radiology right?

Thanks for the responses

 

[Voxel]

Actually, I am hoping for a transitional year. I just want the PGY-1 Year to fly by.

Yes, I will have a life as a radiology resident, but mostly I will be hitting the books after leaving 5-7pm depending on the radiology rotation. My schedule will include reading 3-4hrs/night when I am not on call. Granted, call won't be q3 call. However, call may be overnight or nightfloat, but is brutual at most places. This will mean little to no sleep and up all night reading emergency CT/US/Plain Films. It does not have the physical rigours of general surgery, but it can be mentally exhausting and challenging none the less. And in private practice, call does not go away and private practice radiology has become 24/7 coverage of services.

 

[denise]

As a DO intern, the advice that was given to me was read up on your ACLS. I know it sounds goofy, but I was told, if you read anything at least read that. Actually, you will have to take the test during the orientation week anyway. So I did just that.
The other thing I tried to glance at was pain meds. For me that was a worry point. To get calls, "Mr. Smith is in pain, and he is already on morphine and demerol, what else can we give" Now, 8 months into my internship year,I am much better at pain management, but I still get stumped once in a while (or should I say "afraid" that I am giving too much )
Good Luck

 

[dr.evil]

Hey Voxel, when I said "smooth sailing" I didn't mean you weren't going to work your butt off. Although your hours in the hospital will be a little better than mine as a general surgeon, radiologists work their ever-loving butt off, especially when on overnight (trauma kills us all). At least your call is a little better but it sure is tough to be tired and be in a dark room.

If you're going into residency of any kind, you're definitely going to have times when you're getting killed (unless you're doing dermatology :wink: ).

BTW, you're a smart man to go for the transitional year.

Denise: Great idea about the ACLS and pain meds. I don't know what to give after demerol/morphine except for a little toradol. I'll have to read about that a little.

 

[Sabreman]

Off the topic, sorry, but if demerol and morphine aren't working you give... more. You can't kill a person with ANY dosage of morphine that is just enough to kill their pain.

 

[Voxel]

I hate to state the obvious... but here goes...

I guess you've never seen respiratory arrest from giving more. I know of 2 patients that actually died from this and had their pain meds pushed up too high. Granted they would have died anyway from their metastatic disease. Giving more is not always the best solution.

 

[Winged Scapula]

Giving more is the obvious answer if you haven't reached therapeutic doses. Obviously, patients can and do go into respiratory arrest (hence the availability of Naloxone on crash carts, and bedside for patients with narcotic PCAs).

At any rate, I used to be afraid to give more pain meds until it was shown to me that we regularly write for patients to receive up to 10 mg IV Morphine (via a standard PCA dose) yet we rarely will write for more than 4 mg IV qhourly. Now I've not had to write for someone to have 1-10 mg IV Morphine qhourly, but I do feel a little more ease at giving them more, within those parameters.

 

[Sabreman]

Voxel,

In the case given above "Mr. SoandSo is in pain but is already on morphine and demerol, what do I give?", the obvious answer is to increase the doses since he has not reached therapeutic levels of analgesia. This pt more likely than not is a post-op or pancreatitis pt that the new intern wrote for morphine PCA at too low a dosage. If you feel uncomfortable, you can always put the pt on constant pulse ox monitoring (they never do this on the onc floor but ALWAYS on the surg floor here).

And by the way I have been called at 2am when cross-covering on my sub-I to rush and give narcan to a pt in resp depression from morphine OD. Thanks for asking.

 

[Voxel]

I think though the example is kinda vague because we do not know the dosage nor the vital signs. Of course you can give more, but be ready with the narcan and to run a code if necessary.