Who is the worst at managing patient , when it comes to needing critical care.

[Daimon Michiko Doctor X]

I guessing Some surgeons are pretty bad at when it comes to abandoning patients in the ICU, and leaving all the work with the intensivists. I guess it buys them time for other work .I am going with ortho, I feel like plastics keeps an eye on their patients . Esp burns patients .Spill thy Tea

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[bashwell]

I guessing Some surgeons are pretty bad at when it comes to abandoning patients in the ICU, and leaving all the work with the intensivists. I guess it buys them time for other work .I am going with ortho, I feel like plastics keeps an eye on their patients . Esp burns patients .Spill thy Tea

The worst is the person who tries to get others to debate who is the worst.

 

[jdh71]

 

[deleted547339]

In before the lock!

 

[AdmiralChz]

Oh I thought this was going to be a total homer fest of anesthesiology vs surgery vs IM. That's not a very productive conversation.

 

[Daimon Michiko Doctor X]

Oh I thought this was going to be a total homer fest of anesthesiology vs surgery vs IM. That's not a very productive conversation.

Honestly I trying to get there but I think anesthesiology kicks ass because extensive knowledge of pharmacology airway management and experience . Internal medicine on the other hand are the dumping ground of " we don't know where to put you yet but we can't go home ". They ain't too much antagonism going on they too used to stability

 

[psychbender]

I'd say the pathologists are probably the worst at patient care in the ICU. Geneticists are probably second.

 

[Hernandez]

I'd say the pathologists are probably the worst at patient care in the ICU. Geneticists are probably second.

I dunno. I've seen more pathologists in an icu than allergists, so at least they try!

 

[WeeBay]

hospice and palliative care

 

[psychbender]

hospice and palliative care

Actually, I would love for more of their involvement. I like their outcomes, too

 

[shouldigomd]

I think the worst = hospital paperwork. Nothing more ridiculous than when someone is coming in with a STEMI and is being held up in the ER because of: "ok sir what is your religion, ok sir who should we contact if something goes wrong, ok sir can you sign your name here on these 15 papers i know your chest hurts sir but you need to calm down, ok everyone time out......" Medicine today

 

[deleted547339]

I'd say the pathologists are probably the worst at patient care in the ICU. Geneticists are probably second.

Don't forget psych.

 

[Daimon Michiko Doctor X]

I think I see a pattern here .The more stable your patients are e.g allergies ,dermatology, pathology ,etc the worse at manegement. I think they are too used to little antagonism so to speak

 

[Daimon Michiko Doctor X]

Don't forget psych.

I have totally seen psych neglect a patient because they were "crazy" and it's " in their head" . Then a simple case of infection turned to serious gangrene. Needless to say the internists called up Derm ( just to torture them of course). Then it turned into a case of derm complaining that people why don't take them seriously when they deal with life threatening cases such a gangrene and not just acne. They also mentioned they are on call too in ICU.

 

[Laryngophed]

Is this thread for real?

 

[BigRedBeta]

I'm going to argue for Toxicology.

I have a bunch of stories of things they've told me, but the two most egregious:
1) Citalopram ingestion, already with QTc prolongation on initial EKG, gets to the PICU and I give a dose of mag preemptively. Tox fellow tells me that she would have waited until the patient had an arrhythmia, then checked labs, then repleted only if levels were low...I realize the mag may not have prevented anything, but the negatives are limited and I surely prefer not to have to deal with torsades, so if there was any benefit seems worth it.

2) had another ingestion that wasn't recovering as quickly as we had hoped. We're around 22 hours post ingestion, tox fellow thinks pills are still being absorbed in the GI tract and suggests giving more activated charcoal...really wanted to tell them that's not how GI motility works

 

[deleted547339]

2) had another ingestion that wasn't recovering as quickly as we had hoped. We're around 22 hours post ingestion, tox fellow thinks pills are still being absorbed in the GI tract and suggests giving more activated charcoal...really wanted to tell them that's not how GI motility works

Several toxins slow GI motility significantly and several pills are delayed release....

 

[BJJVP]

2) had another ingestion that wasn't recovering as quickly as we had hoped. We're around 22 hours post ingestion, tox fellow thinks pills are still being absorbed in the GI tract and suggests giving more activated charcoal...really wanted to tell them that's not how GI motility works

Maybe he was thinking of enterohepatic circulation? I am not sure. Maybe one of the toxicology guys can chime in.

 

[jdh71]

I'm going to argue for Toxicology.

I have a bunch of stories of things they've told me, but the two most egregious:
1) Citalopram ingestion, already with QTc prolongation on initial EKG, gets to the PICU and I give a dose of mag preemptively. Tox fellow tells me that she would have waited until the patient had an arrhythmia, then checked labs, then repleted only if levels were low...I realize the mag may not have prevented anything, but the negatives are limited and I surely prefer not to have to deal with torsades, so if there was any benefit seems worth it.

2) had another ingestion that wasn't recovering as quickly as we had hoped. We're around 22 hours post ingestion, tox fellow thinks pills are still being absorbed in the GI tract and suggests giving more activated charcoal...really wanted to tell them that's not how GI motility works

Some stuff recirculates through the bile when the bile gets reabsorbed

 

[guest1347]

Medicolegal

 

[deuist]

Not a toxicologist, but several of the tox guys I know have moved away from charcoal. There has been all of 1 article that ever demonstrated a benefit---and its results could not be replicated. Given that there's no proven benefit, that it ruins any chance at endoscopy, and that it generally causes a mess in the patient's bed and room, there has been a push to treat symptoms and laboratory findings instead. I haven't given it in ~4 years.

 

[NontradICUdoc]

Just throwing it out there but, Homeopaths are terrible. With their, just dilute it and call me if you need me attitude it drives me up a wall