Lopressor IV... how much I hate it.

[Faebinder]

Just ranting at the evil medication.

Our floor policy (as in the floor where I admit 90% of my patients) frigging wont give lopressor IV even if the person was on lopressor PO prior to admission. As you can imagine, many of the patients cant take PO, pick your variety of reasons: SBO, Postoperative Ileus, Sigmoid Cancer, blah blah blah.

And so... here comes the heart rate of 150-160 and nurses calling at night... Faebinder... do something.. (argh!!! Must move the patient to telemtry)... check with the chief resident... does not want to move the patient to the telemtry floor AKA "The Death Star".... phone call number 9 and finally a stat nurse is called and he gives the patient IV lopressor and I was like... WTH? They told me they cant do that on the floor... "Yeah, but I am a stat nurse, I can do that." At 4:30 am I just gave up and decided to take the burn. I moved him to the "Death Star" where they finally gave him Lopressor IV and Faebinder was able to get 1.5 hours of sleep before needing to preround.

The moral of the story... I hate lopressor.

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[Tired]

The moral of the story... I hate lopressor.

That's the moral of your story?!

For all the stupid crap I get told "I can't push that!" by the floor nurses, I just have them draw it up and go push it myself. The conversation usually goes like this:

Me: "Can you draw me up 5mg of Lopressor?"
RN: "I can't push that up here!"
Me: "I know, I'll push it."
RN: "Do you know how to push it?"
Me: "Not really, no. I thought I'd just shove it in there."
RN: "Oh my God! You can't do that! I'd better come with you to show you how to do it."
Me: "That would be great! Thanks so much."

Not really a solution for the meds that need to be given frequently (Fentanyl, dilaudid) but it can save you an ICU transfer some times.

 

[Blade28]

I've had to give a ton of these IV meds on the floor before. Lopressor, amiodarone, atropine, morphine, fentanyl, etc. Even Narcan!

 

[Bertelman]

I'm beginning to like my hospital. Sometimes they give me crap about "You have to push the first dose", but then a senior nurse usually tells the young one it's OK, since the Pt. is already on PO.

Either way, the drug hasn't worked for me yet. n=2

 

[toxic-megacolon]

Had a patient who was hypertensive on Ace inhibitors for CHF. He was NPO, but of course the nurses woudn't push IV BP meds. What I did was made it an additive in his TPN! THe nurses unknowingly gave IV enalpril via TPN for about 2 weeks till the pharmacy figured it out one day.

 

[Tired]

Either way, the drug hasn't worked for me yet. n=2

I never give IV BP meds period, unless they're in the unit, in which case it's probably either esmolol or nitroprusside. Even NPO for surgery, I'll still give them the PO meds with a sip of water.

Of course, I don't manage a lot of SBOs.

 

[Bertelman]

I never give IV BP meds period, unless they're in the unit, in which case it's probably either esmolol or nitroprusside. Even NPO for surgery, I'll still give them the PO meds with a sip of water.

Of course, I don't manage a lot of SBOs.

It's more for rate control.

 

[Tired]

It's more for rate control.

I know, meant to quote toxic-megacolon's post. For Lopressor, we usually still give it oral if they're not symptomatic. If they're hemodynamically unstable and require urgent rate control, then Lopressor IV push is probably insufficient anyway, and a drip would be more appropriate.

Although, thinking about it now, our ER likes Lopressor a lot. I still don't know why.

 

[doc02]

The moral of the story... I hate lopressor.

The moral of your story really should be how hospitals have inane policies -- either real (from administrators) or just made-up (by nurses) -- that impede patient care. BUT you're not allowed to follow them, you have to circumvent them at great cost of time and energy to you. It's like some lame game because if you just follow the rule (like you should) and something bad happens to the patient, you'd be blamed for following the rule "mindlessly" and not doing everything humanly possible to get what your patient needed "in this special circumstance." But if you get around it and something bad happens to the patient, you'd be blamed for not following the rule "responsibly" and acting in a reckless and unethical manner.

