Stupid calls from nurses

[gerickson03m]

Actuall Call's

1. My Patient's Leg is 1 inch shorter than the other

2. My patients blood pressure is 98/67

3. My patient was transferred from the SICU 8 hours ago and doesn't have orders

4. Come put in foley bc I can't find the penis

5. The patient has 1000 out of the foley, do you want me to clamp it?

6. Can we advance diet (POD 1 s/p APR with NGT and in the ICU)

7. My patient has neck swelling (the patient was admitted for neck swelling)

9. My PTT is >200, do you want me to increase his heparin

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[Amxcvbcv]

I'd bet that for every inappropriate call from a nurse there are equally annoying goofs by doctors. Thank god there are lawyers to make sure we tell each other these things.

 

[southerndoc]

1. Nurse: "Patient so-and-so's IV came out. Do I need to start another?"
Physician: "Isn't the patient receiving Vanc and Zosyn?"

2. Nurse: "Does the patient really need the mag and potassium IV?"
Physician: "Isn't the patient NPO?"

 

[Anasazi23]

4:30 am....

*Beep! Beep! Beep!*

Me: What's up?
Nurse: This patient is hypoglycemic.
Me: What's his fingerstick?
Nurse: 86.
Me: So what's the problem?
Nurse: Well, that's really low!
Me: Actually, that's perfectly normal.
Nurse: I'm just used to seeing like, 150, 200 or 250. Can you come see the patient?

 

[Mman]

3. My patient was transferred from the SICU 8 hours ago and doesn't have orders

That doesn't sound like a stupid call, that sounds like a good call. The stupid part was whoever didn't write the orders when they were supposed to. It's better to page somebody and let them know that they need to write orders than to do nothing and let everyone look like an idiot on rounds the next day. But yeah, nurses come up with some doozies at times.

 

[mddo2b]

Actuall Call's

1. My Patient's Leg is 1 inch shorter than the other

2. My patients blood pressure is 98/67

3. My patient was transferred from the SICU 8 hours ago and doesn't have orders

4. Come put in foley bc I can't find the penis

5. The patient has 1000 out of the foley, do you want me to clamp it?

6. Can we advance diet (POD 1 s/p APR with NGT and in the ICU)

7. My patient has neck swelling (the patient was admitted for neck swelling)

9. My PTT is >200, do you want me to increase his heparin

I love this one....beeper goes off at 3am to inform you that the pt has a fever of 38.1 When you explain that in the orders it says to call MD if T>=38.3, and that there is a standing tylenol order. Her response, well, i thought you would want to know.

 

[CambieMD]

Actuall Call's

1. My Patient's Leg is 1 inch shorter than the other

2. My patients blood pressure is 98/67

3. My patient was transferred from the SICU 8 hours ago and doesn't have orders

4. Come put in foley bc I can't find the penis

5. The patient has 1000 out of the foley, do you want me to clamp it?

6. Can we advance diet (POD 1 s/p APR with NGT and in the ICU)

7. My patient has neck swelling (the patient was admitted for neck swelling)

9. My PTT is >200, do you want me to increase his heparin

Some of the items on your list may be valid reasons for calling the doc.
Part of the of a nurse is to be concerned for the wellbeing of his /her patients. At times I have been called for"nothing" and other times I we have been able to intervene before a patient really took a nose dive. A good relationship with the nursing staff is essential for a docs survival in the day and age.

A large amount of litigation arises from how telephone calls are handled. If the nurse is completely in left field thank God that you don't have to do anything and can go back to sleep .

If have seen more than one doc sued because he was kept out of the loop. The staff was afraid to call them. You could say that the pt went "bad."Was was an ob case.The other was a surgical case. The only individual named was the doc.

I probably sound like a boring old man and I am. Give the nurses a break and have the right attitude. You will more fun that way.


CambieMD

 

[Doczilla]

Newsflash, y'all...
Nurses don't make those calls because they're idiots. They do it because they don't like you. Several nurses I've spoken to routinely practice this form of torture (usually late at night) on the residents who are d#cks to them. Usually it entails clarifying orders that don't really need to be clarified, requesting permission for drugs on standing order, requesting you to perform skills they easily could have done, or informing you of a normal patient condition.

One surgical resident here made a derogatory commentabout the ICU nurses unfortunately (for him) within their earshot. He was paged every 30 minutes all night long to random hospital numbers (even the elevator phones).

You'll note that the residents who are popular with the nurses rarely get those calls.

'zilla

 

[gvmatt]

here is my most favorite call that i got-
5am - my pt's bp is high, so i gave her her bp meds.
i went and checked the bp - was actually down 10 pts since the last check! and the pt was admitted for esrd with uncontrolled bp.

here is the call i wish i had gotten-
my pt's iv is out and phlebotomy couldn't get one in and neither could i.
- the pt required iv abx for a highly resistant infxn only sensitive to one abx - iv had been out 20 hrs by the time i went to her bedside to see how she was doing. pt missed 3 doses of abx.

