I have been doing overtime cover this week. Weekdays from 5pm to 11pm, and a Saturday from 8am to 11pm. I covered the Geriatrics and Neuro ward this week.
1) Powerchart went down, Geriatrics ward left uncovered overnight:
On a fateful Friday night, none other than this Friday, the hospital decided to have a software upgrade, and the Powerchart (which we rely on to order investigations and view blood results at RPA) was down from 6pm Friday to 3am Saturday. Doctors could not view blood results of new admissions, unless they go through some complex time-consuming manual process!
And since the Geri’s ward had been rather quiet at the beginning of the week, there were a lot of admissions towards the end of the week!
Apparently, it had been so hectic yesterday that the night intern did not get a chance to cover the Geri’s ward! Which meant, a lot of tasks for me this whole Saturday morning – three new admissions, two of which was not particularly stable, meaning I had to ring up the med registrar (=CR in Taiwan)! And lots of IV cannulas to do!
2) Crazy bloods
Furthermore, as we viewed the blood results of many patients (esp new admissions) whom we weren’t able to view the previous day, we saw a lot of patients with pretty shocking electrolytes! 2 hyponatremias of approx 110-120, and 2 patients with pretty drastic drops in Hb. In fact, one malnourished alcoholic patient had Na 114, Hb 77, random glucose 2.7!
3) Discharge summaries
At noon, the neurology registrar asked me to do two electronic discharge summaries. Now, I have not been attached to any teams this term, so I did not know how it worked. When I figured out how it worked it turned out for some strange reason they did not give me access to writing discharge letters, so in the end I had to do the paper discharge summaries!
4) Patient most likely ok but still need to be assess fully
There were many things that popped up where I had to review the patient fully to really make sure the patient was ok, and the patient turned out to be ok, eg. Chest pain which was really musculoskeletal from the fall rather than a cardiac pain; Bradycardia (90 drop to 49!) which started resolving itself when I examined the patient; Patient with one pupil 1mm smaller than the other pupil
5) Dodgy ED staff
One orthopaedic patient with cellulitis, query osteomyelitis, with penicillin allergy, was charted benzyl penicillin and flucloxacillin by the ED staff, and starting having a bit of expiratory wheeze! The ED person wrote that the orthopedics registrar saw the patient with him…. Then the orthopedic reg came up to the ward and said he’s never seen the patient before, and told me to change the antibiotic of cephazolin!
6) “Background” list of illnesses goes on forever in Geriatrics patients!
One of the patients I mentioned above had chest pain which was not new in onset. One of the reason I found it so important to review the patient fully, even though her complaint is most likely from her fall, was because her background goes like this: CCF, AF, Tachy/Brady Syndrome, Rheumatic heart disease, Defibrillator in situ, Hypertension, recurrent falls, chronic urinary incontinence, glaucoma, asthma, paranoid delusions!
7) Aggressive patient
One patient (a 35y.o married male! Can’t believe he’s able to get himself married!), kept screaming and shouting swear words at medical staff (eg “you fucking slut”, etc etc) and crying! His noise filled the whole neuro ward! When the staff try to give him anything he’d just scream swear and cry louder! I prescribed 5mg diazepam iv to try to settle him and charted 5mg Droperidol iv (in case if the diazepam does not settle him)! He started calming down, and then his IV cannula tissued! I was asked to put in a cannula and when he heard about the needle, he started screaming again! So I decided not to put it in!
By the time it was handover, my brain was truly dead! Saw too many patients today! Couldn’t even focus my eyes! I handed over approximately 4 patients, one of whom I couldn’t even remember the details of, other than her electrolytes being deranged and the geri’s reg wanting me to do her bloods and chase it up (and obviously the med reg kept asking me for more details and I simply couldn’t because I couldn’t even remember the patient well since I reviewed so many different patients that I lost count)!
Oh it was the Taiwanese in med BBQ today, an once in a year event! I wish I was there enjoying the BBQ and the weekend><
1) Powerchart went down, Geriatrics ward left uncovered overnight:
On a fateful Friday night, none other than this Friday, the hospital decided to have a software upgrade, and the Powerchart (which we rely on to order investigations and view blood results at RPA) was down from 6pm Friday to 3am Saturday. Doctors could not view blood results of new admissions, unless they go through some complex time-consuming manual process!
And since the Geri’s ward had been rather quiet at the beginning of the week, there were a lot of admissions towards the end of the week!
Apparently, it had been so hectic yesterday that the night intern did not get a chance to cover the Geri’s ward! Which meant, a lot of tasks for me this whole Saturday morning – three new admissions, two of which was not particularly stable, meaning I had to ring up the med registrar (=CR in Taiwan)! And lots of IV cannulas to do!
2) Crazy bloods
Furthermore, as we viewed the blood results of many patients (esp new admissions) whom we weren’t able to view the previous day, we saw a lot of patients with pretty shocking electrolytes! 2 hyponatremias of approx 110-120, and 2 patients with pretty drastic drops in Hb. In fact, one malnourished alcoholic patient had Na 114, Hb 77, random glucose 2.7!
3) Discharge summaries
At noon, the neurology registrar asked me to do two electronic discharge summaries. Now, I have not been attached to any teams this term, so I did not know how it worked. When I figured out how it worked it turned out for some strange reason they did not give me access to writing discharge letters, so in the end I had to do the paper discharge summaries!
4) Patient most likely ok but still need to be assess fully
There were many things that popped up where I had to review the patient fully to really make sure the patient was ok, and the patient turned out to be ok, eg. Chest pain which was really musculoskeletal from the fall rather than a cardiac pain; Bradycardia (90 drop to 49!) which started resolving itself when I examined the patient; Patient with one pupil 1mm smaller than the other pupil
5) Dodgy ED staff
One orthopaedic patient with cellulitis, query osteomyelitis, with penicillin allergy, was charted benzyl penicillin and flucloxacillin by the ED staff, and starting having a bit of expiratory wheeze! The ED person wrote that the orthopedics registrar saw the patient with him…. Then the orthopedic reg came up to the ward and said he’s never seen the patient before, and told me to change the antibiotic of cephazolin!
6) “Background” list of illnesses goes on forever in Geriatrics patients!
One of the patients I mentioned above had chest pain which was not new in onset. One of the reason I found it so important to review the patient fully, even though her complaint is most likely from her fall, was because her background goes like this: CCF, AF, Tachy/Brady Syndrome, Rheumatic heart disease, Defibrillator in situ, Hypertension, recurrent falls, chronic urinary incontinence, glaucoma, asthma, paranoid delusions!
7) Aggressive patient
One patient (a 35y.o married male! Can’t believe he’s able to get himself married!), kept screaming and shouting swear words at medical staff (eg “you fucking slut”, etc etc) and crying! His noise filled the whole neuro ward! When the staff try to give him anything he’d just scream swear and cry louder! I prescribed 5mg diazepam iv to try to settle him and charted 5mg Droperidol iv (in case if the diazepam does not settle him)! He started calming down, and then his IV cannula tissued! I was asked to put in a cannula and when he heard about the needle, he started screaming again! So I decided not to put it in!
By the time it was handover, my brain was truly dead! Saw too many patients today! Couldn’t even focus my eyes! I handed over approximately 4 patients, one of whom I couldn’t even remember the details of, other than her electrolytes being deranged and the geri’s reg wanting me to do her bloods and chase it up (and obviously the med reg kept asking me for more details and I simply couldn’t because I couldn’t even remember the patient well since I reviewed so many different patients that I lost count)!
Oh it was the Taiwanese in med BBQ today, an once in a year event! I wish I was there enjoying the BBQ and the weekend><
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