Technically, if someone tells me I can't use an IV med because it's against the rules and the patient can't take PO, I should just be allowed to walk away from the situation without a care in the world and watch television in the call room.

 

[Tired]

Technically, if someone tells me I can't use an IV med because it's against the rules and the patient can't take PO, I should just be allowed to walk away from the situation without a care in the world and watch television in the call room.

Alternatively, you can just immediately transfer the patient to the unit. This can be a little annoying to your colleagues at first, but if you have an open unit (as we do), you're not screwing the ICU team because you can continue to manage the patient as the primary team.

Floor nurses can frustrate you, but everyone knows that ICU nurses are downright scary when they get really mad. And when you transfer them a patient just because the floor wouldn't do something, you better believe there are some inter-departmental recriminations there.

I've done it with lumbar drains. As I advance up the PGY ladder, I will do it more often for other things.

 

[doc02]

Floor nurses can frustrate you, but everyone knows that ICU nurses are downright scary when they get really mad. And when you transfer them a patient just because the floor wouldn't do something, you better believe there are some inter-departmental recriminations there.

They're only "scary" to residents because they can page you with lots of things if they get angry. They have no more power than any other nurse. If they complain, it will of course be noted but that doesn't mean it will be acted on. The only reason it seems like they have more power is because units are much smaller microcosms of the hospital. They are isolated, fewer beds, lower ratios of nurse to patients, and everyone is basically usually within about 20 feet of each other. Everything is magnified and it seems like they "control" the ICU, but they are no different from the floors.

 

[Tired]

They're only "scary" to residents because they can page you with lots of things if they get angry. They have no more power than any other nurse. If they complain, it will of course be noted but that doesn't mean it will be acted on. The only reason it seems like they have more power is because units are much smaller microcosms of the hospital. They are isolated, fewer beds, lower ratios of nurse to patients, and everyone is basically usually within about 20 feet of each other. Everything is magnified and it seems like they "control" the ICU, but they are no different from the floors.

No, I mean scary to the other nurses in the hospital. You transfer someone to them who is rock-solid stable, and they want to know why. You say, "The patient needed Lopressor IV, and the floor wouldn't give it." You better believe they make some angry phone calls to that floor's nursing supervisor.

 

[JayneCobb]

the magic words to make IV Lopressor a go in my hospital. IV piggyback.

I threatened to call a code one night because the nurses "can't give IV cardizem on the floor because we're not ACLS certified" Well guess what? I as a physician am, so go get me the damn medicine and I'll push it myself.

I really get so very sick of all the damn nit-picky rules which gives the hospital technicalities on how to charge more money. You're either a regular nursing floor, a step-down, or unit.

 

[Bertelman]

...Floor nurses can frustrate you, but everyone knows that ICU nurses are downright scary when they get really mad....

I saw a fellow intern break down nearly to tears last wekend on call because the ICU nurses ganged up on her. She was relaively blameless, except that she didn't bring her flak jacket when she responded to the page.

Boy, she's gonna get broken soon.

 

[Tired]

I saw a fellow intern break down nearly to tears last wekend on call because the ICU nurses ganged up on her. She was relaively blameless, except that she didn't bring her flak jacket when she responded to the page.

Sad. I saw a similar situation as an MS4 between an R2 and the entire ICU staff. They accused him of "not taking nursing concerns seriously" about some hematemesis, despite the fact that he had come to see the patient three times during the night. No tears, but he was struck speechless as nurse after nurse piled on, telling him that he needed "to learn to respect the opinions of nurses who have been doing this a lot longer than [him]."

Finally the attending walked in, told everyone to shut up and get the hell out of the room.

It was classic. I wish I had recorded it on my cell phone.

 

[doc02]

If a nurse ever tried to pile on me and lecture me to respect them based on how long they were working, I'd just ask them a few questions on medical management and laugh as they failed. That's how you handle that. You don't need to raise your voice or anything, just put them on the spot and bulldoze them down with knowledge. I've had to do that a few times and it's pretty fun because they start out acting all aggressive and like sharks that can taste blood and just a few seconds later they're all on the defensive and stammering and pretending they have work to do on the other side of the ICU. Do that enough times and they'll stop because they don't like being humbled in front of everyone.