 

[Arch Guillotti]

Newsflash, y'all...
Nurses don't make those calls because they're idiots. They do it because they don't like you.

I would argue that either statement is likely to be true at the VA. Probably moreso the former. The worst call I got this year was from a nurse at the VA who couldn't pull a femoral line at 4 am because "we aren't allowed to do that." I can buy that, except he was dead. Then she paged me later and told me I needed to hurry up because the funeral home was on the way.

 

[DrGarfield]

I would argue that either statement is likely to be true at the VA. Probably moreso the former. The worst call I got this year was from a nurse at the VA who couldn't pull a femoral line at 4 am because "we aren't allowed to do that." I can buy that, except he was dead. Then she paged me later and told me I needed to hurry up because the funeral home was on the way.

This one was hilarious!

 

[Goose...Fraba]

Great guys...just great.....cant wait for freakin intern year to start

no seriously, lets hear some more this thread is great!

Goose

 

[mick2003]

Paged during my intern year in the middle of the night for a patient who was wheezing. Nurse didn't give him his PRN neb treatment because he was NPO.

 

[Idiopathic]

As a 3rd year student on OB, I decided that I could nap @ around 3:30 AM, since no px was in active labor (one woman was a 1-2 s progression for, like days)

About 4:15 AM we get woken up with: "Doctors, come quick...she's a nine...and pushing!"

Needless to say, when she was properly examined, and was maybe a 2, we had several questions...until, that is, she delivered a beatuiful, 3 lb, 3 oz bowel movement.

Oh, yeah...her rectum was a nine.

 

[USAF MD '05]

...until, that is, she delivered a beatuiful, 3 lb, 3 oz bowel movement.

Oh, yeah...her rectum was a nine.

LOL! That's classic!

 

[DOtobe]

Paged during my intern year in the middle of the night for a patient who was wheezing. Nurse didn't give him his PRN neb treatment because he was NPO.

 

[tripod]

here's a good one that happened a few nights ago

"my patient is on this medicine protocol and we just got the PTT back. I need to decrease the dose by 20%. what's 20% of 1.5?"
hehe so she got yelled at for about 2 mins after asking that

 

[mdblue]

Actuall Call's

1. My Patient's Leg is 1 inch shorter than the other

2. My patients blood pressure is 98/67

3. My patient was transferred from the SICU 8 hours ago and doesn't have orders

4. Come put in foley bc I can't find the penis

5. The patient has 1000 out of the foley, do you want me to clamp it?

6. Can we advance diet (POD 1 s/p APR with NGT and in the ICU)

7. My patient has neck swelling (the patient was admitted for neck swelling)

9. My PTT is >200, do you want me to increase his heparin

Call at 2 AM-' the BUN is really low...can you come and start some BUN IV stat
(The hospital uses one of those computerized system where it automatically flags up vaalues out of the range)

 

[tRmedic21]

I'd also be inclined to believe that alot of these things (the mundane ones, not the "I'm stupid" ones) are just the nurses making the doc's life hell for one reason or another. I foresee alot of my classmates from Basic Sciences getting very little sleep during their intern year, for precisely this reason. I actually heard one of my classmates say (completely serious), "What do you mean? Just tell the nurse that's HER job, we're MED STUDENTS."


I almost wish I was doing rotations with that nimrod, I could do absolutely nothing all day and still look like the star.

 

[mddo2b]

Call at 2 AM-' the BUN is really low...can you come and start some BUN IV stat
(The hospital uses one of those computerized system where it automatically flags up vaalues out of the range)

I started to laugh, but then i realized how often this happens.......preety sad

 

[southerndoc]

Call at 2 AM-' the BUN is really low...can you come and start some BUN IV stat
(The hospital uses one of those computerized system where it automatically flags up vaalues out of the range)

A friend of mine fielded a 2 am call with a low BUN. The nurse didn't ask to give the patient some BUN though.

I have to admit that he handled it very well.

What did he tell her? "The low BUN could be a sign of overhydration. We need to monitor his urine output every hour. How about this. Since the guy has a Foley, we can measure it. Measure his urine output every hour and adjust his fluids so that he receives half of what he peed out the hour before."

 

[supercut]

Very resourceful of him!!! Alas, I'm not that creative.

One of my favorites from intern year, on vascular surgery, a call from the PACU..."I just looked under the dressing and there's an incision there. Thought you'd want to know" (HMMMMM...how in the world did that happen?)

