l********y
发帖数: 2295 | 1 6am-7am: Arrive to the residents’ workroom to receive checkout from the
night float intern covering your service. Earlier in the year, you will
probably arrive on the earlier side of this time, but you MUST arrive prior
to 7am because this is when night float gets to leave.
Early morning before work rounds with the resident and med students: Look
through eResults and RadWeb to gather information about your patients for
the day. This includes looking at all bloodwork, radiology, and other
studies that happened overnight or later in the afternoon the previous day.
During this time you should:
Replace electrolytes and check chemistry.
Potassium. Goal potassium is 3.5 or greater here. If the patient has a
history of a cardiac arrhythmia, then we generally shoot for 4 or greater.
The general rule of thumb is that, for every 10 milliequivalents of
potassium you give, the serum potassium should increase by 0.1. We like to
give potassium ORALLY IF POSSIBLE. Be careful when replacing potassium in a
patient with renal failure. We typically do not administer more than 40
milliequivalents at a time.
Magnesium. Goal magnesium is around 2. This can be replaced either orally or
intravenously. Oral magnesium can cause diarrhea if you give too much.
Phosphorus. This is generally not replaced as much as the other two, but it
is something to keep in mind. Hypophosphatemia can keep patients from
weaning from the vent, and remember that phosphorus is a necessary component
of ATP!!
Sodium: For patients who are not eating (acronym: NPO), it is important to
make sure they are getting free water with their tube nutrition, otherwise
they will become hypernatremic.
Kidney function.
Is it changing, more specifically, is it getting worse? Are you withholding
fluids, diuresing, giving nephrotoxic drugs?
Does the kidney function warrant hemodialysis? Remember your A-E-I-O-Us!
Check CBC and follow alarming trends.
Is hemoglobin lower than yesterday? Has it been trending downward for the
past couple of days? Does it need to be repeated or evaluated further?
Is the patient neutropenic? Did the white count jump up significantly over
the past couple of days? Did the patient get steroids recently? Is the
patient developing a new infection?
Are the platelets going down? WHY???
Check all radiology, procedures, consultant notes and note these.
Morning report: This is typically 7am-8am. You and your resident will
formulate whether or not you want to have all of your information looked
through BEFORE or AFTER morning report.
Work rounds: You and the resident and the medical students will round as a
team. This is when you will see all of the patients in one day and formulate
the day’s plan for that specific patient. You as the intern will be
responsible for putting in all orders during this time. Some residents will
have you see the patients on your own at this time before rounds, and then
will “run the list” (briefly go over the plans for all of the patients)
before attending rounds.
Attending rounds: Self explanatory. This is when you present the plans for
the patients to the attending and modify the plan if necessary. During this
time you might have access to a computer from which you can look up results
as needed and also enter orders.
Post-rounds, hopefully before noon: Time to get work done! You and your
resident will discuss how the work will be divided, but in general, an
intern puts in all of the orders and then starts working on the discharge
instructions for the patients to be discharged that day. The resident can
then start writing daily progress notes and following up with or notifying
consultants of pending consults. The resident is also responsible for
dictating the discharge summary.
Afternoon: The afternoon is for doing procedures, finishing up work from the
morning, discharging patients, admitting new patients, etc. Later in the
afternoon is a time to start working on your sign-out notes for night float.
Sign-out notes: You will receive formal training on this, but a good and
helpful acronym to use is SBAR, which stands for Situation, Background,
Assessment, and Recommendation. A generic example is as follows:
53yom with alcoholic cirrhosis with known varices and encephalopathy here
with GI bleed, currently hemodynamically stable
1. GI bleed: suspect from varices, on nexium/octreotide/ceftriaxone, GI
to scope in the morning, received blood/FFP/platelets
2. Cirrhosis: NPO but not encephalopathic, continuing rifaximin and
lactulose, holding nadolol while bleeding
3. Coagulopathy: INR 1.7 on admission, goal is to keep below 1.5,
platelets adequate at 84
Full code/sick/central line
[ ] please follow up Q6H H/H | l*******i
发帖数: 24 | 2 You started residency already? light-speeding! | l********y
发帖数: 2295 | 3 nope, just got from a resident...
thought it might be helpful for the intern-to-be.
【在 l*******i 的大作中提到】
: You started residency already? light-speeding!
| h***y
发帖数: 834 | | k*******0
发帖数: 355 | 5 5:30-7:00am morning round with chief and medical students: present patients,
changing dressings, draw stat blood labs
7:30am-7:30pm floor, operation room, clinic (no lunch break, put snack in your white
coat pockets)
8:00-8:30pm evening round with chief
9:00pm drive to home from parking lot | l********y
发帖数: 2295 | 6 wow，一天在医院16个小时啊～～～
patients,
your white
【在 k*******0 的大作中提到】
: 5:30-7:00am morning round with chief and medical students: present patients,
: changing dressings, draw stat blood labs
: 7:30am-7:30pm floor, operation room, clinic (no lunch break, put snack in your white
: coat pockets)
: 8:00-8:30pm evening round with chief
: 9:00pm drive to home from parking lot
| k*******0
发帖数: 355 | 7 no, that is the schedule for pre-call intern
On-call intern : work in hospital 24 hours, start 5:30am and leave next day
(post-call day) after morning round
Post-call intern: leave after morning round and go home sleep, start the
next day morning as pre-call intern
that is our beautiful Q3 rhythm: Pre-call, On-call, Post-call, Pre-call, On-
call, Post-call......Isn't it amazing?
【在 l********y 的大作中提到】
: wow，一天在医院16个小时啊～～～
:
: patients,
: your white
| l********y
发帖数: 2295 | 8 外科是很残酷啊，我们想也不敢想。所以说你现在是乖乖虎了，呵呵。
day
On-
【在 k*******0 的大作中提到】
: no, that is the schedule for pre-call intern
: On-call intern : work in hospital 24 hours, start 5:30am and leave next day
: (post-call day) after morning round
: Post-call intern: leave after morning round and go home sleep, start the
: next day morning as pre-call intern
: that is our beautiful Q3 rhythm: Pre-call, On-call, Post-call, Pre-call, On-
: call, Post-call......Isn't it amazing?
| k*******0
发帖数: 355 | 9 Pre-call intern schedule:
5:30-7:00am morning round: with chief and medical students: present patients
,changing dressings, draw stat blood labs
7:30am-7:30pm day work: floor, operation room, clinic (no lunch break,it's
better for you to put snacks in your whitecoat pockets)
8:00-8:30pm evening round: with chief
9:00pm drive to home from parking lot
On-call intern schedule: work in hospital 24 hours, start 5:30am and leave the next day(post-call day) after morning round
Post-call intern: leave after morning round and go home to sleep the whole day, start the next day morning as pre-call intern
This is our beautiful Q3 rhythm: Pre-call, On-call, Post-call, Pre-call, On-call, Post-call......Isn't it amazing? | l********y
发帖数: 2295 | |
|
