Two great things about being an intern

[neutropeniaboy]

#1. How the patient tells you one thing and then tells the attending someting entirely different a short time later.

#2. How when rounding with one attending, s/he tells you to undo the things the previous attending did -- and later have the the things undone undone yet again.

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[Stormreaver]

So true. SO TRUE.

#3- All the nurses get to boss you around because you truly don't know where that chart with orders on it goes.

#4- The IT ppl are always yelling at you for messing up the orders on the computer.

 

[Newdoc2002]

Amen. The patients will even tell the medical student something they denied 20 minutes prior. Stuck in the middle baby!

 

[Winged Scapula]

5. Getting yelled at (or at least chastized) for not doing something you didn't know to do, but were somehow supposed to divine the knowledge to do.

6. Feeling like you're getting stupider by the day - you've forgotten all your basic science from medical school but you're darn good at writing bowel regimins!

 

[Roentgen]

OK, just to share in the frustration:

7. Why are nurses so obsessed with electrolytes??

8. Colace- written for the nurse, not the patent.

9. Ambien- thank you, God.

10. How to find Echo/c-scope/etc results from 1984?

 

[Winged Scapula]

Originally posted by Roentgen
OK, just to share in the frustration:

7. Why are nurses so obsessed with electrolytes??

is it electrolytes they're concerned with or the little "H" and "L"s next to the value that they seem to freak out about?

 

[Stormreaver]

A friend of mine was paged in the middle of the night by the nurse for an otherwise stable patient with a low BUN. He told her to give him an IV BUN infusion and tell him the result in the morning.... Obviously everyone got a good laugh out of the whole episode...

 

[UHS2002]

Originally posted by Kimberli Cox


is it electrolytes they're concerned with or the little "H" and "L"s next to the value that they seem to freak out about?

Most definitely the Hs and Ls...

I had a nurse interrupt me while I was checking out one of my patients and had finished saying "all her labs are ok" to announce loudly for all to hear: " but Dr., her K is 3.2" ...

 

[neutropeniaboy]

Originally posted by Roentgen
OK, just to share in the frustration:

8. Colace- written for the nurse, not the patent.

9. Ambien- thank you, God.

I had a patient who was on Zestril and was living in the low 90s/50s...completely asymptomatic and making good urine. I was asked several times to d/c the Zestril. Finally, I got frustrated and d/c'd the Zestril and added lisinopril.

Ambien...I almost never write for prn meds. Only SSI. I just think it's a bad idea. 9 times out of 10, the person will be okay, but that one time will turn out to burn you. Even though Ambien is relatively benign....

 

[gherelin]

during orientation, we were firmly instructed never to write for ssi, ?ou're just chasing sugars," come to find out everyone, including the chiefs, always want you to write for ssi, AND, ssi is even pre-printed on the order sheet

 

[neutropeniaboy]

Originally posted by gherelin
during orientation, we were firmly instructed never to write for ssi, ?ou're just chasing sugars," come to find out everyone, including the chiefs, always want you to write for ssi, AND, ssi is even pre-printed on the order sheet

We're pretty aggressive about it. I generally recalculate the regular and NPH dosing for my diabetic patients since half don't seem to have the correct dose anyway in an effort to avoid having to use the SS. But, since anyone with a sugar >150 generally won't heal as well, we end up having to throw a slug or two every now and then.

 

[MustafaMond]

THe other night I got woken up at 3 am. The nurse said "Doc! there is a patient w/ a K of 3.3!" "What shoud we do!"

Our computer program "flags" high's and low's as critical highs, and critical lows....I yelled at her to never wake me up unless there is a flagged value in her menu...she got all pissed off and said it was her job...

Its funny...there was a pt beforethe same day w/ a K of 5.7, that was never reported to me...

I kind of apologized though...cuz a nurse is a good friend to have, when the shiznitz goes down on the wards...



