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Saturday, November 12, 2005

10 Things I learnt being on-call

10 Things I learnt being on weekend on-call today:

1) Weekend hand-overs are no use if there are no clear instructions, eg. posterior compartment syndrome (????)

2) When you're left by yourself to do a ward round on all the surgical patients, while your Reg and SHO goes off to theatre for a perf DU (which you actually diagnosed, and wanted to go to theatre instead to see what they do to your man), you really have to be ON the ball.

3) When you're left with an SHO who is absolutely useless and slow, it's better to do the ward round yourself. That way, you know the patients, and you finish earlier as well. I was doing pretty ok for time, until my SHO came out of theatre and joined me, and the ward round slowed to 3 patients in an hour (when previously I finished 2 wards in an hour)

4) When you have 2 sick patients on hand, one with oxygen sats of 85% and low BP and bradycardic, and another patient who just had a right hemicolectomy and was receiving fluids and a blood transfusion but was anuric, and you are the ONLY doctor on the wards (as the SHO and Reg were in theatre), and you have another patient waiting to be seen in SAU, in pain, how do you prioritise? Add to that, ward work. Plus being bleeped by other wards as well.

Well, fluid challenge the guy receiving a blood transfusion, and get the nurses to flush the catheter. Meanwhile, tend to the patient with 85% sats yourself. Examine, venflon, bloods, ABG (get the student nurse to run it up to ITU to get results), urgent CXR (coz he was sounding very chesty), catheterise him, and give a fluid challenge as well. Then check the obs again, and wait and see. Oh yeah, and get an ECG while at that. Then go back to the other patient and check that he is all well - which was the case.

Meanwhile, when other wards bleep you for other silly things such as 'oh, can you catheterise this patient?' on a urology ward. 'Oh, why can't you guys catheterise him?' 'Oh, because he is a surgical patient, and not a urology patient'. That is just plain silly. Especially when you have to deal with 2 sick patients, another one whose laparotomy wound was just bleeding out after the VAC dressing was taken off. You don't have the patience or the time to deal with crap like that. That brings me on to my next point.

5) Learn how to say NO. Especially to things such as that mentioned above. Sometimes nurses can be absolutely ridiculous.

6) When you are short of time, you somehow manage to get things done at one go, and half the time you would normally take to do on a normal day's ward work. I've managed to get in venflons and do ABGs at the first attempt and get it (I don't usually do these, coz my usual inpatients are really well), and especially when you are short of time, or the patient is acutely unwell (more the former, really).

7) It really pays to eat properly. And also, get to know the nurses. That way, you get cups of tea in between jobs. =)

8) I've come to the conclusion that the green cannulas (larger bore, faster flow) are much better than the pink or blue ones. I've always put in a green venflon, never a pink or a blue one (bigger gauge, smaller bore), but that's coz when I started surgery, my SHO told me to always use a green cannula, and never a blue one, a pink one if really difficult. I did a blue one the other day, and it was really weird. Couldn't get it in. Used a green one instead, and got that in quite easily. Guess I got used to it.

9) You can send up arterial blood samples for FBC and U+Es, if you can't get blood from the patient (esp if the patient is oedematous). The best way? Use an ABG syringe. It fills by itself. =)

Hurrah for me, coz the patient just feels the initial prick of the venflon or the ABG, and they say they don't feel any pain after that.

10) When you are late for a shift, be obviously late, and don't lie about the reason why!

11) When it is time to go home after a long day's shift work, go home!

That's my words of wisdom for today. I liked the business of today. And it's a good feeling when you know you have your team AVAILABLE to ask when it gets a bit manic.