On Call Tips Lindsay Wrighton, PGY 1.99 June 25, 2008 Don’t worry . . . Everyone has their first call Take a deep breath You won’t know everything Ask questions The nurses will help you Senior is there General thingies . . . Good night sleep prior to call Sleep when you can Stay organized Do stuff for the morning the night before Get sign out/give sign off Getting sign out . . . Ask questions Pertinent do’s Pertinent don’t Giving sign out: make sure list is updated! Bad List Good List 1800 1900 – Smith BMP, 9200 2000 2100 – John CXR, s/p CT pull at 1500, 8200 2200 2300 0000 – Doe Neuro chk 8200, Brown repeat Ab exam, 8300 100 200 300 400 – Black CE’s 8200 500 600 Keeping track of consults. . . Name: Seen MR: Chiefed Location: Orders Consult for: List F/u: labs, studies, etc. Troubleshooting . . . Get as much info from nurse as possible Must sees: chest pain, SOB, hypotension, ALOC, wound, nurse is concerned Think pathophysiology See pt, come up with plan then call senior SEE BIG picture DOs . . . Go to floors at beginning of your call Be in call room at 6 Listen to the nurses Be patient! Order appropriate cultures Sign out to team in am www.my2way.com DO NOTs . . . Narc/Benzos/Benadryl in old guys Give anti-emetics in trauma pts/bowel surgery pts NGT Do not write PRN orders Change pt management (diet, etc) Be motivated by tiredness Tachycardia Pain control Hypovolemia Fever BP/UOP/Hgb Cardiac event 12 lead EKG, CE’s x3 Hypotension Hypovolemia HR/UOP Re-check cuff/manual BP Cardiac event 12 lead EKG, CE’s x3 Hypertension Pain control Hx/of HTN – not on home meds Fluid overload Central/TBI Low Urine Output Meds on bladder Old guys: BPH Hypovolemia Clogged foley Renal failure ALOC/Agitation Hospital delerium (esp oldies) Meds As cause/Meds have expired Infection Hypoxemia Stroke Call 1: Tachycardia Call 2: Annoyance Call 3: Calling in a Consult Call 4: Calling the Senior If you prank your fellow interns . . . Intern Year is FUN!