Thursday, July 24, 2008

Where do they find these docs???

I go out on a MET call the other night (known to some of you also as rapid response teams ) and it is for this older gentleman who is unresponsive. We go through our usual protocols and the nursing super is asked by the floor nurses if we want the hospitalist and she agrees to it since we have done our thing and cannot really do more at this point.
In he walks. Having had prior experience with him I know that I am really no better off except that I have someone who can write orders. We disagree on what is wrong with the patient. The floor nurses found him acutely unresponsive and hypotensive. This doc thinks that it's the klonopin they restarted today despite the fact that he usually takes it at home. I think it's an acute stroke. But either way he's a DNR/DNI and the family doesn't want much major done.
We do do some bloodwork and a CT of his head. He has some irregular neuro respirations and his tongue is falling back into his throat due to his mental status. So my doc asks for anesthesia to be paged to find out how to manage the airway. The nursing super's and my jaws hit the floor!! We remind him that he is a DNR/DNI and that if he gets anesthesia involved they will want to intubate. They really don't like being invited to parties they cannot be involved in anyway. I suggest a nasal trumpet (or nasal airway) for this purpose. This will nicely get his tongue out of the way and help him maintain his airway to the best of his OWN abilities. He agrees. And then asks "can YOU put that in?" Uhhh YUP *eyeroll*!!
The floor nurses then cart the patient off to CT scan and I'm finishing my paperwork and getting ready to go back to the CCU when this doc comes up to me and is asking me tons of questions about the nasal trumpet. Basic questions too! Such as "how do you know when to use those?" "How do you put them in?" "Are they better than an oral airway?" "Do they aspirate less with them?" On and on and on. I'm getting more nervous by the minute as he is a hospitalist who is supposed to be prepared for any situation that happens in a hospital. I could understand if an OB or a dermatologist or even a regular internist who mostly sees patients in the office but occasionally sees them in the hospital doesn't know this stuff. But a hospitalist???
So, I have just two questions for you:
1. Where do they get these docs????
2. Am I asking too much?????

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