Another great thing about residency is getting to meet all the friendly and cooperative surgery pigs!!!
not

 

[tussy]

Originally posted by MustafaMond
[B


Another great thing about residency is getting to meet all the friendly and cooperative surgery pigs!!!
not [/B]

Hey, why are you throwing insults at us surgery residents??? We're just trying to survive this residency thing too.

 

[Winged Scapula]

Originally posted by MustafaMond

Another great thing about residency is getting to meet all the friendly and cooperative surgery pigs!!!
not

Hey why all the hate? We're not bad guys...really!!

My favorite "thanks for waking me with this information" was a nurse who called me at 2:30 am with NORMAL LABS on a non-critical, floor patient. I thanked her (she was unknown to me, probably an agency nurse) and then told her thta since the labs had been drawn at 10 pm, I checked them before I went to be 4 HOURS ago!!!

One of our intermediate care nurses had a tendency to call with labs when they came back - usually around 5:00 am. Now, mind you - we rounded at the SAME TIME EVERYDAY: 5:30 am. So, at 5:00 I am usually getting those last few winks (provided I am getting any at all). I rather curtly (apparently) reminded her of the above facts and she never called me again with normal, or slightly out of whack labs.

 

[tussy]

I'm in the ICU and i've given up trying to avoid the many calls about abnormal labs in the morning, just an hour before rounds. When i get the first call i crawl out of bed, then travel bed to bed and initial all the abnormal blood work and write appropriate orders. It usually only takes 15 min and then i get a peaceful 45 min of sleep before rounds.

 

[MustafaMond]

OOps!

I meant to say "surgery PG's"!!!!!

Im sorry, yall.....i was actually making fun of surgery resident, but I didnt mean to call you swine....

Id never say something that stupid.

sorry again

 

[Winged Scapula]

Originally posted by tussy
I'm in the ICU and i've given up trying to avoid the many calls about abnormal labs in the morning, just an hour before rounds. When i get the first call i crawl out of bed, then travel bed to bed and initial all the abnormal blood work and write appropriate orders. It usually only takes 15 min and then i get a peaceful 45 min of sleep before rounds.

tussy...are you not allowed to give verbal/telephone orders? I can't imagine getting out of bed to fix someone's potassium when I could just answer the page and tell the nurse how much to give, and then co-sign the order when I arrive for rounds.

 

[tussy]

Originally posted by Kimberli Cox


tussy...are you not allowed to give verbal/telephone orders? I can't imagine getting out of bed to fix someone's potassium when I could just answer the page and tell the nurse how much to give, and then co-sign the order when I arrive for rounds.

I can give verbal orders, but it means for an hour i get a phone call q10 min! For some reason the nurses can't all get together and call at one time. It's easier to just spend 10 minutes run around the unit quickly and get all the orders written. My call room is right on the unit, so it's not a long trip.

 

[gherelin]

Originally posted by neutropeniaboy


We're pretty aggressive about it. I generally recalculate the regular and NPH dosing for my diabetic patients

Neutropenia boy--how do u calc. it?thanks for any tips

 

[neutropeniaboy]

Originally posted by gherelin

Originally posted by neutropeniaboy


We're pretty aggressive about it. I generally recalculate the regular and NPH dosing for my diabetic patients

Neutropenia boy--how do u calc. it?thanks for any tips

0.6-1.2 units per kilogram. I usually start at 0.6 when I calculate. 2/3 of the total dose in the AM and 1/3 of the total dose in the PM. If the guy weighs 100 kilos, that's 60 units total and 40 units AM and 20 units PM.

Then, for the AM, I do 2/3 NPH and 1/3 regular. For the PM, I do 1/2 NPH and 1/2 regular. For the 100 kilo guy, that turns out to be approximately 30 units NPH AM, 10 units regular AM, 10 units NPH PM and 10 units regular PM.

You really need to anticipate the person's being there for a while, because if it's just a couple of days, you could really mess up the person's insulin schedule.

Of course, if the person has acceptable glucose levels anyway, I don't even bother.

 

[Winged Scapula]

Originally posted by MustafaMond
OOps!