 

[danielmd06]

In reference to the above posts about ICU nurses...

Always be willing to learn from them, but always be willing to stand your ground when you are right. Don't be bullied.

Every time you switch to a new environment, like a Trauma ICU, a Surgical ICU, a Stroke Unit, a Cardiac Care Unit, a Medical ICU, a regular floor, or a Neuro ICU, remember that meds, protocol, and emergencies can differ drastically.

It's not fair for someone who has worked in one particular environment for five years to give someone else (aka "the new intern") grief when that second person has been there for a grand total of two weeks.

Be willing to learn, willing to help, willing to teach, and above all...be willing to be professional.

 

[doc02]

Always be willing to learn from them

I disagree with this. People say this a lot in an attempt to be concilliatory; after all, it's very nice to say "we can all learn a lot from each other. Thing is, when you "learn" things from ICU nurses, it's like I said before: you'll find that it's knowledge from their point of view. Rather than "do this for these medical reasons and here is the physiology or rationale behind it," it's more like "do this because, well, I've seen a lot of people do it in the past." For example, one person had a dropping BP and a nurse told me I should start a random pressor. Now, I'm no expert on which pressor to choose yet, so I asked her why she made that choice, hoping I could learn a little. She just said, "we always use it." Huh. Decades of ICU experience and that's your pearl of wisdom for me?

 

[Chronic Student]

So, did you learn not to listen to that nurse for her random pressor selection?

If so, you've learned something.

Not trying to be cute, but you can always learn something from someone. Maybe not technical medical knowledge, but you might learn what not to do, how that nurse thinks and every once in awhile someone who has been doing a particular thing for a long time might know a little even if they don't know all of the pathophysiology and pharmoacokinetics behind something.

-Mike

 

[doc02]

So, did you learn not to listen to that nurse for her random pressor selection?

If so, you've learned something.

I already knew that, though.

 

[Bertelman]

Always be willing to learn from them

I disagree with this.

I think the key is that you are willing to learn. I'd agree that you may not learn much from nurses about indications for certain medications, but believe me, if you take the attitude that there is nothing you will ever learn from a nurse (which it seems you have), you will likely be missing out on some tidbits that may make your life easier.

I don't ask a nurse why certain med should be given, because I'll be damned if I let them sniff some ignorance coming from me. But I certainly ask them other questions about why they do what they do, how to get tests ordered/accomplished, etc. I've worked a fair number of jobs in a hospital, and anyone else who has would agree that there is something, no matter how menial, that can be learned from just about every hospital employee. I'm not saying I will ask the person grilling my pizza how I should treat that lady upstairs, but I'm also willing to learn just about anything from just about anybody every day I show up for work. Sometimes I'm disappointed, but you would be surprised at how much easier it is for me to get info or help from the nurses I get along with.

 

[doc02]

I certainly ask them other questions about why they do what they do, how to get tests ordered/accomplished, etc.

Usually when people say that "nurses can teach you a lot," they don't mean "...about nursing." The implied message is that they can teach you about medical care, which is false. If you mean "about nursing," then sure. I have no problem with that.

 

[jennyboo]

Our floor policy (as in the floor where I admit 90% of my patients) frigging wont give lopressor IV even if the person was on lopressor PO prior to admission. As you can imagine, many of the patients cant take PO, pick your variety of reasons: SBO, Postoperative Ileus, Sigmoid Cancer, blah blah blah.

And so... here comes the heart rate of 150-160 and nurses calling at night... Faebinder... do something.. (argh!!! Must move the patient to telemtry)... check with the chief resident... does not want to move the patient to the telemtry floor AKA "The Death Star".... phone call number 9 and finally a stat nurse is called and he gives the patient IV lopressor and I was like... WTH?

Yeah, where I did my internship the floor nurses couldn't push IV Lopressor either.... Lopressor IV had to be administered either on a telemetry floor hooked up to monitors, or by a stat nurse with a portable monitor.

