Sponsored Links
Page 1 of 2 12 LastLast
Results 1 to 10 of 16
Like Tree7Likes

Thread: Intern Survival Guide

  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
    Join Date
    Jan 2006
    Location
    NY
    Posts
    5,842
    Downloads
    43
    Uploads
    0
    Blog Entries
    29
    Thanks
    0
    Thanked 0 Times in 0 Posts

    Intern Survival Guide

    Advertisements



    Intern Survival Guide

    This is from the forum the website above.

    Tips on surviving floor rotations

    1) Be organized AND always write things down! You need to develop a good system to keep track of your patients’ information/daily labs/ ‘to do’ list. Some suggestions:

    a. Copy your dictated H/P, fold it in half and write your daily vitals, labs, studies and ‘to do’ list on the back. You can also have a separate ‘to do’ list (examples on page 31.32).
    b. There are pre-printed H/P and daily sheets you can use but many find them too time consuming. (http://www.medfools.com/downloads/medicine)
    c. Copy every pt’s H&P, daily progress note and put it in a folder. Just don’t lose your folder. You may want to put your contact information so that they can page you if it is found.
    d. Use your daily sign-out sheet and put whatever important information on the sign-out sheet during the day.


    2) Pre-round: 6:30-9:00AM (You have to pick up your sign-out sheet by 7:00AM)

    a. Get to work early and get your notes started or finished before rounds. It really helps to have your notes done before rounds so you can work on other things after rounds.

    b. Many people pre-write or pre-type their progress notes. This makes a lot of sense particularly for chronic patients where the plan does not change very much. If you do this, leave some room under the active issues so that you can hand-write additional thoughts based on that morning’s labs. You don’t have to have the perfect plan or have all the labs in the morning. You can add addendum to your notes later if the plan changes during rounds.

    c. Correct abnormal electrolytes early. At the beginning of the year you may feel a little uncomfortable so call your resident. Below are some recommendations.

    i. Potassium: Each 10 mEq is equivalent to 0.1 increase on the lab level.
    1. Supplement all potassium below 3.8-4.0 unless pt has renal failure (3.0-3.4 may be acceptable, check with resident)
    2. KCl 10mEq IV (run over one hour)
    a. If pt has a central line you can run IV per protocol
    b. Can give 1ml of 1% lidocaine with each 10mEq bag if it’s painful: be careful with pts with cardiac conditions
    3. K-Dur 10mEq PO (tablet)
    4. K-Lyte 25mEq PO (liquid)
    a. Has a lot of bicarb so if pt is alkolotic give KCl
    5. K-Phos 2 tabs PO
    6. K-Phos 10mmol IV (run over one hour)
    7. Give 10mEq for every 0.1 below 4.0
    8. Watch potassium closely in pts on lasix.
    9. You can also add 20mEq KCl to each 1L bag of IV fluid
    10. Remember K+ will not correct unless you replace Mg
    11. Make sure to correct potassium cautiously in patients with renal disease, particularly those with end-stage renal disease.

    ii. Magnesium
    1. Supplement all Mg below 2.0 unless pt has renal failure (around 1.6 is fine, check with resident)
    2. For every 0.5 deficit, give 1 g of Mg
    3. Magnesium Sulfate 1 g IV (run over 1 hour) or 400mEq MgOxide po BID or TID

    iii. Phosphorous
    1. Consider supplement if less than 2.0
    2. Particularly important for patients in respiratory distress (ATP).
    3. K-Phos 2 tabs PO q daily
    4. Neutra-Phos 2 packs PO q daily
    a. only helps pts taking po
    b. give it with meals
    c. K-phos 10mmol IV
    5. Na-phos 10mmol IV
    iv. Calcium
    1. check albumin to correct level
    2. calcium carbonate
    a. Tums: 500mg tab = 25 mEq cal
    b. Os-Cal: 650mg = 13 mEq cal


    3) Progress Notes: (sample on page 31)

    a. SOAP note
    i. S: what happened overnight (start with telemetry events or acute events)
    ii. O: vital signs (include finger stick glucose checks, I/O, weight if applicable)
    iii. A/P: Assessment of pt and your plan for the day
    iv. Code status
    v. Social (update family), disposition plan


    4) Rounds: Time for rounding is usually between 9:30-11:30 but can vary. Rounding is a time to present your pts and also for learning and teaching.
    a. Presentation: Concise and relevant information only. Always get the most recent lab data and look at all micro, radiology studies (listen to all reports before rounds)
    b. Teaching: Interns are not expected to read all the time but you should read on topics related to your patients. It’s always good to bring in articles. You can access KP on-line library (http://cl.kp.org ) or use Up-to-date for information.