And one of my colleagues, while cross covering ped surg, at 2am.."I was looking through the orders in the computer and there's not a diagnosis in there for this kid. Can you put it in?" (This is a colleague who's behaviour is usually appropriate and polite, so it's hard to imagine that was a punishment call)

 

[soon2bdoc2003]

survived my intern year without too many stupid calls.. the fun ones in my old hospital went something like this:

2:30am *beep* *beep*
me -hello??
nurse -yes dr i just went to check on this patient and he is cold and stiff and there no dnr on the chart.. can you call the family??
me -grrrrr

one of my all time favs:

3:45am *beep* *beep*
me - hullo?
nurse - patient compaining of toothache
me - give him a tylenol
nurse - i just gave him tylenol for fever.. can i give another for the toothache
me - why dont you give him a cup of chicken soup and a handjob instead
*click*

that one earned me 1 month of probation.

For the most part, nurses are ok.. the ones that speak english and have a brain i rarely even interact with, and the non-english speaking ones are usually that right combination of cute/dumb/easy that you really need halfway through a rough call. ICU nurses are doc wannabes and will huff and puff all day long but guess what friend its called an ORDER for a reason.. otherwise they would call it a SUGGESTION.

As far as "punishment" goes..
A) calls are not meant for sleeping.. you should be ready and willing to hump for 30 hours especially in a busy icu
B) its a 2 way street.. sit in the unit all night long and put new orders every 30 minutes. Change fluids from LR to NS for no reason, then change it back an hour later. Anybody thats constipated gets a fleet. Dont be shy with the kayexelate... have you ever seen what kind of BM that stuff produces?? Send stool samples on all febrile patients. Attack their professionalism daily.. patients that are unclean get orders like "q4h oral cleaning" and "clean patient daily" these will anger a nurse for at least a week. Order all drugs "1st dose stat" then document in the chart when that dose was actually given. When placing lines, create a DISASTER of a mess then walk out and ask the nurse to call housekeeping or if you really want to piss them off just ask them to go clean it up.

I have another 30 or so items on that list but eventually they'll start equating calling you with pain and misery and the calls will stop. Remember you are the doctor and the nurses work FOR YOU no matter what crap their union reps have been feeding them. If you cant train the nurses to at least work with you then its simply your failure as a physician.

and people wonder why i went into anesthesia.. lol..

 

[southerndoc]

I don't want to create misery for nurses because when that happens, they won't call when patients need things. I for one don't want a patient to suffer in pain because the nurses are afraid to call me.

I'm generally nice to the nurses, but many tell me that I'm intense. They know to have their ducks in a row before they call. Don't call me to tell a patient has a low sat without knowing the respiratory rate. Don't call to say a patient has a low blood pressure without knowing the heart rate. Either way I always go see the patient, but judging by the other numbers, it determines how fast I see the patient. A patient with a systolic of 90 and a heart rate of 50 on metoprolol doesn't get an urgent response as a patient with a systolic of 90 and a heart rate of 140. There are sometimes when you can't see the patient right away (i.e., in the middle of a code, in the trauma bay, etc.), but it determines if I want to bother a co-intern to see the patient in my absence.

At any rate, I hate making a mess. I clean up after myself, always use a pad when inserting central lines (or pulling them), etc.

 

[clc17]

beep beep
Me- hi, what's up
Nurse- i was reading this order and I am really uncomfortable with it
Me- which order
Nurse- the 10 Units insulin 1 amp glucose, Calcium carbonate, and kayexelate
Me- ok, I wrote that order 3 hours ago, whats wrong
Nurse- well, the pt FSG is only 121. I am not comfortable giving the insluing
Me- ok, then if it makes you feel better give the glucose first
Nurse- no, you wrote insulin first. i am not comfortable with this. if you want it that way come and change order of the order.

Team on rounds goes up to pt floor, you know, since pt AM K was 6.5 and apparently he hadn't yet been treated for that. Attempt by attending in vain to get nurse to carry out order. Nursing (now not just one nurse, but all nurses onthe unit) saying they are all uncomfortable giving IV insulin to the patient with a FSG of 121. All saying they have NEVER seen this set of orders in their lives. Looking at all doctors like we are crazy. Instructed nursing manager to teach nursing team about the treatment of hyperkalemia. All nurses in unit in class the next week.

 

[Loopo Henle]

its a 2 way street.. sit in the unit all night long and put new orders every 30 minutes. Change fluids from LR to NS for no reason, then change it back an hour later. Anybody thats constipated gets a fleet. Dont be shy with the kayexelate... have you ever seen what kind of BM that stuff produces?? Send stool samples on all febrile patients. Attack their professionalism daily.. patients that are unclean get orders like "q4h oral cleaning" and "clean patient daily" these will anger a nurse for at least a week. Order all drugs "1st dose stat" then document in the chart when that dose was actually given. When placing lines, create a DISASTER of a mess then walk out and ask the nurse to call housekeeping or if you really want to piss them off just ask them to go clean it up.

I have another 30 or so items on that list but eventually they'll start equating calling you with pain and misery and the calls will stop. Remember you are the doctor and the nurses work FOR YOU no matter what crap their union reps have been feeding them. If you cant train the nurses to at least work with you then its simply your failure as a physician.

and people wonder why i went into anesthesia.. lol..

I tell you that is such a professional way to act!!! Remember who is on the receiving end of all that kayexelate. The freakin' patient. Try not to forget who is taking care of that patient for twelve hours in a row while you are off doing greater things. That would be the nurse. Have some sympathy for the nurses for God's sake. Alot of these people have two year degrees. You can not expect them to operate on your level. Keep treating the nurses like crap and your life will be miserable in the end. I am sure there is a nursing message board somewhere full of stories about *****ic things stupid residents have done. I am a former RN, and I am soon to be a MD. I think all of you should have to work as a nurse for a week, and I guarantee you would be whistling a different tune.

 

[RedBlanket]

Sometimes you just don't believe this stuff until it happens to you; just had this conversation (called out of grand rounds for this actually) a few days ago about a surgery patient:

Nurse: I'm calling to let you know that Ms. So-and-so's BP is 124/60
Me: OK. What seems to be the problem?
Nurse: Well she's written for a number of BP meds [antihypertensives], should I give them to her today?
Me: What's her HR? (knowing she's on metoprolol)
Nurse: 74
Me: Have any of her antihypertensives meds or doses changed in the last few days?
Nurse: No
Me: Well they seem to be working don't they?
Nurse: I guess so... So I should give them to her?
Me: Yes, please.

This actually left me laughing for quite some time (probably wouldn't have generated the same response @ 3AM). I doubt it was a revenge call since it was my first morning on a new service.

 

[f_w]

> This actually left me laughing for quite some time (probably wouldn't
> have generated the same response @ 3AM). I doubt it was a
> revenge call since it was my first morning on a new service.

No, this was a 'lets check out the new guy' call. Your professional response spared you a 3 am call by the nurses nighttime buddy.

 

[deleted59964]

I'm an ICU nurse turned MS. Can't wait to page myself at 9 am with a dumb question, and if I reply with a smart ass answer, I'll page myself at 4.15 am for a an order for D5W to KVO.

Come on guys give the nurses a break - yes you will get some dumb questions, what do you expect - there is one hell of a nursing shortage - so anyone with a pulse can become a nurse.

Some nurses are pretty bright and their experience can save your ass when you least expect it and most need it.

 

[CambieMD]

I'm an ICU nurse turned MS. Can't wait to page myself at 9 am with a dumb question, and if I reply with a smart ass answer, I'll page myself at 4.15 am for a an order for D5W to KVO.

Come on guys give the nurses a break - yes you will get some dumb questions, what do you expect - there is one hell of a nursing shortage - so anyone with a pulse can become a nurse.

Some nurses are pretty bright and their experience can save your ass when you least expect it and most need it.

This topic serves no purpose but to offend nuses. Some of the calls sounded pretty reasonable to me. I remember one that referred to a patients ' blood pressure.The nurse called with a bp that was normal. The bp may have been low compared to previous readings, a relative hypotension. Nurses often catch things that we miss because we are too busy. Lighten up guys.

CambieMD

 

[southerndoc]

This topic serves no purpose but to offend nuses. Some of the calls sounded pretty reasonable to me. I remember one that referred to a patients ' blood pressure.The nurse called with a bp that was normal. The bp may have been low compared to previous readings, a relative hypotension. Nurses often catch things that we miss because we are too busy. Lighten up guys.

CambieMD

Cambie, it's all in good humor.

You can't tell me that nurses don't sit around discussing the stupid things that we residents do on a daily basis.

 

[Winged Scapula]

4. Come put in foley bc I can't find the penis

I was actually consulted by the Medicine team at the VA during my 3rd year for this. The patient was so obese that his penis was truly hidden from view (and I guess no one wanted to go diving to look for it); a couple of hearty pushes in both groins and guess who came to dinner?

 

[EvoDevo]

I was actually consulted by the Medicine team at the VA during my 3rd year for this. The patient was so obese that his penis was truly hidden from view (and I guess no one wanted to go diving to look for it); a couple of hearty pushes in both groins and guess who came to dinner?

OMG.

 

[mddo2b]

I tell you that is such a professional way to act!!! Remember who is on the receiving end of all that kayexelate. The freakin' patient. Try not to forget who is taking care of that patient for twelve hours in a row while you are off doing greater things. That would be the nurse. Have some sympathy for the nurses for God's sake. Alot of these people have two year degrees. You can not expect them to operate on your level. Keep treating the nurses like crap and your life will be miserable in the end. I am sure there is a nursing message board somewhere full of stories about *****ic things stupid residents have done. I am a former RN, and I am soon to be a MD. I think all of you should have to work as a nurse for a week, and I guarantee you would be whistling a different tune.

relax....this is a place where we can complain without worrying about revenge....also, this shold be a no ass kissing zone, geeze, ciould your head be any further up the nurses asses

 

[EYESURG]

3:45am *beep* *beep*
me - hullo?
nurse - patient compaining of toothache
me - give him a tylenol
nurse - i just gave him tylenol for fever.. can i give another for the toothache
me - why dont you give him a cup of chicken soup and a handjob instead
*click*
..

This is absolutely hillarious. This is like the scrubs show

 

[EYESURG]

This topic serves no purpose but to offend nuses. Some of the calls sounded pretty reasonable to me. I remember one that referred to a patients ' blood pressure.The nurse called with a bp that was normal. The bp may have been low compared to previous readings, a relative hypotension. Nurses often catch things that we miss because we are too busy. Lighten up guys.

CambieMD

You are taking it too seriously....these posts are hillarious!!!

 

[EYESURG]

relax....this is a place where we can complain without worrying about revenge....also, this shold be a no ass kissing zone, geeze, ciould your head be any further up the nurses asses

Oh Sh... This is good stuff

 

[EYESURG]

Originally Posted by CambieMD
This topic serves no purpose but to offend nuses. Some of the calls sounded pretty reasonable to me. I remember one that referred to a patients ' blood pressure.The nurse called with a bp that was normal. The bp may have been low compared to previous readings, a relative hypotension. Nurses often catch things that we miss because we are too busy. Lighten up guys.

CambieMD


I think CambieMD is sleeping with a nurse. What do you guys think?

 

[Loopo Henle]

relax....this is a place where we can complain without worrying about revenge....also, this shold be a no ass kissing zone, geeze, ciould your head be any further up the nurses asses

I am a nurse so I guess my head is up my own ass!!!

 

[mamadoc]

I have another 30 or so items on that list but eventually they'll start equating calling you with pain and misery and the calls will stop. Remember you are the doctor and the nurses work FOR YOU no matter what crap their union reps have been feeding them. If you cant train the nurses to at least work with you then its simply your failure as a physician.

The "lighten up" police are going to get after me, too, but I just can't leave this one sitting here. After your "punishment," sure the nurses are calling YOU less. They are calling some other poor joe MORE - I have gotten calls for patients that weren't mine because the nurses "couldn't get hold of the other resident." Thanks a lot, pal. **** rolls downhill and when you crap on the nurses, ALL of us end up covered in it.

Aside from that, training the nurses not to call you seems a pretty bad idea if your job is to make sure you're hearing about how your patients are doing, no? If you don't trust the nurses to have good judgment, consider that they won't be able to figure out when they really should risk your wrath with a call - seems like a bad idea all around.

 

[Powel6016]

Hey,

I'm not a doctor but going into a 6 year md program this year. Some of these stories are hilarious but they give me a heads up to be nice to the nurses when working. Good stuff!


Peace,
Justin

 

[f_w]

In a hospital, the the nurses are the 'Marines'. And similar to the marines, the nursing staff motto often seems to be 'No Better Friend, No Worse Enemy'.

If you have them on your side, you will enjoy blissful sleep on call while your orders, while respected, are bent in a way as to not kill the patient. If you are on their receiving end, your internship/residency will be long and miserable. Remember, 10 years later, they will still be there while you are long forgotten. If you PO one of them, you PO'd all of them. (In a hospital, no matter how large, ALL the nurses know each other. Keep that im mind if you think about writing abusive orders.)

 

[ribcrackindoc]

A few points:
The nurses union has done a tremendous job at getting their nurses hyperinflated salaries at pathetically low expectations.

At most places the nurses have a ton of free time to go for a smoke q1 hour, hate themselves for not having the work ethic or intelligence to become physicians, and form a bichin circle where they discuss for hours about how they're overworked, underpaid, and underappreciated. They chant "this place would fall apart without us and don't you forget it!!!!!!!"

The mighty, and I mean MIGHTY nurses union is to blame. It's no longer a nurses responsibility to know anything about the human body.

Many nurses try to use their anecdotal experiences to outsmart physicians, especially med students and residents. Once in a while, they know a little fact that the intern didn't. Then they pat themselves on the backs and go back to the bitchin circle.

As physicians, we are supposed know what to do, the nurses aren't. The nurses aren't even expected to have common sense or basic knowledge about the human body, it's not in their job description. And we certainly can't expect them to do/know things outside their job description!

While we can't expect much of anything from them, it's still fun to share all the dumb things they say and do which make our call nights miserable. These stories have been hilarious, keep em coming!!!!

