NIghts
I had a rough week of nights with may sick patients.
The first few nights i was able to get some sleep but the next few nights were tough and I was unable to get any sleep. The nights are mostly consumed monetary telemetry as I have two patients with heart rates going up to the 180s at 2 o'clock in the morning. The first patient was being treated for pyelonephritis with ceftriaxone. Uncharacteristically, she did not appear to be responding to the antibiotic as she was still spiking fevers, still looked in significant discomfort and continue to have chills. As her heart rate increase I grew increasingly concerned that she may be going into complete septic shock. Multiple fluid boluses were ordered and an additional dose of gentamicin was ordered. After two nights of no response to the ceftriaxone and another night of me requiring a sporadic dose of gentamicin with fluent boldness and supplemental oxygen, and abdominal ultrasound was performed showing that the likely cause of her infection was an acute cholecystitis. We may have been anchoring on the diagnosis that was presented after being evaluated in the emergency department. She had a history upon the fighters and urinalysis that indicated urinary tract infection with classic right CVA tenderness, however she did have a subtle sign of itchiness in her palms. The quicker diagnosis of acute Coley may have led her to surgery quicker, but ultimately she was transferred on the third day of hospitalization for cholecystectomy. Following this procedure her fevers and tachycardia have resolved and she was discharged the next day. It was a lesson not to get caught anchoring and to consider a broad range of differentials.
The other patient was an AIDS patient, noncompliant with medications and had a full-blown pulmonary infection presumed tuberculosis versus PJP versus coccidiomycosis Our another typo pulmonary infection. He is very agitated that night not taking his medications, he pulled out his IV and bit into a sailing back. He was in giving Ativan and Haldol to sedate him enough to place restraints and administer the necessary medications. His heart rate improved upon his medications the next day he was transferred to the ICU.
with his grandson realize that I probably would not like to be a hospitalist especially at night. The anticipation is a lot to do with specimen you have very sick patients require close monitoring. I found it very difficult to even attempt to get sleep at that moment. after those nights were over hours always glad to see sunlight because I knew I would soon be going home.
The first few nights i was able to get some sleep but the next few nights were tough and I was unable to get any sleep. The nights are mostly consumed monetary telemetry as I have two patients with heart rates going up to the 180s at 2 o'clock in the morning. The first patient was being treated for pyelonephritis with ceftriaxone. Uncharacteristically, she did not appear to be responding to the antibiotic as she was still spiking fevers, still looked in significant discomfort and continue to have chills. As her heart rate increase I grew increasingly concerned that she may be going into complete septic shock. Multiple fluid boluses were ordered and an additional dose of gentamicin was ordered. After two nights of no response to the ceftriaxone and another night of me requiring a sporadic dose of gentamicin with fluent boldness and supplemental oxygen, and abdominal ultrasound was performed showing that the likely cause of her infection was an acute cholecystitis. We may have been anchoring on the diagnosis that was presented after being evaluated in the emergency department. She had a history upon the fighters and urinalysis that indicated urinary tract infection with classic right CVA tenderness, however she did have a subtle sign of itchiness in her palms. The quicker diagnosis of acute Coley may have led her to surgery quicker, but ultimately she was transferred on the third day of hospitalization for cholecystectomy. Following this procedure her fevers and tachycardia have resolved and she was discharged the next day. It was a lesson not to get caught anchoring and to consider a broad range of differentials.
The other patient was an AIDS patient, noncompliant with medications and had a full-blown pulmonary infection presumed tuberculosis versus PJP versus coccidiomycosis Our another typo pulmonary infection. He is very agitated that night not taking his medications, he pulled out his IV and bit into a sailing back. He was in giving Ativan and Haldol to sedate him enough to place restraints and administer the necessary medications. His heart rate improved upon his medications the next day he was transferred to the ICU.
with his grandson realize that I probably would not like to be a hospitalist especially at night. The anticipation is a lot to do with specimen you have very sick patients require close monitoring. I found it very difficult to even attempt to get sleep at that moment. after those nights were over hours always glad to see sunlight because I knew I would soon be going home.
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