1. I've decided to keep a tally of most critical labs in one admission, starting today (not including renal failure patients): hgb, glucose, potassium, chloride, PT and INR
2. Farawyn's what I learned thread was way cooler than mine are.
Adding an 80s song makes any thread way cooler.
3. Don't trust a 0600 portable chest X-ray to tell you if pulling a chest tube at 1600 is a good idea. It really sucks to tell someone they have a pneumo still.
4. If someone has q4h benzos and opiates, bring both when they ask for one because they'll just ask for the other after you've already run to the med room twice for them.
5. When someone's paracentesis site is still actively dripping rather steadily, it makes me want to squeeze that sucker and see how far I can shoot the fluid out.
6. This week, it actually was sarcoidosis.
7. I know what sarcoidosis is now.
Sarcoidosis sucks.
8. Doctors really need to stop saying, "we're going to go ahead and discharge you," without adding, "this afternoon", especially when they know full well they won't be putting in discharges anytime soon.
9. I think I've realized that the best docs we have actually enjoy my unit the best because they chart there.
I think it's over in the what has it gots in it's pocketsesss, Precious? Thread. NGT asked for it after the toenail clippings comment.
Link to this thread......?
I lifted a massive quantity of oxy out of a (apparently not) detoxing patient's pocket several weeks ago.
He had had escalating behaviors in the morning and received Ativan early. 4 mg, because that's our WAS protocol when the downward spiral begins. About 10 hours later, he was still knocked out. He also had had urine labs hanging in the balance the entire day, so I'd been sitting outside his room as much as possible to grab that pee when he woke up. So I waited..... Shift change was 30 minutes away.
I put in a considerable amount of effort into waking him up. He said he couldn't pee, so I took advantage of the standing straight cath order I'd received earlier after bladder scanning over 300 mL. Shift change arrived, with me straight cathing him, getting hung up on some kind of blockage just beyond the meatus of his member (so still within the external genitalia). He slept through all of this.
I got beyond the blockage, and decided an indwelling was a good idea. Night nurse helped me with the conversion so I wouldn't be walking away from a draining straight catheter. As we got the pants off this guy, there they were. The probably 100 oxycodone hanging out in his pocket.
So I called the hospitalist to update and get an order to leave the indwelling in place. I also requested narcan. He was apparently standing in front of a crashing patient and he only heard about every other word I said, told me narcan is not indicated if the patient is stable, but said the indwelling could stay. A few minutes later, he realized what I was saying and called back. Dude was narcanned, woke right up.
Farawyn
12,646 Posts
I think it's over in the what has it gots in it's pocketsesss, Precious? Thread. NGT asked for it after the toenail clippings comment.