SURGERY RESIDENT BLOG

And review books to boot!

Getting consulting services to document their recommendations

I’ve recently found myself in a situation where I am taking care of a postoperative patient who keeps going into supraventricular tachycardia to the 180’s to 200’s. Cardiology has seen him and have recommended increasing his metoprolol until he stops doing that. This plan has not worked well, and he keeps going into rates of 180’s. The problem is that the Cardiology service hasn’t seen the patient in several days.

My plan is to ask Cardiology to document their recommendations in the patient’s chart. I believe they should have been doing this all along, but the only thing they did was write a consult note when they were initially consulted, and then disappeared.

What do you guys do when a consulting service is failing to see your patient, and/or failing to document their recommendations?

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SNF: Waiting in the hospital forever to discharge to a skilled nursing facility

I have a patient in the hospital now who had an esophagectomy for esophageal cancer. He is currently NPO, tolerating jejunostomy tube feeds, and is doing well and is ready for discharge. However, we can’t find a skilled nursing facility that will take him! Their rationale is always they can’t take him because he is getting tube feeds.

My question is, why would a facility refuse to accept a patient because he is getting tube feeds? Is it because they would make less money out of the patient? Any other thoughts?

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Cholecystectomy: How to remove the gallbladder from the abdominal wall

Well, this doesn’t happen often but as I was trying to remove the gallbladder from the abdominal wall (it had been placed in an endocatch bag), the bag ruptured. This was in the setting of a very large gallstone. I tried to pull out the bag but it wouldn’t come out. I then tried using a peon to spread the fascia open wider, and even used the cautery to extend the skin incision. The bag ultimately ruptured while I was trying to pull out the gallbladder.

My question to you guys is this: When you find yourself with a gallbladder that you cannot pull out of the abdominal wall, what techniques do you use so that you are able to pull it out, without rupturing the bag?

Another question I have for you guys is if you do have bile spillage on your port site, do you still close with running monocryl or do you staple the incision? What is your preference?

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Unclogging Jejunostomy Tubes

We all get called to the ER with this problem. A patient who has a jejunostomy tube presents with it clogged. First, I try irrigation with warm water. Then there is the Clog Zapper which is pancreatic enzymes. I find that using the thin blue tip attached to the syringe allows me to do multiple takes of pushing and pulling really fast to almost dissolve the clogged material.

My question is, what do you do to manage clogged jejunostomy tubes or clogged feeding tubes? What are steps 1, 2, 3, 4, etc for you?

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Colonoscopies: Advancing past the hepatic flexure

I’m planning to do colonoscopies in the future as part of my practice. Aside from the usual issues with getting past the sigmoid colon, I sometimes get stuck trying to get past the hepatic flexure. Often my scope is looped and I spend a lot of time trying to undo that. Does anyone out there have any tips on how to do this?

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INTJ Learning, Memory, and Retrieval

As an INTJ I’ve been trying to determine how I learn, memorize, and retrieve information. I would say I don’t have the best memory in the world but I’m working on it. As an INTJ, how do you best learn? I definitely need some tips on this one.

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Ioban Placement

Ioban Placement

 

https://www.youtube.com/watch?v=VmD6ephiN2I

 

 

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Don’t be in a rush to graduate from college to get to medical school

Don’t be in a rush to become a doctor.

Some college students are determined to finish college in three years flat. They believe they will be considered smarter if they finish faster. They want to graduate ASAP so that the can become doctors in a hurry.

Don’t be in such a rush to finish college in three years.

Rest assured, there is no reason to rush through college. College is a great place to learn about new people, cultures, religions, science, etc. It is a place for self discovery and academic discovery. It is a place to develop and sustain your curiosity.

It is not a place to rush past in order to get to your goal. Enjoy college. Enjoy the experience. And whether that means you graduate in four to five years, so be it.

There is no hurry to get into medical school.

The right medical school will be there waiting for you.

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How to show interest on a rotation

The third year of medical school comes with several challenges. One of which is proving to the residents and attendings on your rotation that you are interested in the service.

The key to survival is acting like you are interested on your rotation, whether or not you really are. If you do this, the residents will like you more and will want to teach you the “tricks of their trade.”

If you don’t appear interested in what the residents are doing, they will likely think of you as a bad, uninterested medical student, and give you a bad evaluation.

Here are some tips to show interest on your clinical rotation:

1) Don’t lose your team. If you find yourself alone or don’t know where the team is, page the intern, then the senior residents to find out where they are. It is better to be annoying and interested, than disinterested.

2) Stay with your team. Do not go off and disappear. You want the team to know where you are. If you have to leave, tell them where you are going — i.e. to class, etc.

3) Ask questions. Ask thoughtful questions at least once a day to the residents and attendings. Asking questions shows that you are interested.

4) Show up on time. Don’t be late. Punctuality is highly regarded.

5) Be dependable. If your job is to get numbers in the morning, make sure you are finished with that long before the team rounds. You do not want to leave to make copies when the team is already ready to round.

6) If you are on a surgery rotation and they ask you if you’d like to do A, B, or C, say, “Yes, I’d love to!”

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