I meant to say "surgery PG's"!!!!!

Im sorry, yall.....i was actually making fun of surgery resident, but I didnt mean to call you swine....

Id never say something that stupid.

sorry again

Not sure if this makes things *much* better, after all, you are still saying that your surgery residents are unfriendly and uncooperative. Oh well, we can't all be heros can we?!

 

[Winged Scapula]

Originally posted by tussy


I can give verbal orders, but it means for an hour i get a phone call q10 min! For some reason the nurses can't all get together and call at one time. It's easier to just spend 10 minutes run around the unit quickly and get all the orders written. My call room is right on the unit, so it's not a long trip.

Ahh...we only have a problem with a few nurses who will call us pre-rounds with such things. Most of them, especially the SICU nurses who have been around awhile, will wait until we round as the labs don't come back much before we round anyway. But I see your point...same reason I check the patients after change of shift at 11:00 pm; for some reason, that becomes the "witching hour" when things that have sat all day unanswered suddenly become and urgent "need to know" (ie, like the nurse who called my intern at 2:30 am and wanted to know what the discharge plans were for her patient - mind you, he was DAYS from going home and she knew that, just wanted to be "prepared" when he did go. At 2:30 frickin' AM. She heard about it from me when I found out...and I don't generally raise a fuss. But talk about abuse.)

 

[gherelin]

Originally posted by neutropeniaboy


0.6-1.2 units per kilogram. I usually start at 0.6 when I calculate. 2/3 of the total dose in the AM and 1/3 of the total dose in the PM. If the guy weighs 100 kilos, that's 60 units total and 40 units AM and 20 units PM.

Oh yeah, now I remember! Thanks NB. I put in my palm pilot-too bad it isn't in the medcalc program. I vaguely remembered some way of figuring it out based on the fact that a healthy pancreas produces about 40unit/day and then looking at sugars to est. about what it is producing and then going from there but can't remember that one....
Anyway, thanks for your help!

 

[Sabreman]

My pet peeve so far has been this...

We have text pagers here, which are the greatest thing since sliced bread (as much as any pager can be "good" for an intern). We can prioritize our callbacks and frequently just put the order in the computer without even having to call back. However, some nurses, quite a few actually, have realized that just paging with the return number and no message FORCES me to immediately return the call since it might be important, while I can put off returning the "You just ordered a liter of NS on the new septic lady, can you call and explain why?" pages. The few times I have explained that I am not actually watching TV elsewhere where I can jump to call her back have gotten me snooty responses, but I am determined to end this... or maybe I should admit defeat. Depends on the day, I guess.

 

[Voxel]

How about being paged at 5AM (rounds start @ 6) and I had just fallen asleep at 4:45AM. I get this page about a cross-cover patient. Nurse says to me "This post-op patient has not made any urine for the past 6 hours. You've got to come up here right away. I think there's something wrong with her". I am still kinda groggy and get my butt upstairs.

Upon arriving to the floor, I ask "Are you sure there is no urine in the foley bag?"

She replies, "*what foley bag?*"

I reply, "You mean the patient has been urinating on their own?"

She replies, "Yes since 11PM there is no urine in the toilet urine catcher."

To which I reply, "Has the patient called you all night?"

She replys, "No."

I check the room and the patient (40ish woman) is sound asleep! (I read her chart just for fun and she is post-op day number 6 with the words d/c poss tomorrow written in the last progress note)

 

[Stormreaver]

I feel for you, brother!

 

[Stormreaver]

For the first 2 weeks of residency we had "intern school". One of our Chiefs described it best: "What to do until a real doctor arrives."

 

[Airborne]

I like that saying

And I'll make sure to remember it in 2 years time

 

[beamer]

the student following beeping me at 3 pm for a 6 am k of 7...asking me in a arrogant tone..." are u aware that ur pt has this high a k value ".....stupid ass...i finished givin him the calcium,insulin-dex and nahco3 and the kayexalate...so go back to where u were hiding!!!!!!!!!