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MEIMEIZ2007: Several Residents' shamed 趣事
作者:USMedEdu
发表时间:2008-12-02
更新时间:2008-12-02
浏览:882次
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发信人: MEIMEIZ2007 (caregiver), 信区: MedicalCareer
标 题: Residents 趣事
发信站: BBS 未名空间站 (Tue Dec 2 00:37:11 2008)

First of all, I am not a doctor. I am a RN in a community hospital. There
are quite a few stories about residents here.

1. One resident (PGY-1) told an RN, Dr. M is only responsible for
ventilators,and Dr. M not supposed to write this order. This resident did
not realize that Dr. M is not only a pulmonary physician but also he is the
medical director. Dr. M is responsible for all ICU patients.

2. our hospital policy is that primary doctor/family practictor/attending
needs to talk to specialty physician to get consult. One night, a patient
had respiratory failure and needed pulmonary physician. A resident (Dr.B)
insisted that it was the RN responsibility to call pulmonary physician to
get consult. After argument between this RN and Dr.B, this issue was moved
to charge nurse. Charge nurse explained the policy to Dr. B. Guess what Dr.
B said: I AM CHIEF RESIDENT.I HAVE BEEN HERE THREE YEARS, AND I NEVER BEEN
ASKED TO TALK TO SPECIALTY. What a shame for a chief!

3. One night, a patient had respiratory distress and pancreatitis. His TEMP
103F, Bicab 10, anion gap WNL. Pulmonary physician Dr. A ordered Bicab drip
and suggested a resident (Dr. C) to start antibiotic. Guess what Dr. C
question: why he needs Bicab drip? I don't think he needs antibiotic. Just
start tylenol 650mg PRN Q 4hr. Later on Dr. A said to the RN, I guess they (
residents) need time to learn. Guess what happen, the next early morning,
another resident took over this patient, and write the order: zosyn and
vancomycin STAT.

Everybody needs time to learn. However, if you are willing to be open to
take advice from others, you are less likely to make a mistake. Generally,
most RNs here are willing to help residents and respect them. But if their
attitudes are not in the right track, what can we do?
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 70.242.]


发信人: acne (麦地米虫), 信区: MedicalCareer
标 题: Re: Residents 趣事
发信站: BBS 未名空间站 (Tue Dec 2 01:22:02 2008)

Thanks for the imput.

In our hospital, at very begining, it is the secretary to call the consult.
Later attending say no,no,no. The secretary does not know the pt well, the
resident should call the attending for consult.

For the third pt, I just look through the UPTODATE. For prophylasix of
pancreatitis, normally people give gut decontamination and PO abx. Why this
pt is on Vanco+zoysn? Any other evidence of sepsis/ other infection?
Bicarb drip is normally given while PH is below 7.10 ~ 7.15, what is the PH
of this pt?

--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 204.126.]



发信人: sdmd08 (Beyond the sea), 信区: MedicalCareer
标 题: Re: Residents 趣事
发信站: BBS 未名空间站 (Tue Dec 2 09:48:15 2008)

The patient likely has SIRS.IF the contrast CT shows any sign of necrotzing
pancreatitis, antiobitics is indicated. If not, it is controversial. After
all, severe pancreattitis itself comes with SIRS, even in the absence of
infection. However,if the patient has lines for several days with high fever
. Zosyn with vanco are reasonable after blood cultures are drawn.

For bicard, it is controversial as well. Only clear indication is the non-AG
metabolic acidosis. It is also acceptable to give bicard INFUSION not bolus
for severe metabolic acidosis. there are so many different opions (not
evidence).

In practice, many MD would just cover it for legal issues.

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