tag:blogger.com,1999:blog-5883634615775822475.post6366968840706529920..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: Tough caseGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger37125tag:blogger.com,1999:blog-5883634615775822475.post-62513326435736171672010-11-05T03:11:29.231-04:002010-11-05T03:11:29.231-04:00As a neurosurgery resident I dictate similar thing...As a neurosurgery resident I dictate similar things all the time. Trauma patient comes in a little confused and combative (likely drunk) and the ER gives him sedation to calm him down. Then I get a stat page to come assess the patient with a "rapidly declining neuroexam" only to find a snowed patient with a negative head CT. I would be amazed if the neurosurg resident gave the meds, we are stingy bastards when it comes to sedation.Cushinghttps://www.blogger.com/profile/14776264821323529037noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-85882345165393862032010-09-28T10:07:26.085-04:002010-09-28T10:07:26.085-04:00Yep. Completely unclear. I think we need a neuro c...Yep. Completely unclear. I think we need a neuro consult.The Motherhttps://www.blogger.com/profile/15157821003454766570noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-54598866954875157812010-09-26T20:33:32.678-04:002010-09-26T20:33:32.678-04:00Sooo...WHY did they give the patient the diazepam ...Sooo...WHY did they give the patient the diazepam and haloperidol, then? What did they expect those drugs to do?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-65141492519496416152010-09-26T18:24:30.769-04:002010-09-26T18:24:30.769-04:00Resident gives patient 10 mg diazepam and 10 mg ha...Resident gives patient 10 mg diazepam and 10 mg haloperidol, and wonders why the patient suddenly becomes lethargic?! Lights are on but nobody is home - this is someone who should definitely not be a brain surgeon, in any sense of the term.<br /><br />(Although...I must admit that a smaller dose of haloperidol would likely be more effective for my chronic insomnia than crappy old Ambien CR and all the other stuff I take along with it...) <br /><br />WV: pachaut: plattdeutsch for "passed out"Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-64717473473988869322010-09-26T10:53:07.819-04:002010-09-26T10:53:07.819-04:00neurosurgeons are not god's gift. they are god...neurosurgeons are not god's gift. they are god incarnate.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-43689404393206261212010-09-25T19:20:18.599-04:002010-09-25T19:20:18.599-04:00I'm not a medical professional, so I surmise f...I'm not a medical professional, so I surmise from reading the comments that the two drugs are both seditives?<br />Every field has their own lingo that people in it understand, while those outside it can try to puzzle it out as a mental exercise.<br />For example, in my own field of mechanical design, I spent the last several days wrestling with "mating conditions". And no, I don't mean giving the pieces of hardware Vi@gr@ and chocolate, as well as a motel room key.<br />I'm off to Wikipedia to look up the two drugs.Donhttp://labtroll17@gmail.comnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68759235487807941762010-09-25T17:25:56.548-04:002010-09-25T17:25:56.548-04:00Well....at least they didn't take him back to ...Well....at least they didn't take him back to the ORDr. Jnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-9352857054679088132010-09-25T15:04:49.558-04:002010-09-25T15:04:49.558-04:00Duhhhh!!!! that was enough to take down a small vi...Duhhhh!!!! that was enough to take down a small village!!<br /><br />And to think that the neurosurgical resident will someday in the VERY NEAR FUTURE grow up and become a neurosurgeon who thinks he's God's gift to the planet because of his specialty! <br /><br />Heaven help us all......MOJITOGIRLhttps://www.blogger.com/profile/09334559491475100582noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-26222601974415930472010-09-25T01:11:18.033-04:002010-09-25T01:11:18.033-04:00Hospice chaplain wondering if the patient had form...Hospice chaplain wondering if the patient had formulated advance directives before this Baffling Episode. Haloperidol is still a useful drug in palliative care but has to be deployed by someone with a brain.<br /><br />On reflection the resident might need the advance directives sooner.terri chttps://www.blogger.com/profile/09398808840234914275noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-82370891593067834802010-09-25T00:51:33.813-04:002010-09-25T00:51:33.813-04:00"Dick F***ing Tracy!""Dick F***ing Tracy!"Southnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-58238405231085213982010-09-24T21:33:24.702-04:002010-09-24T21:33:24.702-04:00That will sedate a horse. Literally.That will sedate a horse. Literally.Outridernoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-29512020584866086592010-09-24T21:12:41.335-04:002010-09-24T21:12:41.335-04:00no wonder the insurance companies are charging a f...no wonder the insurance companies are charging a fortune, is there no accountability ??? How can the cause of the patients lethargy be UNCLEAR??? And to then call a neurologist??? <br />Dont get sick people.Mrs Ahttps://www.blogger.com/profile/03109885833512528798noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-38603212943192313732010-09-24T18:38:36.597-04:002010-09-24T18:38:36.597-04:00OOOHHHH! Can I have 10 and 10? Pick Me! Pick