Dumbest thing a doctor has done/said to you

Anna Flaxis, BSN, RN · Oct 30, 2015

Lol. Guys oxygenation was a bit more important in the moment so we went with it.

Next time, look into High Flow Nasal Cannula. It has some advantages over BiPap in the setting of pneumonia.

OhioCCRN, MSN, NP · Oct 30, 2015

Lol. Guys oxygenation was a bit more important in the moment so we went with it.

I know, it's just super frustrating as an ICU nurse when people need intubation asap, and the team is still ******* around with bipap. Your case was probably different , but in my experience we are usually delaying the inevitable with pneumonia + respiratory distress. Usually the bipap gives them a little burst of respiratory energy and then they completely crash and then things get really ugly

Anna Flaxis, BSN, RN · Oct 30, 2015

^ CPAP and BiPap have a really good track record of heading off intubation, and are often worth a try.

anh06005, MSN, APRN, NP · Oct 30, 2015

I know, it's just super frustrating as an ICU nurse when people need intubation asap, and the team is still ******* around with bipap. Your case was probably different , but in my experience we are usually delaying the inevitable with pneumonia + respiratory distress. Usually the bipap gives them a little burst of respiratory energy and then they completely crash and then things get really ugly

I've never been an ICU nurse so haven't had those situations (and hope I never caused one lol). I think now that residents and hospitalists stay all night the patient may have gotten intubated during this incident. At the time, though, on nights only if we called a code did we get an ER doc in the room. If they weren't busy maybe they'd come for a rapid. Otherwise the patient only saw a doc at night if they got transferred to the unit and HAD to be seen within so long.

We made due with what we had available and since RT suggested BiPap we figured it was worth a shot at least!

I didn't realize the situation would cause so much controversy lol. I've just always had the thought that if something wouldn't hurt the patient why can't we try it at least? Worst case: guy got intubated. Best case: he wouldn't (which is what happened with us)

anh06005, MSN, APRN, NP · Oct 30, 2015

Oh and the guy was on the younger side. If he had been frail and elderly likely would have been handled differently.

Tex. · Oct 30, 2015

Next time, look into High Flow Nasal Cannula. It has some advantages over BiPap in the setting of pneumonia.

In my facility, I tend to see NC--->HFNC--->BIPAP--->then Entubation. If, and only if, there is time and the ABGs aren't horrific. Anyone in distress buys a vent.

Anna Flaxis, BSN, RN · Oct 30, 2015

In my facility, I tend to see NC--->HFNC--->BIPAP--->then Entubation. If, and only if, there is time and the ABGs aren't horrific. Anyone in distress buys a vent.

This is a nice article on that topic:

https://www.mcgill.ca/criticalcare/teaching/files/intubation

applesxoranges, BSN, RN · Oct 30, 2015

Resident said that geodon and cogentin were the same drug. Attending had given us a verbal order for cogentin, ativan, haldol. She said she'd go put it in and repeated geodon instead of cogentin. I said he said cogentin. She said that. I was like "uhhh. are you sure?"

I check orders. She put in geodon. So I go back and ask her if she really, really meant to put in geodon instead of cogentin. The attending corrected her and she told the attending that he had said geodon instead of cogentin.

Here.I.Stand, BSN, RN · Oct 30, 2015

Hypertonic saline in hyponatremia has one role and that is to correct seizures. Other than that fast correction can lead to central pontine myelinolysis or other debilitating CNS problems. You can give 3% but you really shouldn't correct hyponatremia over 10 points per 24 hours.

No time to elaborate right now, but in neurotrauma pts in the ICU, hyponatremia is exactly why we give it. I can come back to this later

travduck, BSN, RN, CNM · Oct 31, 2015

In my first year of residency I had a patient with a spontaneous pneumo. My attending told me to put in a toravent. I had never done one before. What was I supposed to do? So I youtubed thoravent and found out how to put one in. As a resident that is the name of the game. if you don't know something look it up while you have an attending looking over your shoulder. Granted my attending was "looking over my shoulder" from a floor away but still.

Good for you. None of us know everything or did everything yesterday. Better to look it up and then clarify if there are still questions rather than do harm. Lots of time you may already know - just not by that name or you have a n on-boxed type patient,

Angelicpurl · Oct 31, 2015

Hmm....like others have said, "where did I begin???"

