Advice for new interns

[DVMDream]

This is basically an identical list to me, although several of the common abx I have a fridge chart for so I don't have the doses properly memorized.

Also the answer for doxy is both, lol.

I know, that's why I can never remember which dose is appropriate for which condition.

---

Members don't see this ad.

 

[dyachei]

I know the dose, but only from a neuro rotation. I have had 1 status case since I graduated. Most cases aren't actively seizing when I see them. But I do like that I can give rectal diazepam or IN midaz. i tnd to send 1 dose home with owners just in case when they have many seizures

 

[LetItSnow]

Drugs I have memorized...

Cerenia, convenia, rimadyl, most of the antibiotics, benadryl, dexsp for allergic reactions, and most of the anesthetic drugs. But this is after a year of repetitive use of these drugs and occasionally I'll not use doxycycline for a while (as an example) and my brain will go was that one 5 or 10mg/kg??? Then I'll have to look it up.

Sure, we all have those memorized out in practice. But the poster was asking about drugs going into an ECC rotation, specific for emergent/urgent use.

 

[DVMDream]

Sure, we all have those memorized out in practice. But the poster was asking about drugs going into an ECC rotation, specific for emergent/urgent use.

Sorry for getting side tracked??? Threads never should go "off topic."

 

[LetItSnow]

Sorry for getting side tracked??? Threads never should go "off topic."

Damn straight. It makes people like you grumpy.

Don't be so defensive. I was just saying "hey, that's why I didn't mention drugs like that."

Ms. Grumpypants.

(We need to give you the secret handshake for the Grump Society.)

 

[DVMDream]

Damn straight. It makes people like you grumpy.

Don't be so defensive. I was just saying "hey, that's why I didn't mention drugs like that."

Ms. Grumpypants.

(We need to give you the secret handshake for the Grump Society.)

Not being grumpy my post states "this is after a year of repetitive use" so clearly not advising anyone to remember them now.

 

[deleted498041]

I know the dose, but only from a neuro rotation. I have had 1 status case since I graduated. Most cases aren't actively seizing when I see them. But I do like that I can give rectal diazepam or IN midaz. i tnd to send 1 dose home with owners just in case when they have many seizures

Wasn't there some paper recently on IN diazepam/midazolam? I've started dreaming about my internship in anticipation, so I don't remember if I dreamed that or if I actually heard someone mention a paper on it...

[edit] I found this Diazepam pharmacokinetics after nasal drop and atomized nasal administration in dogs. - PubMed - NCBI but I swear there was a more recent paper that was actually looking at clinical status, not pharmacokinetics. Oh god, maybe I did dream it.

 

[Angelo84]

on the good easy/ rough calculations for ER. Remember 1 ml/ 20 pounds for atropine, Valium, lidocaine ( for v tach). 0.1 ml/ 20 pounds for epinephrine. Double doses for epi/atropine if giving endotracheally prior to IVC placement in a code. Blocked cat with high potassium dextrose, calcium gluconate ( 3ml/ cat IF 10%solution) and insulin if needed to buy you time.
Also especially as new doctors consider the suggestions your experienced staff offers!

 

[Coquette22]

General advice for all new vets (interns or otherwise): Guard your off time. Seriously. I know fresh out of school you want to see all the things and do all the things, but you WILL burn out if you do that. Get out of the hospital when you can. Even if it's just a five minute walk around the block at lunch time. Have outside hobbies. You'll probably be friends with your internmates and coworkers, but try to have at least some outside relationships where you can be not a vet. Find other things to talk about with your internmates/coworkers. Admittedly I'm a GP and didn't do an internship, but I developed a reputation with certain receptionists for being a spoiled brat because I would insist on *gasp* getting a lunch hour or *shock* wanting to leave on time and *horror* not being double booked. I know, right? I'm so high maintenance. But this is necessary for my mental health. I'm not even 30, don't need to be a curmudgeon yet.

 

[DVMDream]

General advice for all new vets (interns or otherwise): Guard your off time. Seriously. I know fresh out of school you want to see all the things and do all the things, but you WILL burn out if you do that. Get out of the hospital when you can. Even if it's just a five minute walk around the block at lunch time. Have outside hobbies. You'll probably be friends with your internmates and coworkers, but try to have at least some outside relationships where you can be not a vet. Find other things to talk about with your internmates/coworkers. Admittedly I'm a GP and didn't do an internship, but I developed a reputation with certain receptionists for being a spoiled brat because I would insist on *gasp* getting a lunch hour or *shock* wanting to leave on time and *horror* not being double booked. I know, right? I'm so high maintenance. But this is necessary for my mental health. I'm not even 30, don't need to be a curmudgeon yet.

Yup, I insist on all these things... what do you mean you won't see this dog during your lunch??? Because I said no. Gasp, shock, horror... if the other staff aren't expected to miss lunch to see the patient then why should I be expected to? No, **** that. And those emergencies at 10 till close...nope there are at least 5 emergency clinics in the area, take your pick. I've been here 12 hours already by closing time, it is time I go home. I need to go home and have a few hours doing something other than eating, showering and sleeping.

 

[Coquette22]

DVMD we might be the same person. Actual conversation I had during my last weekend at my previous job:
Receptionist: The woman with the five puppies is running late. She won't be here until 4:30.
Me: Didn't we intentionally schedule her for 3 to give enough time to do everything before I'm off at 5?
Receptionist: She said she could only come at 4. And now she's running 30 minutes late.
Me: *rapidly running out of ****s to give* Whatever.
Client then shows up at 4:50. Nope.
Receptionist: Well can you do one or two?
Me: Since I still have a crap ton of records to write, I'm on call tonight and she missed her appointment time by almost an hour, I'm not inclined to do any of them.
Receptionist: ...So, will you do them?
Me: What did I just say?
Receptionist: ..well you said you weren't inclined...
Me: Yep. That means I won't. Tell her to reschedule. Unless she wants to pay an emerg fee for every puppy past 5 o'clock.

