NPO question

[buckley]

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Lest another surgeon berate me (the poor hapless IM prelim)...could you guys please list the surgeries which need strict NPO vs those NPO with meds? I don't need the weird stuff, just the common ones, including the imaging studies...I never knew you had to be NPO for an MRI...I thought that was magnetic fields...?!?@ dumbiedee dumbiedoo there goes my self-esteem in intern waterloo...

 

[Winged Scapula]

There is no hard and fast rule regarding this; it depends on the surgery planned, the meds the patient is taking, age of the patient, the type of anesthesia planned, etc.

Since there are no rules, you are better off checking with the specific attending. Rules will vary.

As for MRI, one of the complications of Gadolinium is N/V; that, coupled with the possibility that the patient will need sedation for anxiety, means they need to be NPO. Same goes for HIDA. The radiology residents/techs at your program will have a list of what is required for any test you order; it would be helpful to get a copy.

 

[Dejavu]

From the ASA website (www.asahq.org) here is an article that may answer your questions.

http://www.asahq.org/publicationsAndServices/NPO.pdf

 

[HomerSD]

npo for an mri? That's a seriously anal retentive radiology department you've got there.

As for the surgery question, just do whatever you want. Then if the surgeon gives you crap, just say, "i don't answer to you, you donkey ****er."

lol!!

 

[buckley]

Thanks for the replies...althogh Im still as cueless as ever--now Im like, ok...so not everyone is npo for an mri?!?! It's just so hard to navigate through this attending1-attending2,3,4-patient-RN-resident-dependent world. Sometimes I feel I'm dealing with the actual pathology less than 10% of the time. And then when we round, I feel everybody understands my patient better than me. And of course I find that pathetic. Aaaargh! I know I'm not really this dumb or this slow or this inefficient. My seniors are always trying to give me feedback and they were helpful, but now, I feel Im just receiving all the comments and just...receiving...I don't even know what to do with the feedbacks anymore. I just accept them and smile and say I'm sorry. Laugh with their jokes about how it's another dumb mistake. Better to laugh with the gang right...even if the joke's on me. It's so frustrating to be repeating the same errors, to forget stuff I can't imagine forgetting. It's been three months and I can't count the number of times I wished the floors would just swallow me alive and transport me back home to my couch. I even have a motto in my head now--PATIENT BEFORE PRIDE. That shows you how much I've had to swallow and admit being that dumb intern. Does it really get better? I just want it to be over, but then I think it's a lot worse to be that dumb resident. And hence I understand why people quit residencies. I dont want to quit, but I just wished I didn't dread going to work and thinking,"ok, what's the next booboo buckley's gonna make.." It's not the work that's tiring me out, but the feeling that I'm NOT doing the work. Sigh. I should put myself on NPO now pending self-esteem lobotomy. Go reread The Gift of Acabar...or maybe just Sedaris...

 

[Winged Scapula]

Whether or not your patient needs to be NPO for an MRI depends on your department regulations, more so than any real medical reason, most of the time, IMHO.

Check with the Rads department techs or residents and they will tell you which tests require NPO, which are recommended and for which it doesn't matter. It may also depend on the patient - since children often need to be sedated, they may need to be NPO or just Breast Milk for a few hours prior to the procedure.

Despite protestations elsewhere, it *does* get better. I thought I was the world's worst intern, until I had my own interns and then suddenly I saw that I was no worse than anyone else. I doubt you are the worst they've seen and probably not worse than your colleagues. Try and let it run off your back.