I don't know about policies at your hospital, but everywhere I've been a heart rate of 150 is an arrhythmia until proven otherwise. Thus, any new onset of tachycardia without obvious explanation merits at least an EKG, and telemetry is probably indicated. If it's Afib in a patient who has paroxysmal Afib, then you can push metoprolol or diltiazem until you get rate control (to below 100) with no workup. If it's new onset, unless you have an obvious reason you need a workup (EKG, electrolytes, enzymes). If it's an SVT or a slow VT... well, you get the picture.

So no matter who pushes the rate controlling medication or where they are at the time, the patient probably should still go to telemetry when a bed becomes available.

If the RN isn't allowed to push the metoprolol, you can:

1) Ask for stat nurse to come and do it.

2) Push it yourself. Have them get an EKG first to cover your butt. Then have them hook the patient up to a portable telemetry monitor and also don't forget to have someone take a BP. The metoprolol usually comes as 1mg/mL with a total of 5mL per vial.... To play it safe, push 2.5mg (half the vial), wait two minutes, push the other half if still not rate controlled, and continue until you either get your desired effect, or reach your max (mine: metoprolol 5mg IV q5min to max 3 doses) and have to try something else. Don't forget to check the BP as well as the HR. Also make sure the IV bag is actually open and dripping while you're pushing, otherwise your Lopressor is gonna stay in the tubing and not get to the patient.

 

[Tired]

Now, I'm no expert on which pressor to choose yet, so I asked her why she made that choice, hoping I could learn a little. She just said, "we always use it." Huh. Decades of ICU experience and that's your pearl of wisdom for me?

I actually ask quite often which meds certain attendings prefer. God knows that there are enough staff docs out there who are unexplainably loyal to particular medications, and the moment you suggest something else, they treat you like you're an idiot. Asking the RNs what is normally given for whatever condition can save you a lot of hassle on rounds.

Example: I&D'd a routine abscess today on the buttock. Now the surgical literature, from what I recall, would argue that antibiotics after I&D is probably unnecessary, but of course 75% of the docs where I work still use it. I ask the nurse what my attending uses; she says Clinda. Nevermind that our antibiogram shows about 40% MRSA resistance to Clinda, and I'd rather use Bactrim. Come presentation, he asks what I'd give for antibiotics. I say Clinda, he smiles, score one for me.

 

[GoodMonkey]

one of my absolute worst pet peeves about regular floors in my hospital (as opposed to step down or a unit) is that i can't give IV pain medication. none. all pain meds either have to be oral or IM. (these poor people are getting their morphine q3 or whatever as shots in the arm. )

it's one of the most asinine rules i can imagine. in situations where i have to go do a big wound vac change or dressing change and my patient isn't in SDU/ICU, occasionally, occasionally a reasonable nurse, s/he will let me push it IV prior to the procedure on a regular floor, but i have to do it. and i am allowed to do that maybe 10% of the time that i ask.

asinine.

 

[doc02]

Example: I&D'd a routine abscess today on the buttock. Now the surgical literature, from what I recall, would argue that antibiotics after I&D is probably unnecessary, but of course 75% of the docs where I work still use it. I ask the nurse what my attending uses; she says Clinda. Nevermind that our antibiogram shows about 40% MRSA resistance to Clinda, and I'd rather use Bactrim. Come presentation, he asks what I'd give for antibiotics. I say Clinda, he smiles, score one for me.

Nah, I'd rather just have the attending get angry than do it that way. But that's just me personally.

 

[Tired]

Nah, I'd rather just have the attending get angry than do it that way. But that's just me personally.

They never let me do it my way, unless I just do it and tell them later. That works with inpatients, but not someone I'm sending out from the ER, because they always want to hear about the patient before I discharge them.

 

[Faebinder]

They never let me do it my way, unless I just do it and tell them later. That works with inpatients, but not someone I'm sending out from the ER, because they always want to hear about the patient before I discharge them.

