nycsurg

I can't really imagine how there was confusion. NS is pretty much the only fluid you would use for a Neuro pt. (Well, that or hypertonic saline or bicarb)

Because they need intraop dvt ppx, and prophylactic heparin does not cause clinically significant bleding For outpatients, anesthesia will give 5000u heparin subq after intubation

Someone going through chemo is at very high risk for dvt. Unless the hgb of 8 is an acute change, the heparin should be given. With platelets of 75 HIT is a possibility, but it is far far more likely to be related to the chemo. On a somewhat related note - do not hold subq heparin for surgery

A few more from last night! 8) If the patient is in pain, and you give morphine and then the pain is improved, that does not need a page. 9) Neither does normal vital signs. 10)

At a few hospitals that I work at (all the city hospitals), nurses outside of stepdown/sicu are not allowed to push IV medications at all. No BP meds, no pain meds, not even benadryl or ativan. So I order everything inside a minibag, from labetalol to morphine.

Some random things 1) Please know the patient's name and brief history when you call - I have 30-50 patients at night. Tell me you are calling about room 1118 isnt helpful. Tell me you are calling about Ms. Smith, or if you want to be really helpful, Ms. Smith, Dr. So and Sos pt in room 18. 2) Please know what you are calling about. I am always shocked when I get paged "hi, patient so and so has a really high blood pressure." "Ok, what is it?" "Oh, let me look that up for you." I mean really? 3) Non urgent things, including benadryl requests, non-fever elevations in temperatre (100.1, etc), patient having 2 IV fluid orders after returning from the OR, all of these things should go through either text paging system, or be bundled with a bunch of other stuff. 4) Edited in - please dont page for things you know are wrong for the patient. Unless the patient has an actual allergy, I am never ever going to order benadryl or ambien for a 98 year old. No, I am not ordering dilaudid because the patient "doesnt want to swallow pills". I get that the patient is hungry and is complaining a lot but no I am not giving the patient with small bowel obstruction a regular diet. More edits 5) When you come back from break, please make sure issues were actually paged. One of the things that makes me angriest is at 4 AM when I start recording vitals for the list, I see that the patient had a fever overnight. Ill call the floor "Why was I not paged when this pt had a fever?" "Oh, I was on break, i thought the covering nurse paged you." I would so much rather get paged twice about an actual issue that not get paged at all. 6) If possible, try not to page when we are signing out. I get its the end of your shift and you want to clear things up as much as possible for the new shift, but sign out of 30-50 patients is honestly a very dangerous time, and distractions for non urgent matters are pretty bad. 7) Just a bit of perspective - Last night i had 35 patients. If each nurse pages me twice overnight (on average, really though most of the nurses wont page me at all, and a few will page me a lot), thats 70 pages. Even if I hang up after only 1 minute of waiting on the phone, thats an entire hour out of my night spent waiting for the unit secretary to find the nurse who paged me. And I find that 1 minute spent waiting is on the shorter end.

You can discontinue metformin after the CT scan. Also the chance of lactic acidosis is very small to begin with.

This is very wrong. A 22g IV has like 1/4th the flow rate of an 18g. You also cannot use a 22g for powered injection for certain CT scan protocols. I mean sure, if the patient is entirely stable, and not preop, and not going to need a CT scan, a 22 is fine. But any patient that could possibly go to the OR, anyone who might suddenly become sick, deserves at least 1 large iv. Doing the right thing for the patient sometimes involves sticking them with a great big IV. The worst thing in the world is when the patient is crashing, and you realize that the patient came up from the ED with only a 24g iv in the finger.

That alcoholic patient is absolutely in need of an ngt. It is needed for gastric lavage, to ensure that this is an upper GI bleed. Ngts should not be placed in patients who have a fresh gastric surgery, or patients with the possibility of a skull base fracture.