Have you encountered useless residents?

[seks]

This pt had been on the unit for a few days. Had been on tinza and asa since admission to the unit.

Start of shift, first day with him. He was c/o mild chest pain and bit of sob. A bit diaphoretic too. His SpO2 were fine but I cranked up the O2 a bit anyway. Paged the resident.

Came in within 5 min and assessed the pt. Came out and told me he sounded crackly and that pt pain has subsided. Ordered 1 time dose of IV Lasix. NOTHING else. I was expecting maybe a nitro spray or chest xray or whatever.

I came in next day...found out pt had a full code late in the night shift and passed away. Code team notes stated probably PE attack.

I don't know...been almost a week and been thinking this death could have been avoided.

[CNAtoMD]

I'm confused as to why you quoted me in your ramblings.

Anywho, ordering Lasix is fine, but the resident should have ruled out other causes as well. I'm not saying mistakes aren't expected. In fact I made the disclaimer that I have made the dumbest mistakes myself.

Still confused about your rambling on about d-dimers in response to my post.

I quoted you because you said you immediately thought PE and many have posed the idea of a d-dimer. My thoughts are that if you have been in the hospital you should never rule out PE by d-dimer. The research has shown that there is a false negative rate of 7-10% for high probability via wells criteria. In my opinion every hospitalized patient is high risk via Wells. Still for every chest pain starting in or out of hospital we cannot rule out every diagnoses by tests. Occasionally we have to use our brains. For every chest pain I see (3-4/day on my job) I cannot order a CT PE and CT aortic dissection for every single one. Sometimes I have to say that I don't think it is a PE or Dissection. Over the next 20 years I will be wrong. At some point someone will die from a PE or a Dissection and I will have missed it. I refuse to order a CT on every single chest pain that walks in the door to prevent that 1.