Tuesday, December 31, 2013

Hard lessons of the past 48 hours:

1. You have to double-check that an HIV test has been drawn. Not sure why, but this one doesn't happen in a timely fashion. Dr. Beck told me to "make sure it gets done" and I didn't heed her advice until it was too late.
2. When you're intubating, curve your stylet yourself. I had to cede an airway because of a crook in my stylet I wasn't expecting. I freaked. Not to worry folks, patient got intubated just fine - just not by me.
3. Go fast when you're getting an ABG. You can't poke gently. It's more of a stab. It hurts, but it doesn't work otherwise. (ABG kits are in respiratory cart in old asthma room...which is just one of about a zillion Grady secrets)
4. Do not order blood cultures in the ED unless the patient is admitted. Period. There is no systematic way for following them up and then they end up "floating out there."
5. Know ALL nurses' names caring for your patients. As hard as I try every shift to do this, I end up retaining about one per shift, which just isn't enough. Also find their hangouts - not obvious.
6. Do not get involved in ANY junk, even benign-appearing junk. Once a patient begins telling you about what their girlfriend's mother's cousin sells (this actually happened tonight), you're not going anywhere for a while unless you reroute that train fast.
7. Don't even get into a patient's detailed description of a tiny segmented brown insect and how many of them there are unless it happens to be a spider.
8. Quit at quitting time? This seems to be possible? I can't.
9. CHECK OFF YOUR BOXES.
10. If you think a patient is having a STEMI and you need a repeat EKG and the EKG tech rolls by and you say, "Oh, hi, um, I just ordered an EKG for the patient in room 7-" and he cuts you off and says, "Well you got 'bout 3 or 4 people in front of you then you'll get your EKG," you are completely within your rights to say, "I am very concerned this patient may be having a cardiac event and he needs his EKG to come before the others."
11. You can reduce a rectal prolapse by sprinkling sugar on it. Teaching point of the evening.

* Numbers 6 and 7 were the funniest things I heard all night and I wish I could just walk around and ask people their stories.

1 comment:

Richie Gunn said...

whew! Number 9 is really tough for me! I pretty much got that other stuff down pat! Turkey's in the oven it's almost day.