Worst doctors orders ever received

Published

  • Specializes in ED, Tele, Med/surg, Psych, correctional. Has 15 years experience.

You are reading page 11 of Worst doctors orders ever received

Footballnut

161 Posts

Specializes in CAPA RN, ED RN. Has 45 years experience.

Good grief ThrowEd! Sounds like herding cats.

Footballnut

161 Posts

Specializes in CAPA RN, ED RN. Has 45 years experience.

My personal order from hell is the the order for succinylcholine for a renal failure patient. Usually the doc gasps and says "thanks" but I had one ask three times not too long ago. I do always say "no" unless they can prove to me that the patient has a normal potassium. But who knows when the pt first rolls into the ED half dead?

I saw a patient die within 2-3 minutes after such a thing. A non ED doc, who actually knew the patient was hyperkalemic, cruised through and ordered succ for an intubation. What a helpless feeling it was to watch the rythmn widen and flatten out to nothing and be unable to resuscitate the patient.

Specializes in EMERGENCY. Has 16 years experience.

lying and standing blood presure for someone who is bed ridden, elderly, with bilateral amputation of legs.

mcknis

977 Posts

Specializes in Med Surg, ER, OR.

Or how about SCDs or TEDs for a bilat amputee! Can't make this stuff up!

Specializes in Emergency.

The order was written exactly as follows:

Insulin 35u qhs.

So I called the admitting physician for clarification, got his covering partner who told me that his partner absolutely, did not write that order. I respond by saying "with all due respect Dr. I'm looking at he order and your partner's signature is on it." He said he would get back to me. About 15 minutes later the physician who wrote the order calls me back. He tells me to call the medical doctor. I tell him the patient is from the VA and doesn't have one at my hospital, but he is welcome to call in a medical consult. He proceeds to tell me that he doesn't have time for this and I need to figure out what to give this patient because he is a surgeon and he "doesn't do insulin." Can you imagine?

Then there is always the report from the ER nurse telling me the patient I'm getting has bilateral pedal pulses. The patient arrives and I asses him and notice the man is a bilateral AKA. Admitting diagnosis: Gangrene of the stump. I was like COME ON!!! Are you kidding me? Idiots.

Specializes in ED. Has 25 years experience.

One of my personal favorites is an order for KVO fluids on a patient with a BS of 984 and clearly HHNK.

Dx: "new onset DM". Sigh...:banghead:

Specializes in Pediatric/Adolescent, Med-Surg.
One of my personal favorites is an order for KVO fluids on a patient with a BS of 984 and clearly HHNK.

Dx: "new onset DM". Sigh...:banghead:

Actually, as an endocrine nurse that sees new onset's regularly, they need fluids, especially something with K in it. After the insulin drip is started, their K will start to drop, and to keep it from dropping to much they need K. Also, these pt's are dehydrated, so fluids are always good.

Specializes in ED. Has 25 years experience.
Actually, as an endocrine nurse that sees new onset's regularly, they need fluids, especially something with K in it. After the insulin drip is started, their K will start to drop, and to keep it from dropping to much they need K. Also, these pt's are dehydrated, so fluids are always good.

This was clearly HHNK, not DKA. Many of our doctors don't know the difference. They'll call HHNK something crazy like DKA although the s/s are markedly different. One of the only thing they have in common is an elevated BS. HHNK folks need fluids, fluids, fluids and then fluids. And then they need more fluids. They are often many liters behind in fluids. For our doctors that can manage to tell the difference, we start with ns and move to 1/2 ns to get the cells hydrated. HHNK is lethal if not managed quickly and efficiently. Much worse in the short term than DKA.

Potassium level is very important to DKA patients, but not as much with HHNK patients who are NOT acidotic.

Insulin gtts take a back seat to fluids for HHNK patients. They will get one eventually, but it is more important to get the fluids going and get the cells rehydrated. The fluids alone will help drop the BS.

And an ER diagnosis of "new onset DM" for a HHNK patient is ridiculous. :chuckle

tnrose

50 Posts

I think this forum is to report strange/funny orders, not to imply that the person posting isn't taking it seriously or didn't follow up.

mom4josh

284 Posts

Specializes in onc, M/S, hospice, nursing informatics. Has 11 years experience.

From a hospitalist: Morphine 0.5 mg q4h IV prn (on a cancer pt)

From another hospitalist: Dilaudid 0.25 mg IV q2h prn (on an actively dying cancer patient in severe pain)

From a hospitalist NP: Ambulate patient (patient paralyzed from mid-chest down, dying from cancer). Um, you want to show me how that's done?

From a bimbo resident: Xanax 10 mg po TID prn (um, we trying to zonk the guy?) She says, "well that's what he says he takes at home." Oh yeah, we give our patients everything they want, right?

Then there are the residents who say, "well, what do you think would help?" Sorry, dude, but you're the one with MD after your name... you figure it out.

Reminds me of the joke: What do they call the person who finished last in his class in medical school?

"Doctor"

:smackingf

tnrose

50 Posts

I applaud your caring attitude, but i think the poster was just saying that if the pt. was able to take care of their own feeding, then it wasn't necessary to write the order to feed, this is supposed to be a funny forum, not to be taken so seriously.

tnrose

50 Posts

as with other post, I don't really think, (and excuse me if I am wrong), that anyone is looking for advice, just posting funny or different orders from docs.

This topic is now closed to further replies.