Here's one of my favorites:
3:30 AM: doot, doot, doot, doot, doot...doot,doot,doot,doot, doot
Intern: This is Dr. X, I was paged
Nurse: yes, about Mrs. Y with the rash on her wrist. Well, the admission not says their is a lesion on her UPPER extremity...
Intern: And?
Nurse: Well, the wrist isn't the upper extremity, are you gonna change it?
Intern: Arms are upper extremities, legs are lower extremities. The wrist is part of the upper extremity, which hangs from the shoulder.
Nurse: So you're not gonna change it?
Intern: Hangs up phone

 

[bell412]

[ Your so right about nurses I mean I've been an RN for 14 years and five of those I was a flight nurse for a busy hospital based 911 service. Currently I'm half way through graduate studies in nurse anesthesia. How about I give you some intelligent calls made by the Doctors.

1. Call came in from a Doctor stating that he had a 2yo having multiple epileptic seizures. We arrive at the ER and I started evaluating the patient and the diagnostics that were done and found a serum sodium of 110. The patient had another grad mal seizure and my partner and I quickly established an airway via endotracheal intubation and started correcting the hyponatremic state. Total hospital time 30 minutes. Total time before seen by an intensivst, one hour.

2. Oh how about this one. Call came in from a Doctor with a patient with 2nd and 3rd degree burns to face and neck. We get there and yours truly Doctor Woctor wanted to do rapid sequence intubation using Norcuron for muscle relaxation. Extremely intelligent decision Doctor Woctor. Come on class how long will a non-depolarzing agents that are similar to vecuronium last. Thats right 30-40 minutes. Now how long does anectine last? Perhaps one minute? By the way whats the Ed95 of anectine? My point is if you can't intubate and can't ventilate your patient dies. It didn't take to long to convince doctor woctor that anectine was the drug of choice that would save his licence. By the way watching him do laryngoscopy was very painful. He goosed twice. (You don't have a clue what I'm talking about do you) My partner was successful the fist attempt. We started the parkland formula for burn recusetaion.

3. Your gonna love this call. We arrive on scene of a roll over MVA. Three were entrapt in the vehicle and one was ejected. The one that was ejected was the most critical. Thank God when we landed on the highway there was a surgeon that happend to be in the line of stopped vehicles. I do my ABC's. I got to B and noticed a flailed segments on both sides of the chest. The surgeon saw asymetry as a hemopnemothorax and wants to go straight to the chest tube. I'm not talking about a thoracostomy I'm talking about a 32 French chest tube. He showed me his medical licence and I backed aside. He through is a chest tube with nothin comin out folks. Ok here the deal if you suspect a asymetric chest with pulmonary decompensation the airway must be managed FIRST. Then you figure out WHY the chest is asymetric. Is there flaied segments or is there a hemo or pnemothorax. The doctor was wrong class, dead wrong. Our bloody scene time was an HOUR. We have strict guidlines for 10 minute scene times. Airway managemment and other crtical intervention are done in the helicopter. This is how lives are saved. You get them to a facility where there are surgical option. Another smart decision mad by the doctors.

I've been in the buisness to long to listen to you med students talk about nurses this way. I know you have busted your ass off for many years and you probably got many more to go. But you know what? You wanted to do it. The choice was yours! The choice I've made I'll never regret. I've had a way cool job as a flight nurse. Now I'm going to become a CRNA. Maybe this nurse is smarter than you?

 

[unregistered]

[ Your so right about nurses I mean I've been an RN for 14 years and five of those I was a flight nurse for a busy hospital based 911 service. Currently I'm half way through graduate studies in nurse anesthesia. How about I give you some intelligent calls made by the Doctors.

1. Call came in from a Doctor stating that he had a 2yo having multiple epileptic seizures. We arrive at the ER and I started evaluating the patient and the diagnostics that were done and found a serum sodium of 110. The patient had another grad mal seizure and my partner and I quickly established an airway via endotracheal intubation and started correcting the hyponatremic state. Total hospital time 30 minutes. Total time before seen by an intensivst, one hour.

2. Oh how about this one. Call came in from a Doctor with a patient with 2nd and 3rd degree burns to face and neck. We get there and yours truly Doctor Woctor wanted to do rapid sequence intubation using Norcuron for muscle relaxation. Extremely intelligent decision Doctor Woctor. Come on class how long will a non-depolarzing agents that are similar to vecuronium last. Thats right 30-40 minutes. Now how long does anectine last? Perhaps one minute? By the way whats the Ed95 of anectine? My point is if you can't intubate and can't ventilate your patient dies. It didn't take to long to convince doctor woctor that anectine was the drug of choice that would save his licence. By the way watching him do laryngoscopy was very painful. He goosed twice. (You don't have a clue what I'm talking about do you) My partner was successful the fist attempt. We started the parkland formula for burn recusetaion.

