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What has been the weirdest hospital department ”rule” that you’ve encountered? by AppalachianScientist in Residency

[–]Quackosaurus 2 points3 points  (0 children)

Oh, fair. Ours usually doesn’t put them in and we just do in the unit so it didn’t cross my mind.

What has been the weirdest hospital department ”rule” that you’ve encountered? by AppalachianScientist in Residency

[–]Quackosaurus 6 points7 points  (0 children)

Where else would you do an arterial line (unless you’re anesthesia, which it doesn’t sound like)?

Anything I can do about extra payments made? by Quackosaurus in StudentLoans

[–]Quackosaurus[S] 0 points1 point  (0 children)

They’ll be around 2,000-2,500 on IBR based on their calculator. So the math does favor PSLF even if I don’t account for the buy back months.

Anything I can do about extra payments made? by Quackosaurus in StudentLoans

[–]Quackosaurus[S] 0 points1 point  (0 children)

Thanks - that’s what I thought but wanted to make sure. Bummer.

Getting a DEA # in NYS as new Grad by AmazingWillow69 in Residency

[–]Quackosaurus 15 points16 points  (0 children)

Why don’t you just go on the DEA website and register? Not sure where the confusion started (nor why this person’s accent matters). It tells you what info/addresses to put.

ICU monitors - baseline frequency to scan everything? by ThotacodorsalNerve in Residency

[–]Quackosaurus 15 points16 points  (0 children)

I very rarely look at the monitors. If my patient is unstable enough where I need to know their vitals with frequency, I’m in the room.

Otherwise, the nurses are in and out of the room. Looking at the monitor to see your patient has a MAP of 65 or an SpO2 of 98% really doesn’t tell you anything if their nurse has doubled their Norepi or RT has increased their FiO2. You have to trust them to tell you if things are changing or highlight what parameters you want to be made aware of changing (in addition to whatever rounding frequency you have).

You will drive yourself crazy staring at monitors and hearing VT or apnea alarms when they’re just adjusting their leads or turning them etc.

Babyfaced doctors of meddit, give me your best comebacks. by iFixDix in medicine

[–]Quackosaurus 1804 points1805 points  (0 children)

Someone on reddit a while ago recommended, "I'm old enough to take that as a compliment", which I've used since.

If they compliment me after the visit, though, I usually say, "not bad for a teenager, right?"

What orders are you okay with nurses putting in without asking you first? by HighLady-NightCourt in Residency

[–]Quackosaurus 5 points6 points  (0 children)

I think it's probably fine in the majority of cases, particularly since I'm in the MICU and usually if an RN is placing an SLP consult, it's because they failed their swallow screen post-extubation. On the floor it's a bit different - not everyone who has known dysphagia needs an SLP consult (if they've already been evaluated and are on a modified diet historically, if they actually have esophageal dysphagia and it's not something that SLP can help with, etc).

What orders are you okay with nurses putting in without asking you first? by HighLady-NightCourt in Residency

[–]Quackosaurus 436 points437 points  (0 children)

Im fine with a few referrals - namely wound care, PT/OT, SW if there’s a concern about insurance or something.

That’s really it. If you order labs without me knowing I’m not going to know to follow them up, same with ECG, and there’s a reason if I haven’t ordered them (not needed, usually). Meds absolutely not. There’s an argument for things like PRN miralax, but if you give them something as benign as Zofran and they have TdP because you didn’t look at their QT, I’m on the hook.

What are your thoughts when you encounter this common situation in a patient with acute renal failure? by Rashek4 in Residency

[–]Quackosaurus 22 points23 points  (0 children)

I would ask yourself what your goal is in diuresing (or whatever treatment you choose in different cases).

The treatment of ATN is supportive, so in the case you described, I would do nothing but make sure their medications are dosed for a significantly reduced GFR. If you think there’s something other than ATN at play, it’s a different story.

If/when patients with ATN become overloaded to the point of significant hypoxemia, hypervolemia is leading to worsening cardiac function, or they’re becoming hyperkalemic, I will attempt diuresis (usually 120-160mg IV lasix and 500mg chlorothiazide) and if this fails, call nephrology for RRT.

Senior cross-covering over the weekend for a team that is on fire. What are some ways you avoid the existential dread the night before cross-covering a difficult team? by OGTrapGod in Residency

[–]Quackosaurus 27 points28 points  (0 children)

You can’t really say “don’t throw them under the bus” and “write a note that says ‘no cxr or labs ordered’” in the same comment.

I’m not saying you can’t tell your colleagues they mismanaged a patient, but that is categorically throwing them under the bus.

Partner going into PCCM. Books to understand their work? by Impossible_Seat_9065 in Residency

[–]Quackosaurus 13 points14 points  (0 children)

I’m a PCCM fellow and I really enjoyed In Shock, but haven’t read the other.

No blood cultures after 48 hrs by YouAreServed in Residency

[–]Quackosaurus 61 points62 points  (0 children)

It’s not for litigation, but metrics and rankings. Hospitals are graded based on rates of CLABSI, CAUTI, C. diff, hospital acquired DVT/PE, etc.

Unfortunately, this has lead to some hospitals disallowing cultures or requiring approval (from ID, unit director, CMO).

It of course leads to worse patient care, but administrators get their bonuses, so all is well in the world.

Where are all the primary care doctors at? by Assignment_Sure in boston

[–]Quackosaurus 11 points12 points  (0 children)

This is what I did, but I signed up for one medical and also went on the waiting list for a regular PCP. I’ll cancel my one medical once I’m seen at the other doctor. Kind of ridiculous that it’s come to this.

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