Been there, done that.. Luckily, my attending is chill with antibiotic selection.

 

[Winged Scapula]

Yeah, where I did my internship the floor nurses couldn't push IV Lopressor either.... Lopressor IV had to be administered either on a telemetry floor hooked up to monitors, or by a stat nurse with a portable monitor.

I don't know about policies at your hospital, but everywhere I've been a heart rate of 150 is an arrhythmia until proven otherwise. Thus, any new onset of tachycardia without obvious explanation merits at least an EKG, and telemetry is probably indicated. If it's Afib in a patient who has paroxysmal Afib, then you can push metoprolol or diltiazem until you get rate control (to below 100) with no workup. If it's new onset, unless you have an obvious reason you need a workup (EKG, electrolytes, enzymes). If it's an SVT or a slow VT... well, you get the picture.

So no matter who pushes the rate controlling medication or where they are at the time, the patient probably should still go to telemetry when a bed becomes available.

If the RN isn't allowed to push the metoprolol, you can:

1) Ask for stat nurse to come and do it.

2) Push it yourself. Have them get an EKG first to cover your butt. Then have them hook the patient up to a portable telemetry monitor and also don't forget to have someone take a BP. The metoprolol usually comes as 1mg/mL with a total of 5mL per vial.... To play it safe, push 2.5mg (half the vial), wait two minutes, push the other half if still not rate controlled, and continue until you either get your desired effect, or reach your max (mine: metoprolol 5mg IV q5min to max 3 doses) and have to try something else. Don't forget to check the BP as well as the HR. Also make sure the IV bag is actually open and dripping while you're pushing, otherwise your Lopressor is gonna stay in the tubing and not get to the patient.

What's a stat nurse?

 

[Faebinder]

What's a stat nurse?

Short Version: Apparently they are nurses who are available to help a nursing floor if one of their patients' condition is too much for the nurses to handle with their duties on that floor. These nurses are ACLS certified I believe.

How I learned what a stat nurse is... (the long agonizing way..)

One day I walk over to one of our patients who is terminal and there are like a million and 1 person outside the door. Half are screaming "We can't handle this patient here." "I dont have enough time." blah blah blah blah... I had to argue with a group of nurses that we are not taking the patient to the ICU cause she is terminal.. what will the ICU do for her? I argued that the attending was planning to come down soon from the OR and discuss the DNR with the family (which was right there). After I cooled off a bunch of them (not really) we started arguing about needing a PICC line in them cause I had told them to stop using her mediport for IVF access (that usually makes nurses mad). So I asked them to put a peripheral and they were like (we cant seem to do it)... so I told them I'll do it myself.... The stat nurse was standing there and looking at me...so when all the nurses disappeared she remained behind and said, "So I guess you wont transfer her." and I was like "No." She replied "Alright, I guess I'll hang around." I was like "I'm sorry, who are you?" She replied "Oh, it's obvious you dont know what is a stat nurse, you have the deer in the headlights look." And there she proceeded to explain what a stat nurse is....

 

[JayneCobb]

And there she proceeded to explain what a stat nurse is....

Never heard of a stat nurse, but if it's anything like a stat lab or a stat ABG or stat EKG, it's anything but stat.

I'm tired, I'm less than amicable at the moment, so ya know what? I'm goign to vent a bit.

Dear Unit secretary,

I realize that yes you do have to put the charts together and that some of my fellow physicians get cranky if there aren't fresh progress notes in them, but when I walk up to you and hand you a chart with stat labs, I mean STAT as in ASAP, as in stop whatever the hell you're doing and get my labs and orders started. I don't dick around, and use the term stat unless I mean it. So don't tell me to sit it down, I want you to aknowledge that you under stand when I nicely say, please input these now as he's very sick. I shouldn't have to explain why, how, where, and to what extent I'm doing to you. and the hint that I'm picking up the phone and calling lab to tell them to get their slow butts up here for "not only stat but stat labs" I'd think you'd clue in that I'm serious. Nevermind that I also asked you to call the nurse supervisor to get me a bed in the Unit, I really can't have been that serious. And when I get direct and point, it's not to be an ass, it's because I don't have the time to explain myself to you, and I shouldn't have to. And when it comes down to it, I could care less what you think about me as I'm here for the patients and that's who I was doing my best to help. So give me a break, help me out a bit, and we'll get along smashingly like I do with the secretary on the other floors.