 

[DVMDream]

DVMD we might be the same person. Actual conversation I had during my last weekend at my previous job:
Receptionist: The woman with the five puppies is running late. She won't be here until 4:30.
Me: Didn't we intentionally schedule her for 3 to give enough time to do everything before I'm off at 5?
Receptionist: She said she could only come at 4. And now she's running 30 minutes late.
Me: *rapidly running out of ****s to give* Whatever.
Client then shows up at 4:50. Nope.
Receptionist: Well can you do one or two?
Me: Since I still have a crap ton of records to write, I'm on call tonight and she missed her appointment time by almost an hour, I'm not inclined to do any of them.
Receptionist: ...So, will you do them?
Me: What did I just say?
Receptionist: ..well you said you weren't inclined...
Me: Yep. That means I won't. Tell her to reschedule. Unless she wants to pay an emerg fee for every puppy past 5 o'clock.

Yes! I think I scared a kennel attendant at a sister clinic one night when I was working there...
It is 6:50PM (we close at 7) and we had been shat on all day by non-stop walk-ins and emergencies. I still had at least an hour to two of charts to write and since I was at a sister clinic, they had to be done that night, not something I could come back to tomorrow.
Anyway...

Kennel: "So I have a lady on the phone that wants to come in."
Me: "We have an 8:30 tomorrow morning"
Kennel: "No, she wants to come tonight. She said that her dog has been acting funny all day. So they put the dog outside for a few hours. They let the dog back in and it won't stop pawing at its face and is still acting funny."
Me: "So, she has known all day and watched her dog 'acting funny', placed the dog outside (because this makes logical sense when your dog isn't acting right) and now wants us to stay late, pay staff to stay late to see the dog that she has had at least 10 hours to be seen today?" "No, here are the emergency clinic numbers, if she is concerned she should take her dog there."
Kennel: "She is concerned, can she come in?"
Me: "No, if she is concerned, she should have called earlier and there are emergency clinics that she can take the dog to. Give her their numbers."

 

[SocialStigma]

Definitely agree that everyone needs to guard their days off. As an intern you won't have many days off unless you're not on call and you don't have any inpatients (or you're on ECC). But I learned pretty quickly to protect as much of my weekend as I could. On my first surgery rotation as an intern, I set up a discharge on Saturday at 10am. The owners didn't show up until 2pm because they decided to go to brunch first. From then on, if the owners couldn't make it by noon, then they couldn't pick up their pet until the next day. As a resident now, I don't stay for a discharge if the owners don't show up by 10am (discharges are all set up for 8:30-9:30am).

 

[KCgophervet]

Definitely agree that everyone needs to guard their days off. As an intern you won't have many days off unless you're not on call and you don't have any inpatients (or you're on ECC). But I learned pretty quickly to protect as much of my weekend as I could. On my first surgery rotation as an intern, I set up a discharge on Saturday at 10am. The owners didn't show up until 2pm because they decided to go to brunch first. From then on, if the owners couldn't make it by noon, then they couldn't pick up their pet until the next day. As a resident now, I don't stay for a discharge if the owners don't show up by 10am (discharges are all set up for 8:30-9:30am).

Literally one of my friends/SAM residents I worked with had that happen to her (and me the student) and then made almost that exact same rule. Thought it was brilliant and loved her for it even more.

 

[Kpowell14]

Definitely agree that everyone needs to guard their days off. As an intern you won't have many days off unless you're not on call and you don't have any inpatients (or you're on ECC). But I learned pretty quickly to protect as much of my weekend as I could. On my first surgery rotation as an intern, I set up a discharge on Saturday at 10am. The owners didn't show up until 2pm because they decided to go to brunch first. From then on, if the owners couldn't make it by noon, then they couldn't pick up their pet until the next day. As a resident now, I don't stay for a discharge if the owners don't show up by 10am (discharges are all set up for 8:30-9:30am).

Definitely going to keep this in mind!!

 

[Trilt]

Crazy!

I see seizuring patients all the frickin' time. I saw two on my last shift alone, one that came in actively seizuring, and one that was clustering for the owner, arrived not seizuring, and started seizuring soon after presentation.

Nothing weird about using midazolam. As best I know, the only real advantage over diazepam (given that nyanko says it doesn't matter) is that it's IM absorption is more predictable than diazepam. We stock both in our hospital ... just out of habit I reach for diazepam for actively seizuring patients and switch to a midazolam CRI if I want to go the CRI route. No real logic to it.

I guess my clinicians just hammered those drug doses into me. I remember a big long rounds chat about "what do you have to have memorized," and all the residents and staff looked around at each other and concluded that seizuring drugs are the biggies. Sounds like the other schools don't emphasize it as much.

I'm glad mine did, considering I see it frequently. In the end, it doesn't really matter. You memorize the drugs you use frequently, so in the long run ... who cares.



Well, I wouldn't expect it in a GP practice, since there are other reasons to have patients in hospital. But any patient I keep (ok, ALMOST any - occasionally I courtesy hospitalize some laceration repair without charging the owner if I know I can't repair it until 2AM or something and I want to let the owner bail and pick up in the AM) they're sick and I'd be remiss if I didn't have venous access in case they declined. 95% of them are on fluids anyway, and of the remainder that might not be, most of those are CHF cases where I want a catheter for giving lasix and other drugs....

I was just thinking about my shift yesterday after recently switching to ER and how I had three seizing animals in twelve hours... and how I definitely have the diazepam dose memorized now. Just thought about this thread and giggled a bit.