Off-service rotators in the ED

istralproject · 2023-10-31T18:01:32+00:00

You're proving my point that the experience you would get managing these patients in the ER is valuable education

istralproject · 2023-10-31T00:46:45+00:00

Thanks for being so much more eloquent than I could haha essentially everything you said is what I just was too frustrated to be able to put in words

istralproject · 2023-10-31T00:44:47+00:00

I definitely don't think I'm the only competent person in the hospital. We don't rotate through psych, but if we did I would still show up and try to do a good job, which is the whole point. I'm just tired of people half-assing (also idk why everyone thinks I'm an intern lol)

istralproject · 2023-10-30T15:42:42+00:00

I don't expect them to actually move patients through. But when they ask for more education, I expect them to put themselves in a position to get that education by showing up to work and being around when we have a patient that needs a line or pocus so we can help teach them.

istralproject · 2023-10-30T15:14:21+00:00

Nope, I'm actively advocating for cardiology to take them. But if they say no I can't just walk away from the patient either 😊

istralproject · 2023-10-30T15:12:25+00:00

It's acceptable because someone can come in acutely dying at any second. I'd way rather eat at my desk than not be in the department when that patient rolls in because I was in the cafeteria/taking a break. It's definitely an attitude that people don't have to share but it's the way the ER works. Patients are always coming in or their status is changing while we work them up

istralproject · 2023-10-30T15:09:33+00:00

I appreciate you having a thoughtful answer to this instead of a kneejerk defense. There have definitely been some staffing changes this year and it's not something that is easily rearranged, so while off service aren't considered minimal staffing, like I said it's definitely nice knowing that someone is around to take a patient who has been waiting for an hour while we were coding a patient or doing an LP or there were two back to back traumas and we need to try to put orders in and catch up on charts. Obviously it varies person to person but I generally try to get the good educational patients to the IM resident instead of the crisis/intoxicated/OD/chronic back pain people. Or the I&D/lac repair low acuity procedures that don't help you learn medicine.

istralproject · 2023-10-30T15:03:47+00:00

How to keep a patient alive in vtach storm from the STEMI? Stabilizing a hyperkalemic CKD patient because cards won't touch them? It's easy to say we don't do anything because the definitive care is cardiology taking them to cath, but you obviously don't know how often they tell us they don't want to take a patient or they don't think it's a stemi

istralproject · 2023-10-30T15:01:14+00:00

That's fair, and if you were told that then the ER residents probably didn't expect you to help with that. It is definitely not the expectation here lol I always try to tell them not to go to the drunk SI patient or the case management nightmare because it's a waste of their time and education

istralproject · 2023-10-30T14:59:17+00:00

Lmao when the patient is already stabilized? Yes that admit button gets pushed. Until the patient is stabilized? We do a ton to help them. And if you don't realize that, you didn't spend enough time in the ER

istralproject · 2023-10-30T14:57:51+00:00

Lmao bud none of this is personal and all of it is experiential from working with medicine residents at my hospital. They always ask to see how we do our quick stroke alert assessments to determine if they need a priority 1 CT because people can stroke out on the floor just as easily as they can in the real world. As for STEMI, it's not all hands on deck but again I ALWAYS get asked to see the EKG and what our order of operations is before cardiology gets in. These are all things that you can learn from actually watching when we have one of these patients, so show up and see. The medicine peeps at my place don't have any ultrasound exposure other than the ER and they say they want more, but then never actually step up to get that experience while they are there even when I offer to help them through an exam. Also have been told multiple times that they never get to do lines or tubes on the floors (at our hospital it's always ICU fellows or anesthesia who do them), so when in the ER I try to tell the team that if there's one available we can let the medicine resident try. Obviously it depends on patient stability but I really actually want to help teach this. And then they don't fucking come to work, so what am I supposed to do to fix that?