And dear respiratory therapist.

40 minutes later is not stat, that's more of when you damn well feel like it. I'm more than capable of obtaining an ABG, and after 30 minutes I did just that, but when I'm trying to coordinate and get the labs and get in touch with attendings and get the ball rolling, there are times when it would be super if you help me out and get one for me. I had that vague suspicion that his pH was less than 7.1 and hot damn it was.

Sincerely,

jayne

 

[jennyboo]

stat nurse: In our hospital, at all times we had a "rapid response RN" or who wasn't assigned to a specific place, but went where s/he was needed. This was usually a critical care RN. They'll come if you or the stationary RNs ask for them to come (assuming they're not held up somewhere else in the hospital).

More important than how fast s/he could come, was the fact that this person is not only extra hands, but can administer certain meds that floor RNs may not be allowed to. Useful if you need someone to push restricted stuff such as adenosine, or to start pressors.

Also very useful if you need to send a claustrophobic patient to MRI in the middle of the night and need an RN to stand there and push sedation, and the patient's floor nurse has eight other patients and can't go.

 

[Winged Scapula]

Interesting. Thanks guys...I've never heard of a stat nurse...wonder if my hospitals didn't have them (or didn't want to tell me, but rather just argue that we can't give IV beta blockers on the floor and I'd have to do it myself or transfer the patient).

 

[telenurse]

As a long time lurker jumping in to the fray, I will just say that..
When I worked as a nurse in an asinine hospital that would not allow RN's to administer IVP medications except in a code situations, I would pull the med from the pyxis, draw it up in a syringe, tape the vial to the syringe, have a flush and an alcohol wipe ready, hand it to the doctor, and then stand by the dynamap and take the darn vitals for him/her, in the cases of IV lopressor for high BP, or rate control.
Some policies are idiotic, why risk a pt decompensating from SVT with heart rates in the 140-160's with all the time it would take arranging a transfer to the ICU, when the ICU has no beds, when it would take 5 minutes to give stat lopressor IV?
Of course my willingness to take these kind of measures made me unpopular, life was hell, and I went to greener pastures with more sensible policies. But I still thought it was insane that at this hospital I could give IV push chemotherapy but not IV push lopressor??
Just my $.02.

 

[doc02]

Half are screaming "We can't handle this patient here." "I dont have enough time." So I asked them to put a peripheral and they were like (we cant seem to do it)...

And yet they get paid a lot of money and aren't constantly getting punched by residents. Next, on Ripley's Believe It Or Not!

 

[Blade28]

When I worked as a nurse in an asinine hospital that would not allow RN's to administer IVP medications except in a code situations, I would pull the med from the pyxis, draw it up in a syringe, tape the vial to the syringe, have a flush and an alcohol wipe ready, hand it to the doctor, and then stand by the dynamap and take the darn vitals for him/her
...
Of course my willingness to take these kind of measures made me unpopular

Unpopular among the other nurses, perhaps, but you would have been the favorite nurse among the residents if you did all that.

 

[Faebinder]

Unpopular among the other nurses, perhaps, but you would have been the favorite nurse among the residents if you did all that.

She would be soooo popular with the residents that she would have us all wrapped around her fingers. Oh well, good nurses are impossible to replace.

 

[JayneCobb]

She would be soooo popular with the residents that she would have us all wrapped around her fingers. Oh well, good nurses are impossible to replace.

amen.

Today's annoyance. Within a space of 5 minutes, I had 3 pages from the same nurse requesting things I'd already ordered. I finally asked her if she'd bother to read them. I said, if there is anything I haven't addressed, page me back then.

