#45 / #46: Double shift / Seizure
I don't know whose idea it was to for me to do a back-to-back shift on Saturday call followed by a Monday call but it was a bad idea. Firstly, let me say that something went wrong because in the month of January most interns have 6 nights of call. I am on two weeks of vacation (half of the month) and I have 5 nights of call. You do the math. It's not really "fair." Not that I got mad or anything - I typically will do whatever anyone asks me to do with a smile.
However, I found that the second consecutive night of call made me incredibly grouchy which had some good (and bad) repercussions. I get signout from three other services in addition to my own on call and one of the interns is post-call so there are usually a lot of unresolved nursing questions that I can't easily answer if the post-call intern doesn't touch base with me before they leave (which was the case on Monday.) Secondly, the other intern who usually helps out with the post-call intern's work had some weird event where he fainted and cracked his head on the operating room floor, so they asked me to cover his service too for the day.
Finally, around 6 PM I started getting slammed with admissions and nursing questions that I felt like I couldn't really quickly resolve. So I went to the head nurse and said: "I'm sorry but I'm a little overworked right now and I can't answer all these questions. Please tell everyone to call me only if a patient is actually sick.." It worked. I stopped getting nuisance calls and only heard about things that actually were important. Wow. Still, I was up until all hours of the morning doing several post-op checks. There was one inappropriate call: the nurse who asked me to prescribe colace (a stool softener) for her patient at midnight. I told her that even though she was calling at midnight that this probably didn't qualify as an emergency and the patient would probably have to wait until either she or I had a free moment to enter in the medicine into the computer.
There was an actual emergency on Saturday night. I got called about a 7-year-old kid who was status-post liver transplant who "had a seizure." Let me tell you, I don't know that much about treating seizures and I was on the complete opposite side of the hospital so I tried to get as much information over the phone as I could, only the nurse who was calling me was the charge nurse and she really didn't know anything about the kid, but she sounded really frantic. I skimmed the chapter in the "Surgery-on-call" book about seizures (not very helpful) and headed over. I got the kid's room and there was no one from nursing around. Pretty weird for how frantic everyone sounded on the phone.
I walked into the room and the kid started seizing again right in front of me. I moved the kid to the center of his bed so he'd avoid smashing his head on anything. Meanwhile, I'm trying as hard as I could to think of what to do in the situation. This was the first time I've ever seen anyone have a seizure, let alone try to treat a pediatric patient. So I called over the call bell (finally four nurses came running) and I remembered that you're supposed to give Ativan to break a seizure if the patient isn't breathing. So with one hand I'm holding onto the kid's shoulder to prevent him from falling down and with the other hand I'm pulling out my "pediatric cheat sheet" to figure out the Ativan dose. By the time I calculated out the dose the kid had stopped seizing. It ended up with a full-scale medical evaluation of the kid - with the chief resident coming in from the department party in a red dress to the neurology resident coming in from home to a stat CT scan. It all turned out fine and the kid didn't have any more seizures after we stopped one of his antibiotics that lowers the seizure threshold.
Last call night: Saturday January 6th / Monday January 8th
Amount of sleep: I don't remember.
Currently reading: ABSITE Review.
Currently watching: youtube.com
Currently listening to: The wind blowing the wind charms outside.
Next call night: Friday January 12th.
However, I found that the second consecutive night of call made me incredibly grouchy which had some good (and bad) repercussions. I get signout from three other services in addition to my own on call and one of the interns is post-call so there are usually a lot of unresolved nursing questions that I can't easily answer if the post-call intern doesn't touch base with me before they leave (which was the case on Monday.) Secondly, the other intern who usually helps out with the post-call intern's work had some weird event where he fainted and cracked his head on the operating room floor, so they asked me to cover his service too for the day.
Finally, around 6 PM I started getting slammed with admissions and nursing questions that I felt like I couldn't really quickly resolve. So I went to the head nurse and said: "I'm sorry but I'm a little overworked right now and I can't answer all these questions. Please tell everyone to call me only if a patient is actually sick.." It worked. I stopped getting nuisance calls and only heard about things that actually were important. Wow. Still, I was up until all hours of the morning doing several post-op checks. There was one inappropriate call: the nurse who asked me to prescribe colace (a stool softener) for her patient at midnight. I told her that even though she was calling at midnight that this probably didn't qualify as an emergency and the patient would probably have to wait until either she or I had a free moment to enter in the medicine into the computer.
There was an actual emergency on Saturday night. I got called about a 7-year-old kid who was status-post liver transplant who "had a seizure." Let me tell you, I don't know that much about treating seizures and I was on the complete opposite side of the hospital so I tried to get as much information over the phone as I could, only the nurse who was calling me was the charge nurse and she really didn't know anything about the kid, but she sounded really frantic. I skimmed the chapter in the "Surgery-on-call" book about seizures (not very helpful) and headed over. I got the kid's room and there was no one from nursing around. Pretty weird for how frantic everyone sounded on the phone.
I walked into the room and the kid started seizing again right in front of me. I moved the kid to the center of his bed so he'd avoid smashing his head on anything. Meanwhile, I'm trying as hard as I could to think of what to do in the situation. This was the first time I've ever seen anyone have a seizure, let alone try to treat a pediatric patient. So I called over the call bell (finally four nurses came running) and I remembered that you're supposed to give Ativan to break a seizure if the patient isn't breathing. So with one hand I'm holding onto the kid's shoulder to prevent him from falling down and with the other hand I'm pulling out my "pediatric cheat sheet" to figure out the Ativan dose. By the time I calculated out the dose the kid had stopped seizing. It ended up with a full-scale medical evaluation of the kid - with the chief resident coming in from the department party in a red dress to the neurology resident coming in from home to a stat CT scan. It all turned out fine and the kid didn't have any more seizures after we stopped one of his antibiotics that lowers the seizure threshold.
Last call night: Saturday January 6th / Monday January 8th
Amount of sleep: I don't remember.
Currently reading: ABSITE Review.
Currently watching: youtube.com
Currently listening to: The wind blowing the wind charms outside.
Next call night: Friday January 12th.
posted by Stephen Maturin @ 1/09/2007 07:04:00 AM
0 Comments:
Post a Comment
<< Home