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Octopus0: First night in night float
作者:USMedEdu
发表时间:2009-07-06
更新时间:2009-07-06
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发信人: Octopus0 (同时能做8件事...该多好), 信区: MedicalCareer
标 题: First night in night float
发信站: BBS 未名空间站 (Sun Jul 5 20:53:13 2009, 美东)

First night in night float
Finally, I have experienced the so-called “NF”. There are many types of
call schedules in residents, short call/ long call… I have not figured out
all of them yet.
NF is a system for residents to get enough sleep. Even the on-call residents
can go home after certain hour (6pm here, 9pm for some other hospitals).
Without NF system, residents usually have to stay in the hospital for a
total of 30 hours, at the end of which they are pretty much dead.

As an NF intern, all I am supposed to do is to get the sign-outs from day-
time teams at 6pm, and to follow lab results, to report to PGY-2 what is
going on, to know what are the critically ill patients and what do we need
to watch out for. Usually the day-time residents/interns will tell you who
the most worrisome patients are.

Follow-up lab results is the most important job for PGY-1. I was told never
to make decision by myself. It is crucial to inform the resident any new
abnormal results so that we can make decision accordingly. Sometimes, a lab/
an order will not be processed for a long time. An intern should contact
all the relevant personnel and get the job done on time. If there is any
unforeseen difficulty, you need to let resident know and document.

last night, I was the only pgy-1 for the medicine floors. I got sign-outs
from 9 teams, about 50 patients intotal.
We started to check lab results from computer system at first. Soon, I got
pages. Pts asking for sleeping pills, pts developing delirium, confusion,
sudden headache, fever… I was the first line to answer the calls. my
resident also covers ER and admitting pts while I don’t have to.

One of the pts had CBC back and plt of 15 by 8pm. Remember the normal should
be 150-300! We are supposed to transfuse plt if plt <20 without signs of
bleeding. I immediately informed my resident and he had already put the
order. I felt so happy since he did not forget me and pt.

Around 11pm, the plt did not come; 12am, not come… I called the nurse and
she told me there was no plt at local blood bank and the plt had to be found
and transported from another blood bank… I told her to page me once the
transfusion was done as instructed by my resident. Then more phone calls,
about o2 sats, about skin itching, … overall, it was a quiet night and
nothing serious happened. I went to sleep.
Some more calls…

Around 3am, my resident called me up asking about the lab results. As for
the transfusion, the plt still had not come! My resident can’t stand
anymore. He talked with the nurse and the nurse documented the event.

Around 4am, a pt spike fever, my resident showed me how to get blood culture
. This is probably one of the only two “scutworks” we need to do. The
other one is ABG.
Then, while we were putting orders, another pt got high fever of 104. again,
blood cultureX2, urine culture, UA and orders… at this time, the morning
twilight came. Another day.
Later, an pt’s NG tube got blocked… I did not get chance to take a look.
My resident told me it can wait.
7am, sign-out to the day teams (9teams!).

Although I was nervous at first, It was not scary at all. I knew my resident
is at my back. It was more tough for him because in addition to covering
the floor, he has to admit from ER.
I have to mention that all the nurses are super nice here!! Most are Chinese
ladies and gentlemen. They are really thoughtful/ helpful. A lot of times I
asked them for suggestions. We chatted for a little while and was invited
for some cookies :)

give me several more nights, I will do better.

can you survive the NF?

I went to call room and lay down at about 12:15am, then got a few calls in
middle, then got up at 3 am. in the morning I did not feel tired at all.
Probably because it was my first day and i was too excited.

7:15 out of hospital, simple breakfast, then sleep until 11am... could not
sleep no more :(

some people argue on "tired residents" vs "ignorant docs". I think NF is
better than 30-hour call. at least for my oneday experience .

I don't know why they gave the cutoff value of 20. It was the
experience of someone else.

so what is the threshold for transfusion if there is bleeding?
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 209.122.]


发信人: dreamtrue (true), 信区: MedicalCareer
标 题: Re: First night in night float
发信站: BBS 未名空间站 (Mon Jul 6 09:32:38 2009, 美东)

The threshold for prophylactic platelet transfusion in pts without
other risk of bleeding should be 10,000.

If with leukemia, sometimes the threshold is 20,000.

Correct me if I'm wrong.

And I have a question

Is the platelet to be newly collected? I had platelet transfusion in China
before, and it;s terrible experience ---- the pooled platelet need to be
collected the same day of my operation , so I waited till late night to get
the operation done.


Thanks
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 129.98.]

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