Day #7 was a classic post-call day – we had 9 new patients. Fortunately I had seen 2 patients on Day #6, which ameliorated the challenge.
Post-call rounds after busy days have a very different flavor than other rounds. We have to work hard, make triage decisions about what to discuss and how much depth to take.
For those former residents who are interested in the types of patients we get:
1. ICU transfer for pneumonia (called on AP film). PA & lateral show no pneumonia. The patient is a classic blue bloater recovering from an exacerbation, but no new disease. He did have an episode of hypotension. The cortrysn stim test was intermediate. We discussed his numbers with endocrine and decided to start him on low dose prednisone (5 mg) with retesting in the future.
2. Patient with atypical chest pain – admitted for MIBI
3. Patient referred from outside hospital to start dialysis. Patient just had fistula placed 3 days ago – so permcath needed.
4. Older man dropped off for placement – his cousin can no longer care for him – obesity and destructive degenerative arthritis have made him immobile
5. Homeless man with protracted nausea and vomiting – labs and endoscopy show no etiology. Iron deficiency anemia. Cardiac fibroelastoma that has caused multiple small strokes.
6. A "pink puffer" complaining of dyspnea – but seemingly unchanged from baseline.
7. A man with known diverticulosis admitted for lower GI bleed – hemodynamically stable and probable d/c today
8. Man with widespread atherosclerotic disease who has a slow healing toe ulcer. He complained for chest pain in vascular clinic – so admitted to our service to await MIBI.
9. Patient transferred for neurosurgery evaluation – probably need surgery – had an asymptomatic episode of either atrial flutter or AVNRT that reverted to sinus rhythm – EP will see if he has this again
We finished rounds for morning report – good thing because I was the attending for morning report. Most of morning report was based on patient 3 and I talked about the issues in this previous rant – Stage III CKD
I went back in the afternoon and worked with the resident for an hour to make certain that we had everything under control. At that time we were waiting for several consultants, but kudos to GI who had given us a consultation and a quick endoscopy! Kudos to EP for quick help.