3. Your gonna love this call. We arrive on scene of a roll over MVA. Three were entrapt in the vehicle and one was ejected. The one that was ejected was the most critical. Thank God when we landed on the highway there was a surgeon that happend to be in the line of stopped vehicles. I do my ABC's. I got to B and noticed a flailed segments on both sides of the chest. The surgeon saw asymetry as a hemopnemothorax and wants to go straight to the chest tube. I'm not talking about a thoracostomy I'm talking about a 32 French chest tube. He showed me his medical licence and I backed aside. He through is a chest tube with nothin comin out folks. Ok here the deal if you suspect a asymetric chest with pulmonary decompensation the airway must be managed FIRST. Then you figure out WHY the chest is asymetric. Is there flaied segments or is there a hemo or pnemothorax. The doctor was wrong class, dead wrong. Our bloody scene time was an HOUR. We have strict guidlines for 10 minute scene times. Airway managemment and other crtical intervention are done in the helicopter. This is how lives are saved. You get them to a facility where there are surgical option. Another smart decision mad by the doctors.

I've been in the buisness to long to listen to you med students talk about nurses this way. I know you have busted your ass off for many years and you probably got many more to go. But you know what? You wanted to do it. The choice was yours! The choice I've made I'll never regret. I've had a way cool job as a flight nurse. Now I'm going to become a CRNA. Maybe this nurse is smarter than you?

Wow - you are very bitter.

"Doctor Woctor?" LOL

 

[jooce]

You're = You are

 

[southerndoc]

[ Your so right about nurses I mean I've been an RN for 14 years and five of those I was a flight nurse for a busy hospital based 911 service. Currently I'm half way through graduate studies in nurse anesthesia. How about I give you some intelligent calls made by the Doctors.

1. Call came in from a Doctor stating that he had a 2yo having multiple epileptic seizures. We arrive at the ER and I started evaluating the patient and the diagnostics that were done and found a serum sodium of 110. The patient had another grad mal seizure and my partner and I quickly established an airway via endotracheal intubation and started correcting the hyponatremic state. Total hospital time 30 minutes. Total time before seen by an intensivst, one hour.

2. Oh how about this one. Call came in from a Doctor with a patient with 2nd and 3rd degree burns to face and neck. We get there and yours truly Doctor Woctor wanted to do rapid sequence intubation using Norcuron for muscle relaxation. Extremely intelligent decision Doctor Woctor. Come on class how long will a non-depolarzing agents that are similar to vecuronium last. Thats right 30-40 minutes. Now how long does anectine last? Perhaps one minute? By the way whats the Ed95 of anectine? My point is if you can't intubate and can't ventilate your patient dies. It didn't take to long to convince doctor woctor that anectine was the drug of choice that would save his licence. By the way watching him do laryngoscopy was very painful. He goosed twice. (You don't have a clue what I'm talking about do you) My partner was successful the fist attempt. We started the parkland formula for burn recusetaion.

3. Your gonna love this call. We arrive on scene of a roll over MVA. Three were entrapt in the vehicle and one was ejected. The one that was ejected was the most critical. Thank God when we landed on the highway there was a surgeon that happend to be in the line of stopped vehicles. I do my ABC's. I got to B and noticed a flailed segments on both sides of the chest. The surgeon saw asymetry as a hemopnemothorax and wants to go straight to the chest tube. I'm not talking about a thoracostomy I'm talking about a 32 French chest tube. He showed me his medical licence and I backed aside. He through is a chest tube with nothin comin out folks. Ok here the deal if you suspect a asymetric chest with pulmonary decompensation the airway must be managed FIRST. Then you figure out WHY the chest is asymetric. Is there flaied segments or is there a hemo or pnemothorax. The doctor was wrong class, dead wrong. Our bloody scene time was an HOUR. We have strict guidlines for 10 minute scene times. Airway managemment and other crtical intervention are done in the helicopter. This is how lives are saved. You get them to a facility where there are surgical option. Another smart decision mad by the doctors.

I've been in the buisness to long to listen to you med students talk about nurses this way. I know you have busted your ass off for many years and you probably got many more to go. But you know what? You wanted to do it. The choice was yours! The choice I've made I'll never regret. I've had a way cool job as a flight nurse. Now I'm going to become a CRNA. Maybe this nurse is smarter than you?

Bell412, as you are aware, succinylcholine in burn patients can cause massive hyperkalemia, leading to cardiac arrest. However, this usually doesn't present for at least 24 hours after the burn and peaks at 5-7 days. Nevertheless, many physicians (and flight paramedics and flight nurses) are taught that succinylcholine is contraindicated in patients suffering severe burns, crush injuries, etc.

Regarding your hyponatremic seizure patient, there are two things to consider: you stated the intensivist had been treating the patient for an hour. It normally takes 30-45 minutes for chemistries to come back. Perhaps two things occurred: either the chemistries just came back or the physician had not looked at them. It's hard to imagine that anyone -- nurse, physician, or even a medical student -- would overlook hyponatremia as a cause of seizures. It's most likely that the chemistries were just coming back. Either that, or this truly was an incompetent physician.

