Overnight Qs

[beachpotato]

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What percentage of overnight care would you say is emergent? I would guess people don't come in often for vitamin prescriptions at 3AM... much. 😛

On an average night, how much time do you get in the on-call room? 😴

Anything else that's different at night?

Thanks -
BP

 

[Hard24Get]

What percentage of overnight care would you say is emergent? I would guess people don't come in often for vitamin prescriptions at 3AM... much. 😛

On an average night, how much time do you get in the on-call room? 😴

Anything else that's different at night?

Thanks -
BP

In my limited number of night shifts, it seems there are a camp of people whose job it is to sit in the ED until about 11 or so, then they go home, leaving the people who are miserable for one reason or the other. The miserable can be in pain, itchy, cut, bleeding, toxic, drug-seeking, crazy, etc, so not all emergent, but usually urgent. I would hate to guess a percentage, since it varies from night, to night.

There is no such thing as a call room in our ED. We have never had that much downtime, there are less of us at night so there are still patients to see. Does this sleeping thing actually happen anywhere? I would be disinclined to train there 😕

 

[beyond all hope]

In a nice community center outside of the city, overnights are usually only REALLY sick people with CHF/Pneumonia/MI or the occasional drunk/whacko. Occasional minor trauma. Suburbans generally have better things things do to at night.

In an urban center, like the one I currently work, people use the ED as a clinic. The less-sick are triaged to the bottom of the stack, and those that don't get seen by fast track you end up seeing at 3 am. The URIs, the back pains, the whackos, the med refills. Unfortunately, the smart ones have walked out by then, leaving only the intellectually challenged to grace you when you are at your most tired and least willing to deal with BS.

At lot of the true emergencies, such as trauma and major medical, also happen at night, so it's an interesting melange of crap and critical patients.

 

[Hawkeye Kid]

i'd say it varies, because last night i saw three people with cc of ear pain.

the night before i saw, in no particular order, 2 SWs to the chest, both with HTX/PTX, a hanging, an acute MI with tombstones in 7 leads, two hypoxic asthma exacerbations, a hypoxic COPDer who went into brady-asystolic arrest as she hit the door, and a few CPs. i'm sure the ear pains were out there, i just didn't get to them...now that's a fun shift.

 

[dchristismi]

What is this call room of which you speak? It is only seen while doing other rotations - when you are in the department at night, there is no sleeping, only running.

And yes, nights are a mix of the "walking well" and the "fixin-to-die." Between 2:00-4:00 we often have a couple of GSWs and/or stabbings, plus a couple of wrecks. Seems like right around 4:30-5 it dawns on the chest painer, the GI bleeder, the COPDer (and lately for me, the child with the brain tumor about to herniate 🙁 ) that they just aren't going to make it until morning, despite their best attempts. Thus, they show up right before crashing. It does make for fun nights, though.

And yes, I'm generalizing. There are occasional nights where it's nothing but ear pain, low back pain and med refills.

 

[ERMudPhud]

So here is my haul from my last two 8 hour overnight shifts in a small suburban/rural ED
1.Chronic pelvic pain
2.Weakness-Hct=20
3.Weakness Heat exhaustion
4. Cervical strain
5. Fell of 30 foot wall last week, shattered elbow
6. URI
7. Peritonitis from perf'd ulcer
8. food poisoning/self limited gastroenteritis
9. Gout vs pseudogout
10. UTI
11. Got drunk fell on face
12. Strained shoulder trying to Repo car
13. Piece of insect in eye
14. Sciatica x10years (drove #13 to ER)
15. Miscarriage
16. Sciatica
17. Babysitting, got drunk, passed out, babysitee called 911
18. Gingivitis (came in to take #17 home)
19. Machete fight victim #1
20. Machete fight victim #2
21. Renal colic
22. Torticollis
23. GIB, INR=15, ARF, CHF

 

[Hard24Get]

So here is my haul from my last two 8 hour
13. Piece of insect in eye
14. Sciatica x10years (drove #13 to ER)
17. Babysitting, got drunk, passed out, babysitee called 911
18. Gingivitis (came in to take #17 home)
19. Machete fight victim #1
20. Machete fight victim #2

Details on the above, please 😛. I was cursed with too many vag bleeders the other night!