    5) After Rounds: You need to prioritize your “to do” list. Call consults, put in e-consults for studies and replace electrolytes early. Always take care of your sickest patients first.


    6) Always ask for help when you need it. Your team should work together. If you are overwhelmed tell your resident. There are usually two interns on a team, so help each other. Sometimes the patient load is very uneven, and it is the resident’s responsibility to redistribute.


    7) Take care of your patients as you would your family members. Remember to keep your patients and their family members updated. You may not always see family around so ask the nurse to call you when they are there. Trust me, it will save you a lot of time at discharge and will also help avoid angry family members and patients.


    8) Dealing with patient’s family:
    a. Large family: You don’t have time to explain everything to everyone. The best thing to do is ask family members to designate a spokesperson to contact for updates.
    b. Angry patient or family: Don’t try to handle the situation yourself. Tell the pt/family member you see that they are upset/angry and that you need to call your resident/attending to be present.


    9) Be nice to nurses, clerks, PT, OT, RT and all other medical staff because they can make your life a lot easier. Interns are sleep-deprived and stressed, but remember to keep your cool. If you run into problems with a staff member call your resident/attending.


    10) Verbal Orders: It is a privilege and can be taken away if we abuse it. All verbal orders must be signed within 24 hours. You can sign someone else’s verbal order. If you disagree with the order you can write on the order that you are signing for “Dr.X”, but you should still sign it. For all verbal orders remember to have the nurse read it back to you and double-check the name of the patient.
    Moderator: USMLE AND Residency Forums.

    Hidden Content
    why even bother with the obvious. Just know where you are need it and where you can help the most.

  2. #2
    butters's Avatar
    butters is offline Senior Member 510 points
    Join Date
    Nov 2005
    Posts
    817
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    this is actually pretty good. wish i had read it prior to starting intern year.

  3. #3
    Jane Yao is offline Newbie
    Join Date
    Jun 2004
    Posts
    1
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts

    Be really really careful about where to go!

    I am an IMG who got into the Psych program in U of Arizona in 2005. Five months into my residency training, the positive evaluation letter was removed from my personal file and replaced with negative ones, I was kicked out. I appealed their decision, even my request for meeting with the discipline committee members was turned down. I filed a complain of discrimination and moved back to Canada, but my family and I had been followed and threatened for years until I called 911 early this year.

  4. #4
    Scientific is offline Senior Member 531 points
    Join Date
    Jan 2006
    Posts
    634
    Downloads
    2
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    I'll add a few things that I've learned so far...(this goes for inpatient issues). The nurse pages you and says:
    1. Pt having Chest Pain- #1- Ask nurse for their vitals, if on monitor, ask if they are having EKG changes. Order Stat Cardiac enzymes, EKG, tell nurse to give pt Morphine, NTG, O2. #2- GO SEE THE PATIENT NOW!
    2. Pt Aggitated/Mental status change- #1- Ask the nurse for vitals, Find out if this is baseline, or if this is new, #2-Go see the patient, Check their meds and see if something you are giving might have caused it, #3- Check UA (especially in older pts), ABG, Chem 7, #4- Haldol 5mg IV x1 if needed.

    Personally, I don't prescribe narcotics for long term pain control unless the patient has cancer or some sort of SERIOUS problem. Here are some alternatives.
    - Motrin 600mg po QID prn, or Naproxen (but these can cause ulcers if used for too long),
    - Gabapentin or Amitriptyline(for fibromyalgia and neurologic pain),
    - Tylenol(but remember liver toxicity!!)- use for single headache, etc
    - Ultram is in fact very addictive!! It's supposed to be less addictive than opiates but I hear it is the #5 most abused pain med! Don't overprescribe!
    - Meloxicam is a great antiinflammatory
    - Don't forget about physical therapy!
    - For patients with more severe pain, if you need a narcotic, another alternative is Methadone. It's good for long term pain control and it is pretty inexpensive as well.

    Will post more later...
    Last edited by Scientific; 10-01-2009 at 12:05 AM.
    Naijaman24 and Paleo2015 like this.

