a mess!

Today I had a patient who came up from the ED on a heparin gtt. When the patient arrived to the floor, I noticed the orders stated that her initial infusion rate per her weight should be more than what it was. I wanted to clarify with the MDs whether they wanted it changed. I looked on my computer which usually identifies the names of the attending followed by the name of the intern underneath. If it is a teaching patient, we go to the interns first. So I found that name, and was going to page him but I saw a young guy in a white coat walking through my patient's door. I said "Are you doctor (last name)?" and he nodded and said "I'm (first name)." I asked him the questions and he stated to increase the heparin gtt rate and draw the PTT 6 hours from when it was started in the ED. Later, the PTT was critically high and protocol was followed, and I paged the attending when this intern never paged back who confirmed how we should proceed. Then the attending told my this guy was a sub-intern and to page the covering hospitalist overnight for any concerns.

At the change of shift, I find out (Duh) that you're not supposed to change the initial infusion rate of a heparin gtt until 6 hours and the PTT is drawn, even if the initial rate differs from the new order for a standard weight based gtt. And then it suddenly dawned on me that a "subintern" probably isn't an intern at all - but a medical student.

So now I can't sleep, I'm sitting up thinking about what is going to happen to this patient whose elevated PTT might have been the result of an order by a medical student who I believe didn't correctly identify himself, carried through by me. I'm trying to figure out what to do about this.