 

[carrigallen]

in my limited experience IV lopressor is less useful... it lasts about 10 minutes and then the rate is back up again. I think it is better to start PO or a drip. It's like giving IV labetalol for blood pressure...it only lasts for 8-20 minutes. So in conclusion, I also hate IV lopressor.

 

[telenurse]

She would be soooo popular with the residents that she would have us all wrapped around her fingers. Oh well, good nurses are impossible to replace.

LOL, when I switched jobs...some of the residents remembered me from their rotations at the VA hospital... Or maybe it was the fact I make good desserts...

Seriously... when I precept new grad nurses my rule is, you never call the doc over anything without your SBAR in place.
S ituation... My pt has a heartrate of 130-150, looks like Afib with RVR
B ackground... S/p Cabg 2 days post up, hx HTN, previous rhythm NSR at 75
A ssessment... BP 140/60, spO2 96% on liters, awake, alert, responsive (pertinent labs )
R ecommendations...Give me an order for EKG (which is already on the way) and some meds please, ( if you forget, the chief prefers amio 150 mg bolus over 15 min, 1 mg/min x6 hours and then 0.5mg/min x18 hours.)

I find using SBAR gets results quickly, and then once the docs get to know me, they tend to have more trust in my judgement when I call them with the "I'm not sure, but pt has the unusual symptom I can't put my finger on, but my spidey sense is going off like crazy, do you mind coming up to assess?"

 

[Bertelman]

in my limited experience IV lopressor is less useful... it lasts about 10 minutes and then the rate is back up again. I think it is better to start PO or a drip. It's like giving IV labetalol for blood pressure...it only lasts for 8-20 minutes. So in conclusion, I also hate IV lopressor.

I've been told that the point of IVP lopressor is to determine if there is a response. Push 5 mg q 5-15 min, if there's no response, there's little point in setting up a drip. Move on to the next drug.

 

[Winged Scapula]

LOL, when I switched jobs...some of the residents remembered me from their rotations at the VA hospital... Or maybe it was the fact I make good desserts...

Seriously... when I precept new grad nurses my rule is, you never call the doc over anything without your SBAR in place.
S ituation... My pt has a heartrate of 130-150, looks like Afib with RVR
B ackground... S/p Cabg 2 days post up, hx HTN, previous rhythm NSR at 75
A ssessment... BP 140/60, spO2 96% on liters, awake, alert, responsive (pertinent labs )
R ecommendations...Give me an order for EKG (which is already on the way) and some meds please, ( if you forget, the chief prefers amio 150 mg bolus over 15 min, 1 mg/min x6 hours and then 0.5mg/min x18 hours.)

I find using SBAR gets results quickly, and then once the docs get to know me, they tend to have more trust in my judgement when I call them with the "I'm not sure, but pt has the unusual symptom I can't put my finger on, but my spidey sense is going off like crazy, do you mind coming up to assess?"

What you mean you actually know what the vitals are and what operation the patient had when you call the physician?

Amazing. I cannot tell you how many times I get pages about patient X by a nurse (if I'm lucky...usually its the nursing assistant who then acts suprised when I want more information and then to give a verbal order, which of course they can't take) with such info. Particularly troubling when I'm moonlighting and have no idea who these patients are.

 

[doc02]

Yeah, I usually get "half-S and crazy-R." And "s" doesn't necessarily stand for "situation."

 

[Blade28]

LOL, when I switched jobs...some of the residents remembered me from their rotations at the VA hospital... Or maybe it was the fact I make good desserts...

Desserts + good knowledge of the patient when paging?

My god you need to come and work in Atlanta.

 

[Tired]

Amazing. I cannot tell you how many times I get pages about patient X by a nurse (if I'm lucky...usually its the nursing assistant who then acts suprised when I want more information and then to give a verbal order, which of course they can't take) with such info.

Oh God, flashback:

Me: "Cross-cover. How can I help you?"
CNA: "This is Julie on 4-south. Mr. Jones is going crazy!"
Me: " . . . what?"
CNA: "Mr. Jones! He's going crazy!"
Me: "What do you mean?"
CNA: "The nurse told me to call you because he's going crazy!"
Me: "What is he doing? What are his vital signs? Is he hurt?"
CNA: "I don't know! The nurse just told me to call you!"