 

[kungfufishing]

gotta love the two for ones. Interestingly not too long ago I had a lady with a URI and her driver checks in to the bed adjacent for dizziness...long story short had a basilar stroke. In all my months I'd say that was the only time that pt #2 actually had anything.

 

[DropkickMurphy]

gotta love the two for ones. Interestingly not too long ago I had a lady with a URI and her driver checks in to the bed adjacent for dizziness...long story short had a basilar stroke. In all my months I'd say that was the only time that pt #2 actually had anything.

The only times (in 11 years of EMS) I've ever had a two for one that turned out to be something serious were both codes for the first patient, the second patient in the first case had a stroke in the front passenger seat of the ambulance (she was too hysterical to drive so we let her ride up front) and in the second case the wife of the patient coded in front of us.

Interestingly enough, both of the patients in the second incident survived and are still alive. I know this because they live a couple of miles from my parents and are friends of my family.

 

[EM_Rebuilder]

Any ED that you are involved with as a Residency Program should not have a call room and if it does, you certainly should not be using it... if you are, then look elsewhere. The ED at any major house, at best, has a slight lull in the middle of the night... but that time is usually filled with chart catch up and maybe some email checks or catching up with each others lives. Remember that shifts are at most 12 hours... if you are working nights, then you should be sleeping during the day and should not even be tired in the middle of the night.

If you by chance moon light at a VERY small very rural ED, then you may in fact, catch much sleep at night. The Family Medicine residents where I came from would work at such places. They would usually work from 5pm friday to 5am on Monday morning. They would get TONS of sleep and see maybe 20 people over the entire weekend. Again, that was ultra rural/small town Texas. Any EM trainee should moonlight at places that are a tab busier than that as you can easily handle it.

As far as off service rotations (ortho, surgery, ICUs, ward services, etc) will be extremely variable on your particular house, particulay service, and the luck of the draw. You should, at most, be in house for 30 straight hours without sleep. And luckily, as EM residents, those days for our life can usually be counted on a few hands at most. I am in the MICU currently. I have had 5 calls so far (Q3). My worst thus far, I slept about 30 minutes, my best.. I watched two westerns in the evening, went to bed around 11pm after showering, and woke to my alarm at 6:30AM.

Just my .02...

 

[FoughtFyr]

As an attending in my last two overnight shifts (11p - 7a) I saw 65 and 51 patients respectively. Had 4 major traumas (genuine SICU players), a handful of minor traumas, a couple of miscarriages, a few raving drunks (including the full on security versus patient brawl), three medical intubations, several central lines...

What the heck is a call room?

- H

 

[iatrosB]

13. Piece of insect in eye
14. Sciatica x10years (drove #13 to ER)
17. Babysitting, got drunk, passed out, babysitee called 911
18. Gingivitis (came in to take #17 home)

only in the ED

love it, i'm putting that in my personal statment

 

[DeLaughterDO]

4. Cervical strain

I've always wanted to congratulate the boyfriend/husband!

You go boy!! 👍

 

[WilcoWorld]

As an attending in my last two overnight shifts (11p - 7a) I saw 65 and 51 patients respectively. Had 4 major traumas (genuine SICU players), a handful of minor traumas, a couple of miscarriages, a few raving drunks (including the full on security versus patient brawl), three medical intubations, several central lines...

What the heck is a call room?

- H

65 patients from 11p-7a!!!
How the heck are you seeing >8 patients an hour?

 

[Jeff698]

65 patients from 11p-7a!!!
How the heck are you seeing >8 patients an hour?

It's good to have residents.

Congrats FF. 🙂

Take care,
Jeff

 

[FoughtFyr]

It's good to have residents.

Congrats FF. 🙂

Take care,
Jeff

Yeah, it's nice! But even still, towards the OPs question, at the end of the night my senior was seeing near 4pph, the second year 2.5pph, and the intern (off-service) ~ 1pph. Hey, I was even picking up my own patients (perish the thought!). Bottom line - nights can be quite busy!

- H

 

[emtcsmith]

Most cardiac arrests/doa's come out between 5a-8am, right before the morning rush. Most wild MVC's and violence related trauma also occur overnight. I've figured the COPD hour to be something like 10p-1a, and the morning brings all the sick old people who woke sick or were sick all night and finally called.

 

[da8s0859q]

I've always wanted to congratulate the boyfriend/husband!

You go boy!! 👍