I had a doctor fresh from residency respond to an RRT. We hooked up the patient to the crash cart & he had textbook 360 BPM V-tach & I saw him go slack. I asked the RT at the head of bed, "does he have a pulse?"& got a no. So I said, charging, did the clears & shocked him. The doc says, "you can't shock SVT unless I say so! I didn't say so & you didn't synchronize it. So if he dies, I'm NOT responsible for your stupidity!" Well the aide had started CPR & we were reading drugs....RT said, I guess I don't need to incubate him either? See, he's NOT BREATHING & we have kinda done this before....after a minute of good CPR, epi....we got him back & transferred him to one of our beds. He told the ICU attending, "he was in V-tach & I told the nurses to shock him, start CPR, give a round of Epi and some Lasix. So we got him back. I've got him on a drip of it now." Uh, Lasix??? Glad didn't! Our doc rolled his eyes & wrote "Dougie Houser?"

I called a doctor one night and asked for an extra dose of NuBain for my pt who refused any other pain med. ER doctor had ordered 1/4 his usual dose & pt upset. MD yelled at me & said, "Give him 12 GRAMS Morphine IV over 15 seconds STAT." Do you mean 12 mg, sir? "Are you deaf, *****? I said GRAMS & I know what I meant!" That's going to take me a while to procur, can I give him a smaller dose in the meantime? "Are you stupid too? Yeah, sure. Do that if it makes you happy." Ok....btw, 12 mg Morphine made my pt very happy. Never slept that night, but happy!

My mom went on an ambulance run back in 70s & responded to BAD MVA. Said person had multiple amputations, including decapitation (had slid under semi trailer). They couldn't find the head for over 30 minutes. Back then, they couldn't just NOT treat without their director ok or a pt refusal. Radioed in & ask for a DOA. MD refused UNTIL they found the head!

I was asked once to convince ANY of our doctors to go say pt had died. It was a small hospital, the primary MD was in a wreck, & ER doctor was swamped with multiple emergencies. We had a dermatologist come in. I asked him to please go say pt had died (DNR but not a state where RN could declare death at that time). We went in & he asked in front of family for a 12 lead EKG, an EEG, & for me to perform corneal stimulation! Pt had been dead about 4 hours....we didn't have EEG capabilities! I took him aside & explained that in other states I've worked as a traveller, we just listen for a minute to the heart & if no pulse or respirations, we can declare a DNR pt dead. He did it & family asked me if he was a student doctor!

I also liked the resident I called once about a pt who slipped on some pudding she spilled on the floor. I saw the fall (was ambulatory roommate back to bed when she stood up) & confirmed she didn't hit her head; she went down on one knee. He ordered q15 minute neuro checks & ortho static vital signs. At 2 AM! So I said I would call him with the results...and did. For 2 hours before he decided that was enough. The next time I had someone fall, head injury or not, I asked him if he wanted q15minute neuro & ortho static vitals. He never did....he always ordered a head CT if they hit their head. He was the one who ordered orthostatic vitals on a pt in Bucks traction & got angry he didn't have them!

ActualNurse · Oct 31, 2015

I was working med surg my first year as a nurse. Doc wrote an order for a med my patient was allergic to. I brought it up and asked for a new order. Doc started yelling at me to stay in my lane and get out of his face. I started walking down the hallway to the nurse manager's office and he chucked the hard chart at me, which bounced off the back of my head.
Nurse manager told me that this particular doc often made "mistakes" like that and she would speak to him... yeah... he never got in trouble for that one, nor did he ever apologize for chucking the chart at me. It makes me glad we have EMRs now

In the "good old days", it was not uncommon for docs to toss charts around, throw surgical instruments at nurses in the OR, etc. Very abusive behaviours. Yet they got away with it. So I would classify this doc''s behaviour as more than dumb. It is abusive. My dumb doctor story is about a doc who was on call for the facility. The patient had unstable blood glucose levels and was symptomatic. I called the doc and at one point he told me I was "forcing" him to order insulin and if the patient went hypoglycemic it would my fault for calling him. I told him no, he did not have to order insulin, I was keeping him informed of the patient's status. He was out to get me and wanted to report me for calling him (when he was on call). I talked to other staff about him and they said he was very erratic in his behaviour but the facility tolerated it. If he was a nurse, I am sure he would have been deemed to be dangerous to his patients and tossed out.