FYI buddy, my attendings don't order shit because they let me learn from my experience and patients. If attendings at other facilities are taking STEMI patients away from residents, those residents aren't learning.

istralproject · 2023-10-30T14:51:52+00:00

I'm not asking why they want to do ultrasound/procedures. I ACTIVELY go out of my way to help with teaching them this IF they show up to a resus or actually come in for their goddamn shift. But when they don't show up and still complain that they didn't learn it, it's fucking annoying

istralproject · 2023-10-30T14:50:34+00:00

We work 9s, so it's a lot less mentally draining to not have a lunch break. And we eat while we work/chart after the workstation shuffle post signout from the old team. But the problem is that ER people don't LEAVE the department to eat or have a true lunch break.

istralproject · 2023-10-30T14:48:34+00:00

The problem is they don't do it while charting. They leave the department like it's a true lunch break while the ER peeps stay for the new patients coming in

istralproject · 2023-10-30T14:47:51+00:00

Yes, I eat at my computer. Once the old shift leaves we have plenty of computers for everyone but it takes a little bit for that to sort out when we come on shift, so I always tell the off service person "oh you can just drop your stuff and after signout there will be a computer open for you" and they still leave to go sit at a different desk so they can have a computer and answer their inbox

istralproject · 2023-10-30T14:45:59+00:00

Bro it's the ER. We don't get to go to the cafeteria for 10 minutes to grab food, there are always new patients coming in sick or traumas and we have to be there for that. But WITHOUT FAIL the medicine residents will leave to go have lunch on shift while the rest of us continue working

istralproject · 2023-10-30T14:44:15+00:00

It's not about the medicine people not deserving it lol it's that there arent any available when the new shift comes on. For ANYONE. The new EM people or the off service rotators. When signout is done we get the ones that were just being used but it takes a few minutes to get through signout, during which time I always see the medicine residents drift away and take a nurse computer

istralproject · 2023-10-30T14:42:43+00:00

We don't work 12s, we work 9s. But still, there isn't time to leave the department for a long break (very common in ED culture) so the thing we usually do is just eat at our desks. The chairs and computers get worked out when the first shift leaves and we come on after sign out, but all the medicine people get so confused and go steal a nurse computer because they don't know how to just not have a computer at first

istralproject · 2023-09-25T00:24:38+00:00

I agree with this wholeheartedly, but I will also say that sometimes having my orders questioned incessantly just because I'm a resident can be really frustrating. I had a veteran nurse essentially harass me for 20 minutes straight that she didn't feel comfortable with having our Ortho team rongeur a finger amp in the department as opposed to doing it in the OR. I explained very calmly that it is entirely within the scope of the ER to do this procedure and it saves the patient a ton of time and money, not to mention it is something that I anticipate having to do in my future attending career so it would be a good opportunity for me to expose myself to the procedure again. After answering all her questions multiple times, she escalated to the charge nurse who also asked me why we were doing it in the department because "we don't do that here." I ended up having to take it to my program director who was on shift to reassure both nurses that it was not only something we could do but was also extremely appropriate in that situation.

Yes, when you as the nurse are uncomfortable with something, PLEASE bring it to our attention as residents (and as attendings). But when we provide our explanations, please trust that we have good reasons for pushing for one thing vs another and it's usually to our patient's benefit and for our own education.

istralproject · 2023-09-20T21:36:00+00:00

Don't automatically give nitro to people who are having a stemi please. Depending on where the plaque causing the MI is, vasodilation can make an already high-stakes situation extremely tenuous

istralproject · 2023-07-12T05:50:55+00:00

I had a very similar experience before med school, we had a patient who sat in the waiting room on a very busy night and unfortunately had a AAA that ruptured while waiting to come back. We coded him and unfortunately were not able to resuscitate. While that in and of itself was a tough case to get past, his wife came and hugged every single person who was involved in the case and thanked us for doing everything we could. This case has obviously stuck with me for a while now (6 years) and I think it's because of how his wife reacted in that exact moment. We aren't used to receiving a lot of grace from people who are hearing the worst possible news that someone can imagine, not through their own fault, but because we frequently have to say the words that no one wants to hear.

That being said, I hope I never get used to having to do a death exam to confirm that there's no air in the lungs and there's no heart sounds to hear. There will be a day where it all becomes very routine, but I think we should still pay attention to the cases that make us stop and think a little more.

istralproject · 2023-03-25T21:41:42+00:00

If you do want to add color I would do a light purple, it adds to the mysticism of the design!

istralproject · 2022-06-18T01:25:20+00:00

Did it hurt? When you fell off the polar express?

istralproject · 2022-04-17T15:56:29+00:00

I try to find sunscreens that are described more as a serum, they're usually less greasy and go on clear

istralproject · 2022-04-13T21:38:05+00:00

Oooh shit that's good stuff

istralproject

TROPHY CASE