Gah.

Turned out to be hypoglycemia-induced delerium.

 

[doc02]

The sad thing is, that actually constitutes an information-packed call compared to what I got. I was paged by a unit clerk, not even a nurse. The entire call:

Me: Hi, I was paged.
Unit Clerk: The nurse wants you to come down here.
Me: OK, what's the problem?
Unit Clerk: I don't know, she didn't say. She just wants you to come down here.
Me: OK, who's the patient?
Unit Clerk: I'm not sure, I didn't ask.
Me: OK. [End of phone call.]

I actually didn't go down right away. I waited for about two minutes, but not because I was being passive-aggressive. I was just sitting there literally wondering how some people qualify to work in a hospital. I couldn't come up with an answer, however, so I went downstairs to figure out what was going on. (Turns out it was nothing.)

 

[JayneCobb]

Jayne's annoyance of the day.

I was paged to come remove a Femoral line, not a big deal. I told them I wanted to review his hospice meds and make sure we didn't want to keep it and I'd be right down. I was paged a total of 3 times by 2 different nurses within a span of 20 minutes or so. So after I finish what I was doing I walk down and there was one of my fellow interns in there helping me out by pulling the line. Not a big deal on his end, but what pissed me off was when I didn't ask how high to jump when the called, the nurse paged the sr resident and LIED to him and said I never called back despite being paged several times. So of course he tells them to page the other intern on a different service to come do it. Then the liar, whom I'd already spoken to and told I would be there in a few, had the nerve to tell me to my face that I had never paged back? I was there, I remember the conversation. that's my patient, my service, and my responsibility. It is inappropriate to pull people off the other service without me asking for their help because some nurse has decided what the proper clinical course of treatment for my patient is.

I should have just went to the nursing supervisor and bitched then instead of threatening to go the next time she pulls **** on me.

 

[Tired]

It is inappropriate to pull people off the other service without me asking for their help because some nurse has decided what the proper clinical course of treatment for my patient is.

When I get called for patients on other services, I will go running if it's something serious. But if I get called for something like pulling a central line, I just laugh and hang up the phone.

Your fellow intern is to blame: either he is a pushover or a tool. My comrades know not to mess with my patients if I'm in-house. It's a respect issue.

 

[doc02]

...when I didn't ask how high to jump when the called, the nurse paged the sr resident and LIED to him and said I never called back despite being paged several times.

Nurses are well-known for both these practices. One is they are mostly female and so they think that by nagging you they can speed up whatever trivial thing they want. I mean, seriously, does it matter if a line comes out at 2 PM or 2 AM (barring infection)? No. And yet these half-******ed nurses decide that since it's someone ELSE'S job it must be done NOW.

What I mean is this: ever try to get a nurse to do something? Ninety-nine times out of a hundred you get, "yeah, I'll get to it when I get to it, cool your jets, hotshot" or some variant. But when a nurse wants someone to do something FOR HER, there's no waiting. In fact, they'll literally expend more energy on that than actually taking care of the patient. Meds will go un-dispensed and patients will lie around in their own stool ...meanwhile, the nurse is bomb-paging you relentlessly at the rate of one page per five seconds and giggling about how funny it is. A lot of these nurses are mentally about five years old.

The other is the old "I'm going to try to get you in trouble by paging the next person on the ladder." Believe me, everyone in the hospital knows that one. I never cease to be amazed at how nurses think all of their tricks are so clever and devious and nobody knows what's going on.

Bottom line: just give them a shot in the head with your elbow and drop them to the ground if they try those games.

 

[JayneCobb]

Your fellow intern is to blame: either he is a pushover or a tool. My comrades know not to mess with my patients if I'm in-house. It's a respect issue.

I don't view it as his fault, he was lied to and we both try like hell to help each other out with the long month we've had this past month. I'd probably have done the same for him if I felt I was helping him out.