治疗打呼噜小窍门3.pptVIP

How to Survive Your First Night On Call Suggestions from a former intern Matthew Deneke, MD April 12, 2006 Your first night on call The pager goes off… Potential news on the other end of the phone “You have (another) admission in the ER.” “Your patient in 305 is crashing.” “The lady in 663 would like something to help her sleep.” When it is scenario #3 Many calls you receive will be for non-urgent patient complaints When called for such complaints, you have several options: Ignore them Be careless Be overly cautious Respond appropriately Cross-Cover When on call, many (if not most) of the patients for whom you are responsible will not be YOUR patients. You must depend upon your colleagues to tell you what you need to know about these patients when they check out Once your colleagues leave, it’s all YOU Check Out List List of patients on a service Used by on call person (usually intern) when called about a patient Often the only information the person on call will know about the patient Usually includes patient names, locations, principal diagnoses, and any issues that need to be followed up overnight. Check Out Should also include any other information someone might need on call Diabetes Renal dysfunction Hepatic dysfunction (cirrhosis) Unstable psychiatric conditions Any medications you want or don’t want given Known potential for instability/overnight issues Check Out Unless not possible, should also include a face-to-face discussion of major issues Remember, check out unto others as you would have them check out unto you. Specific issues Pain Nausea/Vomiting Insomnia Anxiety Agitation Constipation Heartburn Pruritus A couple of more urgent issues Electrolytes The “simple,” “mundane,” and often annoying… Pain Opioids Morphine 2mg IV May repeat q 4 hrs prn Oxycodone 5-10mg PO May repeat q 4 hrs prn Avoid Demerol if possible Increased euphoria, risk of seizures Pain Opioids (cont) Dose adjustments Start with ? dose in elderly or in renal/hepatic dysfunction Use