me! I...OOOHHHH! Can I have 10 and 10? Pick Me! Pick me! I long to be lethargic.SECRET PEPPER PERSON:https://www.blogger.com/profile/06434583043459305729noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-19296148657471749172010-09-24T17:19:13.171-04:002010-09-24T17:19:13.171-04:00Bahaha. Though as an intern/resident I wonder if s...Bahaha. Though as an intern/resident I wonder if someone more senior might have panicked and asked for it "to be safe". Not sure what happens over there but here we don't usually ask for consults without running it past someone more senior. Depends on how senior that resident was though. <br /><br />But MAN, cause, effect. Its all there :-)Dragonflyhttps://www.blogger.com/profile/12759938692575603663noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-65966750062074453722010-09-24T16:58:34.960-04:002010-09-24T16:58:34.960-04:00Hi Dr. Grumpy! (first time commenter)
Your post ...Hi Dr. Grumpy! (first time commenter)<br /><br />Your post reminded me of a resident-dictated H&P I just read this afternoon. It included this section: <br /><br />Surgical History: Appendectomy, Tonsillectomy, Chronic Bronchitis.<br /><br />Huh?? (Hey--I know we were all residents at one time.. but I giggled anyway.) I'm sure at some point someone laughed at my H&Ps! Erhh.. Hmm.. maybe they still do.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-24918817669510210532010-09-24T16:37:52.884-04:002010-09-24T16:37:52.884-04:00In fairness, I don't know if the dictating res...In fairness, I don't know if the dictating resident was the one involved in giving the meds, or calling the neurologist. He may have just been the poor sucker who was told to do the dictation, and was reading the chart.Grumpy, M.D.https://www.blogger.com/profile/09858110332436246760noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-31064457137604420662010-09-24T16:35:32.584-04:002010-09-24T16:35:32.584-04:00In my expert non-medical-professional opinion, a h...In my expert non-medical-professional opinion, a head CT on the resident is called for here.Swami Dilhttps://www.blogger.com/profile/03486227823610436414noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-91784926132632166412010-09-24T16:31:13.546-04:002010-09-24T16:31:13.546-04:00Well, although technically the resident is probabl...Well, although technically the resident is probably smart, once they start surgical residencies, they lose all brain function related to non-cutting activities.ERPhttps://www.blogger.com/profile/15973334581468131595noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-86998551255193941512010-09-24T16:24:47.436-04:002010-09-24T16:24:47.436-04:00Why I always hated working at teaching hospitals.....Why I always hated working at teaching hospitals...bobbiehttps://www.blogger.com/profile/14353836074794786357noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-87822890452549208402010-09-24T16:17:32.931-04:002010-09-24T16:17:32.931-04:00That's where a $5,000,000 liability policy com...That's where a $5,000,000 liability policy comes in handy? <br /><br />This is where it's handy NOT to have Pyxis (automated dispensing cabinet) in the radiology suite.<br /><br />This is where memorization of Beer's Criteria is advisable.<br /><br />Hopefully this is a warning about why propofol is NEVER administered without adequately trained medical personnel and access to oxygen or respiratory support?<br /><br />This is where haloperidol becomes a DO NOT EVER USE again drug.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-78392578930618692442010-09-24T16:12:42.346-04:002010-09-24T16:12:42.346-04:00Seriously ? I have a little medical training, and ...Seriously ? I have a little medical training, and I know right off hand what was wrong.Richhttps://www.blogger.com/profile/05036668428313093960noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-81256285774765446722010-09-24T15:45:06.319-04:002010-09-24T15:45:06.319-04:00the resident really cannot dictate that, after ins...the resident really cannot dictate that, after insisting on overmedicating the patient, the idiot attending demanded a stat neurology consult. or it could have been a clever ploy to get the patient transferred to your service, thereby reducing the neurosurgery workloadAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-55396066821577989042010-09-24T15:37:16.649-04:002010-09-24T15:37:16.649-04:00RealMD- I agree with you. For making a decision li...RealMD- I agree with you. For making a decision like that, I would have intubated the neurology resident, too.Grumpy, M.D.https://www.blogger.com/profile/09858110332436246760noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-43128252458885714082010-09-24T15:32:17.568-04:002010-09-24T15:32:17.568-04:00I had a similar encounter but with a neurology res...I had a similar encounter but with a neurology resident. He decided to give an elderly man with already altered mental status 2mg of Dilaudid and 4mg of Ativan before a lumber puncture. I was the senior resident on call for the ICU and got to intubate him an hour later when his pCO2 was 110.RealMDhttps://www.blogger.com/profile/03647976159616057980noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-66815861590575495822010-09-24T14:47:57.661-04:002010-09-24T14:47:57.661-04:00I'd hate to see the person who wasn't leth...I'd hate to see the person who wasn't lethargic after that particular cocktail O_oMiss Kismetnoreply@blogger.com