I titled my entry today based on the great song in the musical "Oklahoma!" It has to do with the conflict that existed on the open range between farmers building fences to keep their cattle in and the cowmen who pushed their cattle across the open spaces. Both are raising cattle, just in their own way. So too surgeons and medicine doctors, or internists, treat patients, but in their own way.
Which brings me to one of my favorite episodes of "Scrubs" where the main character and his best friend (a medicine intern and a surgical intern) play out the dichotomy between medicine and surgery ala "West Side Story."
Anyway, the reason I bring this up is because part of what is driving me crazy in the MICU is the way the medical interns approach patients. I know in part my prior training is affecting my perception, but seriously, I am suicidal most day on rounds. I just want to know: what is wrong, what are we going to be doing about it, and how soon will they be able to transfer out of the ICU? I don't think about their clinic visits, what their medications were six months ago and 3 hospitalizations earlier, or if they eat beets on Thursdays.
Facts, that's all I want to know. Now, medical people will say the most important part of the exam is the history. In fact, I had a professor in medical school that said that 80% of the time you could make the diagnosis based on history alone. I guess I have to work on my patience... and, dealing with some of the medicine residents, I am going to need a lot of it.
My patients:
an alcoholic, diabetic admitted for leg ulcers who we admitted to the MICU for management of their alcohol withdrawal. They were intubated because we had to sedate them before they went into DT's.
a patient with knee pain who has been taking a LOT of Alleve over the last 2 weeks. So much that they gave themselves an ulcer. In fact, several since I saw the endoscopy while the GI doc did it. Ortho will be coming to see the offending knee tomorrow.
a patient who smoked for a long time, now has emphysema and came in with shortness of breath. They were having a CT scan to look for a pneumonia or possible mass when I was leaving. I wonder if they'll be off of the bipap mask tomorrow.
That's about it. I really don't have a lot going on. It seems like I pick up patients and send them out. I actually picked up a patient that was admitted overnight and discharged them to home this morning. Maybe things will pick up next weekend when I am on-call. Until then, I will be enjoying the attending we have now who also was a surgical resident before changing to anesthesia.... at least I have someone, along with the neurosurgery intern that I can roll my eyes with during rounds... the long, slow painful part of my day.
Showing posts with label delirium tremens. Show all posts
Showing posts with label delirium tremens. Show all posts
Thursday, May 8, 2008
Tuesday, December 25, 2007
Silent Night
I spent the day at the hospital. I took a call day so that everyone else could leave and enjoy their Christmas Day. I called my mom mid-morning and got the report from the night before. She enjoyed the gifts I had sent, and the extra special basket of sugar-free goodies from my fiance.
All in all it was a nice, dare I say, quiet day in the CCU. I had one admission, and one sort of excitement toward the end of the day. For the most part, I had about five hours of watching a CSI marathon and almost all of "Goldeneye" uninterrupted. Mmmm, Pierce Brosnan as James Bond. I could just watch him all day long. For me, there is no more perfect Bond. But, I digress.
If you've followed my prior posts, I think by now we've established some of the rules to follow when it comes to drinking. Something I don't think has come up to this point, mostly because I see people in the ED once and not for several days in a row, is the discussion about what happens to people when they drink excessively for days and weeks and months on end and then come to the hospital where they're not allowed to drink: a little something known as the DT's.
You're ok for the first couple of days. Normal for the most part. Then around day 3 you start to get a little anxious. Maybe, a little more irritable. Your heart rate starts going up and your blood pressure might go up as well. Then the fun starts. You start imagining things that aren't there. You get confused. You might even get physically argumentative. If your medical team is unaware of your alcohol intake (and granted most patients lie when it comes to alcohol consumption which is why as a general rule since med school we've been taught to double anything the patient states is the amount of alcohol they admit to consuming), you might get placed on thiamine and folate and some Ativan (Lorazepam) to help you avoid the mental confusion aspect part. When you start having seizures, that's a bad thing, and you could actually die (so admit to drinking alcohol and how much. Please.)
If they don't, and you lied (of course you did) about the amount of alcohol you consume, you can go into full blown DT's (delirium tremens) which includes shakiness, severe mental status changes, lethargy, etc. and end up like my patient who is now on a ventilator after he became somnulent to the point he couldn't remember to breathe. He would barely breathe when we shook him or called his name, but then he would go off into a stupor. So, now he's got a breathing tube. His girlfriend called later, and I had to tell her that he was on a breathing tube. I couldn't tell her why though, there's this thing called HIPPA which is basically a patient rights document that states your medical information can't be shared with anyone not directly involved in your care. I am sure she would tell me how much he actually drinks... if only I could ask her...
Some shots of downtown Buffalo. I love the city, especially at night. Merry Christmas to all!
CCU Countdown:
Days until the end of the rotation: 12
Actual number of days I will be working during that time: 11
Days left until the painful attending returns: 5
Number of days until my next 24 hours off: 11 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 4
Number of super nurses in the unit: 4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)
All in all it was a nice, dare I say, quiet day in the CCU. I had one admission, and one sort of excitement toward the end of the day. For the most part, I had about five hours of watching a CSI marathon and almost all of "Goldeneye" uninterrupted. Mmmm, Pierce Brosnan as James Bond. I could just watch him all day long. For me, there is no more perfect Bond. But, I digress.
If you've followed my prior posts, I think by now we've established some of the rules to follow when it comes to drinking. Something I don't think has come up to this point, mostly because I see people in the ED once and not for several days in a row, is the discussion about what happens to people when they drink excessively for days and weeks and months on end and then come to the hospital where they're not allowed to drink: a little something known as the DT's.
You're ok for the first couple of days. Normal for the most part. Then around day 3 you start to get a little anxious. Maybe, a little more irritable. Your heart rate starts going up and your blood pressure might go up as well. Then the fun starts. You start imagining things that aren't there. You get confused. You might even get physically argumentative. If your medical team is unaware of your alcohol intake (and granted most patients lie when it comes to alcohol consumption which is why as a general rule since med school we've been taught to double anything the patient states is the amount of alcohol they admit to consuming), you might get placed on thiamine and folate and some Ativan (Lorazepam) to help you avoid the mental confusion aspect part. When you start having seizures, that's a bad thing, and you could actually die (so admit to drinking alcohol and how much. Please.)
If they don't, and you lied (of course you did) about the amount of alcohol you consume, you can go into full blown DT's (delirium tremens) which includes shakiness, severe mental status changes, lethargy, etc. and end up like my patient who is now on a ventilator after he became somnulent to the point he couldn't remember to breathe. He would barely breathe when we shook him or called his name, but then he would go off into a stupor. So, now he's got a breathing tube. His girlfriend called later, and I had to tell her that he was on a breathing tube. I couldn't tell her why though, there's this thing called HIPPA which is basically a patient rights document that states your medical information can't be shared with anyone not directly involved in your care. I am sure she would tell me how much he actually drinks... if only I could ask her...
Some shots of downtown Buffalo. I love the city, especially at night. Merry Christmas to all!
CCU Countdown:
Days until the end of the rotation: 12
Actual number of days I will be working during that time: 11
Days left until the painful attending returns: 5
Number of days until my next 24 hours off: 11 (I am taking the very last day of the rotation off, so it's going to be a while, but worth it in the end.)
Number of short call shifts remaining: 1
Number of long call shifts remaining: 1
Number of patients: 4
Number of super nurses in the unit: 4
Number of evil nurses in the unit: 3
Number of evil Internal Medicine residents: 3 1/2 (1/2 because I like the one I took call with the other day, but he stole one of my procedures)
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