Lastly, as a flight nurse, you truly are "cream of the crop" as far as nurses go. For the most part, it's not the ICU, ED, or flight nurses that page us with stupid stuff. In fact, those nurses usually save us when we screw up. It's the floor nurses who seem to page us with petty stuff.

Happy flying in your Bell 412. I really miss my pre-hospital days... so much so that I question whether I should have remained a paramedic instead of becoming a physician.

 

[Katee80]

Wow - you are very bitter.

"Doctor Woctor?" LOL

Not any more bitter than anyone else taking part in this thread.

K

 

[gerickson03m]

[ Your so right about nurses I mean I've been an RN for 14 years and five of those I was a flight nurse for a busy hospital based 911 service. Currently I'm half way through graduate studies in nurse anesthesia. How about I give you some intelligent calls made by the Doctors.

1. Call came in from a Doctor stating that he had a 2yo having multiple epileptic seizures. We arrive at the ER and I started evaluating the patient and the diagnostics that were done and found a serum sodium of 110. The patient had another grad mal seizure and my partner and I quickly established an airway via endotracheal intubation and started correcting the hyponatremic state. Total hospital time 30 minutes. Total time before seen by an intensivst, one hour.

2. Oh how about this one. Call came in from a Doctor with a patient with 2nd and 3rd degree burns to face and neck. We get there and yours truly Doctor Woctor wanted to do rapid sequence intubation using Norcuron for muscle relaxation. Extremely intelligent decision Doctor Woctor. Come on class how long will a non-depolarzing agents that are similar to vecuronium last. Thats right 30-40 minutes. Now how long does anectine last? Perhaps one minute? By the way whats the Ed95 of anectine? My point is if you can't intubate and can't ventilate your patient dies. It didn't take to long to convince doctor woctor that anectine was the drug of choice that would save his licence. By the way watching him do laryngoscopy was very painful. He goosed twice. (You don't have a clue what I'm talking about do you) My partner was successful the fist attempt. We started the parkland formula for burn recusetaion.

3. Your gonna love this call. We arrive on scene of a roll over MVA. Three were entrapt in the vehicle and one was ejected. The one that was ejected was the most critical. Thank God when we landed on the highway there was a surgeon that happend to be in the line of stopped vehicles. I do my ABC's. I got to B and noticed a flailed segments on both sides of the chest. The surgeon saw asymetry as a hemopnemothorax and wants to go straight to the chest tube. I'm not talking about a thoracostomy I'm talking about a 32 French chest tube. He showed me his medical licence and I backed aside. He through is a chest tube with nothin comin out folks. Ok here the deal if you suspect a asymetric chest with pulmonary decompensation the airway must be managed FIRST. Then you figure out WHY the chest is asymetric. Is there flaied segments or is there a hemo or pnemothorax. The doctor was wrong class, dead wrong. Our bloody scene time was an HOUR. We have strict guidlines for 10 minute scene times. Airway managemment and other crtical intervention are done in the helicopter. This is how lives are saved. You get them to a facility where there are surgical option. Another smart decision mad by the doctors.

I've been in the buisness to long to listen to you med students talk about nurses this way. I know you have busted your ass off for many years and you probably got many more to go. But you know what? You wanted to do it. The choice was yours! The choice I've made I'll never regret. I've had a way cool job as a flight nurse. Now I'm going to become a CRNA. Maybe this nurse is smarter than you?

1. You are comparing a procedure to patient work up and dx. You have displayed your ignorance to the world here.

2. Actually using a very short acting depolarizing agent is bad, especially if you might have problems intubating someone. Having a long acting depolarizing agent will allow you to BETTER ventilate the patient. You can give the patient more sedation if needed.

3. Yes you do ABC's first, if patient is unstable intubation must be done and if not in the field, will be done in the ED or ICU as pulmonary contusion get worse on day #2. if that is fine than managing the flail chest is next. Since most flail chest's have PTX, placing a chest tube is very understandable.

You sound just like most of the pathetic ER nurses walking around wishing that they were real docs but since they are too lazy to do the reading and time to become one. Like my attending always says, IF YOU WANT TO BE A CAPTAIN, YOU HAVE TO GO TO CAPTAIN SCHOOL.

 

[southerndoc]

2. Actually using a very short acting depolarizing agent is bad, especially if you might have problems intubating someone. Having a long acting depolarizing agent will allow you to BETTER ventilate the patient. You can give the patient more sedation if needed.

In general, it is a bad idea to give non-depolarizing paralytics to someone as part of rapid sequence induction. If you are unable to intubate someone, then you are screwed -- you now have a patient who is paralyzed for 30-45 minutes with no secure airway.

By using a depolarizing agent, such as succinylcholine (Anectine), you can safely intubate someone. If you fail to intubate the patient, then you only need to wait about 5-8 minutes for the SCH to wear off. After successfully intubating the patient, then you can give a non-depolarizing agent.