  5. #5
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
    Join Date
    Jan 2006
    Location
    NY
    Posts
    5,842
    Downloads
    43
    Uploads
    0
    Blog Entries
    29
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Thank you scientific.
    Who else wants to share?
    Moderator: USMLE AND Residency Forums.

    Hidden Content
    why even bother with the obvious. Just know where you are need it and where you can help the most.

  6. #6
    rokshana is offline Member Guru 11644 points
    Join Date
    Jun 2004
    Posts
    12,099
    Downloads
    3
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by Scientific View Post
    !
    - For patients with more severe pain, if you need a narcotic, another alternative is Methadone. It's good for long term pain control and it is pretty inexpensive as well.
    .
    gotta be careful though...you'll need to get periodic EKGs if they are long term since it can cause pretty serious arrhythmias
    Last edited by rokshana; 10-14-2009 at 11:26 PM.
    Endocrinology, Diabetes and Metabolism Attending
    ABIM certified IM
    ValueMD-the place "where nothing makes sense, but everything is related-fellow vmd'r gabon

  7. #7
    Groove's Avatar
    Groove is offline Member 534 points
    Join Date
    May 2004
    Location
    In my own head
    Posts
    430
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Please don't prescribe methadone as an intern unless you're being told to by someone much more experienced than you. There's much controversy in medicine over it's use as an analgesic in general, and as rokshana alluded to, dangerous side effects. It has a long half-life, is easy to overdose on, kinetics and dosing is a pain, plus I hate seeing overdoses in the ED with arrhythmias.

    One more thing I'd like to harp on for those of you just starting is to play nice with the nurses, play nice with the nurses, play nice with the nurses. They can make your life infinitely more miserable than you realize. You are new, most of them know more than you, all of them probably know it, the mean ones show it, the nice ones don't. You'll feel insecure as an intern, and like you should have an answer for everything the nurse asks or the need to correct them when they might ask "Doc...you suuuuure about this order?" Learn from them, get on their good side, be humble and you'll make your rotations that much smoother. Also, don't take every question they ask about your management/order/plan on pt/etc.. so personal. It took me awhile to see things from their perspective. THEY are with the patient and family much more than you are throughout the day and are getting peppered with questions. They simply, many times, want to be informed and part of the team, able to relay accurate information to the pt and family about what's going on and put them at ease. Most of the time THAT's why they are asking, not in an effort to be subordinate or question something your doing although your first instinct is to get defensive and puff your chest out. Treat them with the respect they deserve and just be nice. It will get you a long way. My first night as an intern was the only doc on call in a NSICU full of 20 patients that I knew nothing about. I learned MUCH that night from the nurses and that month for that matter. Guess how many times that night I asked "Well...what do you guys usually do when this happens?" It's ok to ask that when the need arises. Everyone knows you're green. You'll learn quickly.

    Please, no methadone. I hate methadone about as much as I hate demerol and n.u.b.a.i.n (why does it keep asterisking that out? lol).

    Doh, keep forgetting how old some of these posts are.
    Last edited by Groove; 12-27-2011 at 07:16 AM.
    Paleo2015 likes this.
    SGU Class of 2009
    PGY-4 Emergency Medicine

  8. #8
    ksbol is offline Newbie 510 points
    Join Date
    Mar 2012
    Posts
    17
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    I appealed their decision, even my request for meeting with the discipline committee members was turned down.

  9. #9
    stledmonds15 is offline Newbie 510 points
    Join Date
    Mar 2013
    Posts
    11
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    nice guide

  10. #10
    Don'tMessWiththePancreas is offline Newbie 510 points
    Join Date
    Jun 2014
    Posts
    2
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    Thanks, this will really help me next year

Page 1 of 2 12 LastLast

Similar Threads

  1. Bahamas Survival Guide
    By trailblazers in forum Ross University School of Medicine
    Replies: 1
    Last Post: 10-19-2010, 10:57 PM
  2. PREMED 1 & 2 survival guide
    By drdj5alive in forum MUA Nevis Premed
    Replies: 1
    Last Post: 01-02-2007, 10:55 PM
  3. Survival Guide
    By Nay in forum Ross University School of Medicine
    Replies: 5
    Last Post: 01-21-2004, 08:21 PM
  4. Welcome to the Intern Survival Forum
    By cdmd in forum Residency Match Forum
    Replies: 0
    Last Post: 03-23-2003, 01:13 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •