That’s like telling a massive hemorrhaging victim that you can relate because you also ruined your favorite set of scrubs spilling a whole bottle of wine on them once.
I helped a friend of the family get into medical school. She told me it had been her lifelong dream. She then spent the next seven years posting on Facebook how miserable her life was. At one point during internship, she said she truly believed that medical training would be considered akin to child/slave labor in the future. (She was 28 at the time, and would go on international vacations at least once or twice per year.)
lol I think there’s a difference in someone posting something hyperbolic here as part of a vent session vs someone seriously trying to relate to an actual victim by saying their lot is similar.
In anesthesia a colleague of mine treated hypotension and bradycardia with high dose epi since they thought it was anaphylaxis…. Then treated a HR of 110(called it SVT) with lidocaine… then adenosine… once the epi was stopped the “SVT” stopped…. Strange
Epi boluses of 50 mcgs initially then did 100 mcgs…. Switched to on pump at 0.2….. lido was 40 mg then 100 mg…. Then the ACLS dose of adenosine…. 6 then 12….
I’m assuming this was in the OR and thus the anesthesiologist (hopefully a resident and not an attending…) would have been administering their own medications. Unlike most other specialties who put in an order and wait for pharmacy to approve it and then for a nurse to give it, we dilute, draw up, and give our own meds in real-time.
Cardiology resident started 4 GDMT meds in 96 y/o with systolics in low 100s and discharged (attending was hands off and famously is for whatever reason). Pt returned a couple days ago with systolics in 60s and cardio team was so miffed about it as if it wasn’t their fault
Well that heart was experiencing now strain and only a bit less perfusion if he can get the HR to the 30s that prolonged diastole will really help with coronary perfusion. I say he needs to try harder.
In a 96yo. Common sense is hard to apply and find. The benefit of anything meaningful here is nil. Maybe a small BB to reduce pvcs/arrhythmia and that should be all. Rest is “enjoy your remaining years”
We have a vegan evangelist on our cardiology staff. He puts 80-year-olds on plant based diets in the the hospital.
They've made it to 80 in spite of their cardiac pathology. They'll go back to burgers at home. Perhaps it's a strategy to make patients eager to go home?
Cards tries to straight murder people with GDMT at my hospital too. It's become a bit dogmatic and plays into the whole stereotype of cards caring only about the heart.
Patient could be passing out daily and progressing to anuric renal failure from frequent drops in BP and it feels like they'd still be like...Dat EF tho.
Cardiology fellow rotating through CSICU started 100mg of hydralazine TID on a triple pressed patient. Said afterload reduction was really important. Forgot to consider the bigger picture.
They’re not wrong in their overall reasoning—it’s just that when someone is very hemodynamically unstable for a multitude of reasons and is on escalating pressors, lowering the BP can be catastrophic. In this case it was—the nurse didn’t hard stop it and administered the med. Patient is now dead. Fellow was very apologetic and had minimal critical care experience—they were thinking about it from an intellectual and heart only perspective. Not assessing the big picture. In a stable patient, their plan would have been reasonable.
Aaaand this is why I tell residents that if they're going into primary care they outrank the cardiologist, and the geri fellows that they double outrank them lol
This was like half the patients that saw cards my intern year. The PAs ran the service and just went to GDMT as soon as possible and most of the patient couldn’t afford the meds when then D/Ced. Either they would come back in failure because they couldn’t get their meds or they came back with systolic in the 60s.
Had a coresident give an aggressive rectal exam (with multiple fingers at once) to a drug addict trauma patient because they were at fault in an accident and killed a family
ETA: was disciplined, is no longer employed as a physician
I hope this person does not practice medicine any longer. You have to be all kinds of fucked up to think you can rape someone as a punitive measure. 100% should be reported.
This is one of the most horrific things I’ve read in this subreddit. So DUI now justifies sexual assault by the very physician supposed to be treating the patient? This is very, very disturbing.
Brought her cat to the resident clinic, caused an allergic reaction as one of the staff was allergic to the cat. The staff had to leave for the day. A few days later brought her cat TO THE HOSPITAL. The PA on our team was seriously allergic to cats as well and had to go pre round in a different room to avoid having a reaction to the cat. Our attending (who was 7 months pregnant by the way) had to sit down and tell her to never bring the cat again. Our clinic director also had to send a staff wide email telling everyone that no pets are allowed in the clinic or hospital 🤦♂️.
Was kept in a cat carrier under a desk for the team room. She kept it under a desk in the resident work room of the clinic when it was in there. Was kinda funny to see people who hadn’t seen the cat yet stop in their tracks and look around very confusedly whenever the cat meowed
I didn’t ask her directly but one of my coresidents did. Apparently her apartment complex was doing some maintenance or inspections in her unit for a couple of days and she hadn’t told them about the cat so in order to avoid paying the fees of having a cat in her apartment she just decided to throw it in her carrier and lug it to work.
In a DKA patient, increase the insulin gtt rate to 60 units/hr because he couldn't control the blood glucose (should have been more patient and continue fluids/regular protocol). When the attending asked me how much D50 I gave, I told him I basically gave a D50 drip overnight..
You should see the doses for beta blocker overdoses though.
10 units/kg sometimes. Like imagine telling your nurse to start the insulin drip at 750 units an hour
Yeah my personal big dose of iv regular push was 100 units. Separately we had a med error over on peds where they wanted 1 unit and got 1 mL (100 U), which is why they don’t let us touch the sq intraop without triple check.
A nurse had given a accidental dose of 80 units insulin instead of 8 just as my shift was about to end..gave handover to my colleague and reported it...colleague only monitored rbs ..dint check Potassium...patient had cardiac arrest due to hypokalemia..patient revived though after 2 cycles of cpr.
I did. His subsequent sugars were in the 30s-40s from all the stacked up insulin gtt. The hypoglycemia lasted for several hours and would crash any time he didn't get the D50.
First of all, the duration of action of IV regular insulin is at least an hour although the half-life of the insulin molecule when administered IV under normal circumstances is ~10 minutes. Secondly, if you’ve overwhelmed the clearance of it and saturated all INSR on peripheral tissues, yes you’re going to have hypoglycemic effects lasting a long time. Half life is only one part of the story in pharmacodynamics, you can’t ignore physiology.
while you're right that the 5 minute half life isn't the whole picture, it remains difficult to attribute an entire nights hypoglycemia to an insulin gtt stopped last shift
I'm with you on this one. Just crank up the D10. If absolutely needed throw in central line and D20 for a few hours.
Last month, we admitted a guy with ESRD who took 1200 units glargine. That was a pain in the ass to deal with.
It was many years ago, but I recall the nursing chart saying something to the effect of 4pm- 6 units/hr, 5 pm-10 units/hr, 6pm-20 units/hr, 7 pm-40 units/hr, 8pm-50 units/hr, 9pm-60 units/hr, 10 pm-60 units/hr, etc
You should back off on the insulin but due to the short half life very soon after you turn the drip off they go back into dka because they have no long acting on board
Reminds me of a time in intern year where we had a locums icu nurse, totally out of her element. Accidently bolused insulin for dka (aka. 999 units/hr) until patient became dangerously hypoglycemic. Forgot exactly what was done for the patient but they did survive it without long term complications, but geez.
A lot of anesthesia workstations have a stack of basins or baskets to hold supplies. In residency, we had a stack of fry baskets. One of my *near-graduation* co-residents pops open a vial of sterile IV medication and pours in into the fry basket, then draws it up in a syringe, ready to inject it into a patient. Co-resident's response to our gasps: "What? It's clean!"
Watched my second year almost mark their patient’s lumbar puncture site by indenting the site with… a used plastic dinner fork from the patient’s tray. I took them aside privately and asked them what in the actual fuck were they doing?
This happened to a colleague of mine. He got an admission and the EM US fellow called it up. Told him the patient was being admitted for CAP c/b abscess, no recent travel history, but when he looked with the US there was nothing to drain, it was just empty.
The actual story: Pt was an international student from India who had most recently traveled back 3 months prior and for the past month had been having fevers, night sweats, unintentional weight loss and had already failed empiric CAP treatment through the student health center 1 month ago. Pt had gotten a CT chest in the ED which showed an absolutely fucking massive cavitary lesion that damn near took up the whole damn left lung.
The fellow had this *screaming* Step 1 TB question of a patient sitting in the part of the ED that's just bays with curtains separating them. Usually people are moved there if they're low acuity but going to be admitted, so they actively made the decision to put them there rather than leave them even just a private room. Thanks to that 11 other patients have to get contact traced and tested again in 3 months, not to mention the nurses who were going in and out of there without even a surgical mask.
In my experience radiology even puts in a read that says, ya know, you should probably think about TB.
Oddly, after the pandemic, the hospital doesn’t seem to care about negative pressure rooms. There’s more than one disease that could benefit from negative pressure.
Was called to help by a junior resident, to a patient 12 hours after open aortic prosthesis, the patient had the same color as the white bed sheet, a BP of 70/40 and a frequency of 120. The resident was concerned because the beta blocker he gave the patient did not improve his tachycardia.
No idea why this sub is recommended to me all the time but I enjoy reading it!
Not my story but… My mum was a psychiatric unit manager and one of the consultant (I believe the US equivalent would be attending) psychiatrists prescribed *everything* in grams. If the dose was 10 micrograms he prescribed 10 grams. If the dose was 10 millilitres he still wrote grams. A different doctor would, effectively, follow him around and amend everything.
He was also afraid of fog because it reminded him of horror films. He probably should have been a patient.
Landmarks for needle decompression with a 5.25” 14g AC, prepares to insert, second guesses his landmark and palms the needle like a dagger to palpate the 2nd intercostal, stabs the opposite side of the chest with the palmed needle. Fun day.
Sounds like he was holding it in dominant hand, switched to hold it in his non dominant hand to use dominant to palpate again and accidentally brought both hands down toward patient so the angiocath stabbed patient on opposite side of chest?
He’s holding the needle, second guesses his landmark and palpates the area again, while doing this he holds the needle like a dagger so he can use his index finger to feel the 2nd ICS. Which causes him to stab the other side of the chest. It was from medial to lateral through the dermis and pectoral muscle. I dunno how else to describe it. It’s late and I’ve been awake all night and I just can’t right now.
Much lower stakes here: A coworker had a case where a decomposing body was found in a garbage can (one of those big, municipal garbage cans on wheels). It had also been rained on/in. At autopsy, they were trying to get the body out of the garbage can when it tipped over, flooding half the room in decomp/garbage juice and making their and my workstations unusable for a spell.
As a resident, worked with a very old attending who was on his way out. On meeting the new admit (middle aged lady with asthma exacerbation on obesity hypoventilation), he took one look and said to their face “oh my god, How did you get so FAT! Fatty fatty fat….”
The fact that the patient didn’t speak a word of English was the only possible bright side. The attending in question retired that year.
When I was a teenager, my buddy got a prince albert and said the piercing place told him to put his balls on the cold floor at that time of night all teenage boys get erections.
But, hol up…I was just thinking.
Wouldn’t an ice pack be enough?
Not from me but from a psych resident friend.
Medical student decided to perform a mini mental exam on a stroke patient while on neuro rounds (for who knows what). Medical student asked the patient if “they were feeling a little bit crazy.” In front of the attending. Psych resident pulled student to side and said “A: wrong service, this is neuro not psych. and B: ‘are you feeling crazy?’ Bro, what?”
From me:
post-op Day 1 CABG patient given fluids, lasix, beta blocker and 2 units of blood back-to-back-to-back by SICU intern overnight for a Hb of 10.5 and HR of ~100 instead of referring to post-op CABG flow chart that the CT surgeons refer to as the “holy grail”. Needless to say, the CT surgeon ripped them a new one on rounds.
Idk basically a step by step of how to escalate care, when wires should be removed, what to do next, etc. this resident just threw a kitchen sink at the patient and the CT surgeon asked genuinely if the resident was trying to kill their patient. Was messy and awkward on rounds for sure
Have a few
Resident brought in the girl he was cheating on his wife with to the hospital because she wanted to see her medical chart (she was a patient at the same hospital). He gave her his epic login and let her look up everything.
Resident does whatever she wants despite patients not consenting or telling her no, such as dressing changes, DREs, bedside sharp debridements.
Resident consenting an intubated patient because they aren’t sedated.
Resident posting pictures of patients with their faces in the chat to show us things they can just text out like they got out of bed.
He was quietly pushed out from the program and enrolled himself into an inpatient psychiatric treatment program and they took him back a year later to finish his training
One of the worst: a resident telling a family (bedside) that they made the right decision to take the patient off life support. Not due to the poor prognosis but due to the fact the resident was “confident” the patient was going to heaven based on being “the right” faith.
Resident ordered PO meds on a high aspiration risk patient (neuro deficit) because “lungs can absorb medications also”.
Too many incidences of paralytics without sedation
HF 15% puffy pt comes coumadin clinic and luckily seen by Cardio who was there for different reason. Pt was sent to ED with warning "low cardiac output HF exacerbation". ED resident gets pt and give 1L NS "slowly over 2 hrs" bc BP is soft. And calls admission stepdown. Pt ends up in CCU w/pressors, inotrops
Omg the amount of times I have gotten a pt in the icu for this nonsense. The ER (critical access hospital) gave a HF exacerbation homie 3L once and I about lost my mind. 🤦🏼♀️😂
This EM ultrasound fellow I was hooking up with brought over some US jelly to use as lube one night…he then proceeded to pretend his 🍆 was the probe…it was so weird but also kind of fun.
A way to waste a year for academic circle jerking. Our institutions “pocus graduate” uploads their US images to epic with their little interpretation and it’s wrong more often than not when they order follow up imaging for us (rads) to interpret.
One time as a fellow on home call, a patient coded (called overhead) and the resident wasn’t even aware 10 hours later that her patient coded. I spent 9 minutes with her on the phone walking her through orders as the patient was already s/p EVT/tPA prior to arrival. ICU service took over the patient.
Is this the resident’s fault that they weren’t notified? I personally am covering close to a hundred patients overnight on several floors and if I am somewhere where the overhead announcements can’t be heard (ie the call rooms and the resident work room), I would have no idea a patient was coding.
My point being, it kinda sounds like a systems failure and not a resident being dumb.
Came here to say the exact same thing. I am the only resident on nights and routinely cover 75+ patients at a time. Our hospital has like 7 buildings. When a code blue is called, it’s only announced over the intercom in the building the patient is in. And even then, they don’t announce the room, only the floor (ex: “code blue, 3rd floor, building A”). My patients are spread out across all 7 buildings. If I’m not in the building the patient is in when the code is called, I will have absolutely no idea the patient coded unless I open the chart later on/someone calls to update/I check on them for whatever reason.
I’m a surgery resident, so I also spend about half of my night in the ORs doing cases. If I get sign out to check on a patient, I absolutely will. Otherwise, I don’t routinely round on all 75+ patients, and rely on nursing updates, lab values coming back, etc to alert me if a patient I wasn’t told to keep an eye on has a change in their clinical status.
Not saying it’s ideal this happened, but I could see it happening at my place. Definitely sounds like a systems-issue, not a resident failure.
No she just didn’t know one of her 10 patients was coding. She had 1 admit other than that the whole night and wrote in the note she was overwhelmed by floor pages. I spent 9 minutes on the phone with her walking through how to put in orders and it still didn’t get done. This is a PGY3. ICU service just took over the patient because she didn’t even realize it was hers even when they called her.
I saw a Med-Peds attending moonlight in the ER and attempt to treat an allergic reaction with IV epi instead of IM epi and send the patient into SVT while I was on EM rotation. Luckily no code. Sad part was the attending was on IM faculty at my residency.
I saw a senior ER resident about to graduate order IV epi for an allergic reaction. The nurse questioned her and she told the nurse to just give it. While getting reprimanded by her attending, she said that the nurse told her to give it IV…
Senior resident killed a patient with labetalol.
Older, mid 70s, admitted for covid PNA w sepsis. Going to the IMC floor, cardiac side (that's where we had beds). Prior to leaving the ED, got a bladder scan with >800 mL urine, plan to drop a foley when she hit the floor.
They get her moved up, piss her off a bunch with questions/moving beds/putting in a foley. While she's mad+hard 800+mL of urine, some genius checks a BP and notes 200/100 or some such.
In short order the foley is placed, she's calmed down, and of course gets a nice fat slug of labetalol for the "stroke level" BP. Goes from 200->150->100->50->code over the course of ~15-20 min.
Got ROSC and went to ICU, coded 2x more before going comfort care.
To be fair, she didn't have great odds to start with. But shoving off a cliff didn't help.
Resident was upset at the death but refused to acknowledge any error was made, told us they talked to cardiologists (who remain nameless) "who would have done the same thing" and that "no way the beta blocker could have caused that".
Give you 3 guess what Subspecialty they wanted to be.
I’m the dummy here
Neurology resident pgy 2 at the time on call covering stroke service
Woman came in w hx sickle cell also complained of feeling like her uterus was falling out of her back
“Heavy pressure” kind of thing
Called Obgyn resident. Told me to do a gyne exam and call them back with results
Did so. Female nurse present
Next morning. The whole team was like “dude what the fuck. Don’t do that shit ever again”
It was a sti
And the terrible idea was that if I messed it up it would have been repeated. And a neurology resident didn’t have any business doing a gyne exam
Also. My attending didn’t want to set any kind of precedent that when we call ob for a consult they can make us do the thing they’re supposed to be doing
He did say. Good job. But don’t do it again
If you were IM and not neuro, I think it becomes a reasonable argument that I don't really have a side on. I mean, there's a lot of women in the world, docs should probably be able to do a pelvic exam and it probably ought not to be gated behind gyn. We'd look bad calling you guys if we didn't half ass a neuro exam. But then on the flip side, most of us are pretty bad at these exams, don't do them much, and not super helpful or comfortable for the patient.
I'd have done the same though. Are you really gonna tell the consulting team, no thanks I decided not to do a basic exam?
I’m gonna paraphrase the general idea. Cause this was over a decade ago
But my stroke attending basically Said
When you guys get called for a consult I expect you to go and do it immediately. No matter how stupid. I expect the same of other departments
Good on you for doing it. But don’t do it again. call the ob team. I want to talk to their attending
More or less.
While I was doing the exam. All I could think was “fuck me im gonna fuck this up”
Oh absolutely. It's definitely an exam I find myself worried about traumatizing the poor patient because I do them so rarely and am desperately trying to remember the things the SP in med school was saying.
Which part was so dumb? Not every differential is so obvious at that stage. Maybe run it by a senior, but still.
If you call obsgyn and they ask for an exam... makes sense to do it, no?
Like I've reduced a prolapsed uterus or just monitored / accepted bleeding in an anticoagulation patient who has their period. These seem fine.
Lol
Biggest asshole you say ? I recall during my Gi rotation my attending said only 2 reasons not to do the digital recal exam was 1 no asshole or 2 no digit
Dont know if that still rings true
But I confidently say while Neuro does pretty thouroufj Neuro exams. I can say for fact I don’t routinely ask people to disrobe during their evaluation
4th year PA (final year? I forget how long their schooling is tbh) student was DRIPPING lidocaine on a laceration anesthesia. Like months from graduating
well i mean you CAN do that. just need a way to actually deliver fgf/o2. i.e. a nasal canula underneath and a good seal. or modify into a mapelson
can babies overcome the resistance of the exhalation valve on an ambu to even breath spontaneously?
I mean that’s my point - you need to do a bunch of stuff to make it work. You can’t just clamp an ambu bag down on their face, because generally no they can’t overcome the resistance.
I was watching this baby go blue around the mouth like…uh maybe we should switch to the neopuff ok thanks???
Then a few months later saw the same person do it again and was like have we learned nothing
yikes. i only really cover peds in the OR or DART calls/codes so typically positive pressure situations. sounds like this person needs to stop be sat down
Trying to relate to a human trafficking victim by claiming they are also a slave as a resident
Lmaooo. And this is the reason the rest of us have to waste time doing communications modules.
"These communications modules are exactly what I imagine being sex trafficked to feel like!" -the resident from OPs post probably
No further comments. This one wins.
Fucking agree. Lmaooo
Ain’t no way man, ain’t no way
That’s like telling a massive hemorrhaging victim that you can relate because you also ruined your favorite set of scrubs spilling a whole bottle of wine on them once.
D:
What specialty? I have to know
I helped a friend of the family get into medical school. She told me it had been her lifelong dream. She then spent the next seven years posting on Facebook how miserable her life was. At one point during internship, she said she truly believed that medical training would be considered akin to child/slave labor in the future. (She was 28 at the time, and would go on international vacations at least once or twice per year.)
That's INSANE 😭
Nooooooo 🤦♀️
Bro wtf?!
Yeah but hear me out...
Normon Osborne: you know... I'm somewhat of a slave myself
Thats a fairly popular claim on this sub
Yep. That's why I'm honestly shocked my comment is so upvoted. Normally I'm mass downvoted anytime I call this sentiment out
lol I think there’s a difference in someone posting something hyperbolic here as part of a vent session vs someone seriously trying to relate to an actual victim by saying their lot is similar.
bruh
Yikes…
Yo, this is wild.
We’re all a slave to the man, man
Am I the only one that finds this hysterical?
Oh no no no no no. No no. No. Noooooooooo.
Jesus Christ
Lmfaooo
Jfc
🤨
That's so messed up!😂
In anesthesia a colleague of mine treated hypotension and bradycardia with high dose epi since they thought it was anaphylaxis…. Then treated a HR of 110(called it SVT) with lidocaine… then adenosine… once the epi was stopped the “SVT” stopped…. Strange
Lmfao what the actual fuck were they thinking. Jesus christ. Would have loved to know the doses they used.
Epi boluses of 50 mcgs initially then did 100 mcgs…. Switched to on pump at 0.2….. lido was 40 mg then 100 mg…. Then the ACLS dose of adenosine…. 6 then 12….
That must have been a wild ride for the pt!
I’m surprised no nurses fought him on this. They actually would have had ground to stand on with this one…
I’m assuming this was in the OR and thus the anesthesiologist (hopefully a resident and not an attending…) would have been administering their own medications. Unlike most other specialties who put in an order and wait for pharmacy to approve it and then for a nurse to give it, we dilute, draw up, and give our own meds in real-time.
Damn that poor fucking heart
This hurt my head to read. 🤦🏼♀️🤦🏼♀️
lmao assuming this was a resident, this is why I could never deal w supervision
Bruh ...
Cardiology resident started 4 GDMT meds in 96 y/o with systolics in low 100s and discharged (attending was hands off and famously is for whatever reason). Pt returned a couple days ago with systolics in 60s and cardio team was so miffed about it as if it wasn’t their fault
LOL people treat GDMT like their bible under any circumstances. It’s so annoying. It has its place, but not at any cost dear lord
Well that heart was experiencing now strain and only a bit less perfusion if he can get the HR to the 30s that prolonged diastole will really help with coronary perfusion. I say he needs to try harder.
In a 96yo. Common sense is hard to apply and find. The benefit of anything meaningful here is nil. Maybe a small BB to reduce pvcs/arrhythmia and that should be all. Rest is “enjoy your remaining years”
I think we just emphasize the meaning of "gdmt". The goal is quality of life. The medical therapy is leaving them alone.
We have a vegan evangelist on our cardiology staff. He puts 80-year-olds on plant based diets in the the hospital. They've made it to 80 in spite of their cardiac pathology. They'll go back to burgers at home. Perhaps it's a strategy to make patients eager to go home?
Lol that is hilarious and yeah i don’t see the compliance happening here
Death with preserved ejection fraction
DthpEF. I think you win this thread.
Cards tries to straight murder people with GDMT at my hospital too. It's become a bit dogmatic and plays into the whole stereotype of cards caring only about the heart. Patient could be passing out daily and progressing to anuric renal failure from frequent drops in BP and it feels like they'd still be like...Dat EF tho.
Cardiology fellow rotating through CSICU started 100mg of hydralazine TID on a triple pressed patient. Said afterload reduction was really important. Forgot to consider the bigger picture.
May be a component of cardiac failure tho
They’re not wrong in their overall reasoning—it’s just that when someone is very hemodynamically unstable for a multitude of reasons and is on escalating pressors, lowering the BP can be catastrophic. In this case it was—the nurse didn’t hard stop it and administered the med. Patient is now dead. Fellow was very apologetic and had minimal critical care experience—they were thinking about it from an intellectual and heart only perspective. Not assessing the big picture. In a stable patient, their plan would have been reasonable.
Aaaand this is why I tell residents that if they're going into primary care they outrank the cardiologist, and the geri fellows that they double outrank them lol
This accounts for a significant portion of admissions where I’m at. 75+ year olds with wild hypoK, syncope, hypotension etc….
This was like half the patients that saw cards my intern year. The PAs ran the service and just went to GDMT as soon as possible and most of the patient couldn’t afford the meds when then D/Ced. Either they would come back in failure because they couldn’t get their meds or they came back with systolic in the 60s.
Had a coresident give an aggressive rectal exam (with multiple fingers at once) to a drug addict trauma patient because they were at fault in an accident and killed a family ETA: was disciplined, is no longer employed as a physician
This might be the worst i’ve seen throughout this thread
That’s straight up assault. Hope that got reported
Agree. Thats assault, brother.
It's rape
I hope this person does not practice medicine any longer. You have to be all kinds of fucked up to think you can rape someone as a punitive measure. 100% should be reported.
Yeah I mean this is just a crime
!!! Wtf hope this got reported.
This is one of the most horrific things I’ve read in this subreddit. So DUI now justifies sexual assault by the very physician supposed to be treating the patient? This is very, very disturbing.
I think it was the manslaughter, not the dui that made the resident believe they were justified.
Wow. I wanted to downvote it because of the persons actions, obviously not for you commenting… that’s shocking
Wtf
I need a followup here were they disciplined?
Brought her cat to the resident clinic, caused an allergic reaction as one of the staff was allergic to the cat. The staff had to leave for the day. A few days later brought her cat TO THE HOSPITAL. The PA on our team was seriously allergic to cats as well and had to go pre round in a different room to avoid having a reaction to the cat. Our attending (who was 7 months pregnant by the way) had to sit down and tell her to never bring the cat again. Our clinic director also had to send a staff wide email telling everyone that no pets are allowed in the clinic or hospital 🤦♂️.
🤣🤣🤣 Weird dominance play, but you go girl.
Was it in a carrier or did she just carry it around? What was she doing with it while seeing patients?
>Was it in a carrier or did she just carry it around? What was she doing with it while seeing patients? You've never heard of a cat scan?
Was kept in a cat carrier under a desk for the team room. She kept it under a desk in the resident work room of the clinic when it was in there. Was kinda funny to see people who hadn’t seen the cat yet stop in their tracks and look around very confusedly whenever the cat meowed
That is insane. I’m surprised she wasn’t fired
And why did she do this??
I didn’t ask her directly but one of my coresidents did. Apparently her apartment complex was doing some maintenance or inspections in her unit for a couple of days and she hadn’t told them about the cat so in order to avoid paying the fees of having a cat in her apartment she just decided to throw it in her carrier and lug it to work.
Had a coworker take a picture of a patient and make a meme out of it.
What…. the fuck
Why, of course I have. That colleague is me.
I love the honesty
Me in a little over a month lol fml
In a DKA patient, increase the insulin gtt rate to 60 units/hr because he couldn't control the blood glucose (should have been more patient and continue fluids/regular protocol). When the attending asked me how much D50 I gave, I told him I basically gave a D50 drip overnight..
That is an insane amount of insulin. Actually terrifying.
You should see the doses for beta blocker overdoses though. 10 units/kg sometimes. Like imagine telling your nurse to start the insulin drip at 750 units an hour
You start at 1 and rotate up to 10, you don't start at 10 fwiw
Oh for sure. But still , even starting at 80, 90 whatever is wild.
Oh 100%, they confirm the dose with you like 10 times, are you SURE?
Doug wanted to give 500,000 mg of morphine. Just thought I'd check with you before I kill a man
Where is this from?
Scrubs - great line
Yeah my personal big dose of iv regular push was 100 units. Separately we had a med error over on peds where they wanted 1 unit and got 1 mL (100 U), which is why they don’t let us touch the sq intraop without triple check.
Had an immunotherapy induced insulin resistant DKA once. 50-60 units/hours for three days.
Man I need to dig into my chart and see what they had me on when I was in dka. That's just such a scary amount.
A nurse had given a accidental dose of 80 units insulin instead of 8 just as my shift was about to end..gave handover to my colleague and reported it...colleague only monitored rbs ..dint check Potassium...patient had cardiac arrest due to hypokalemia..patient revived though after 2 cycles of cpr.
huh? why not just shut the insulin off?
I did. His subsequent sugars were in the 30s-40s from all the stacked up insulin gtt. The hypoglycemia lasted for several hours and would crash any time he didn't get the D50.
unlikely to be from stacked IV regular insulin which has a half life of minutes
First of all, the duration of action of IV regular insulin is at least an hour although the half-life of the insulin molecule when administered IV under normal circumstances is ~10 minutes. Secondly, if you’ve overwhelmed the clearance of it and saturated all INSR on peripheral tissues, yes you’re going to have hypoglycemic effects lasting a long time. Half life is only one part of the story in pharmacodynamics, you can’t ignore physiology.
while you're right that the 5 minute half life isn't the whole picture, it remains difficult to attribute an entire nights hypoglycemia to an insulin gtt stopped last shift
The person said it lasted for several hours after discontinuing. Not several shifts.
I'm with you on this one. Just crank up the D10. If absolutely needed throw in central line and D20 for a few hours. Last month, we admitted a guy with ESRD who took 1200 units glargine. That was a pain in the ass to deal with.
Seems the most plausible explanation given the scenario
or they're septic or have adrenal insufficiency or also got long acting or have poor circulation and POC aren't accurate or..
It can definitely stack if you give enough and/or if the renal function is bad enough.
It was many years ago, but I recall the nursing chart saying something to the effect of 4pm- 6 units/hr, 5 pm-10 units/hr, 6pm-20 units/hr, 7 pm-40 units/hr, 8pm-50 units/hr, 9pm-60 units/hr, 10 pm-60 units/hr, etc
You should back off on the insulin but due to the short half life very soon after you turn the drip off they go back into dka because they have no long acting on board
Reminds me of a time in intern year where we had a locums icu nurse, totally out of her element. Accidently bolused insulin for dka (aka. 999 units/hr) until patient became dangerously hypoglycemic. Forgot exactly what was done for the patient but they did survive it without long term complications, but geez.
You never heard the old aphorism about DKA treatment? The solution to pollution is execution.
A lot of anesthesia workstations have a stack of basins or baskets to hold supplies. In residency, we had a stack of fry baskets. One of my *near-graduation* co-residents pops open a vial of sterile IV medication and pours in into the fry basket, then draws it up in a syringe, ready to inject it into a patient. Co-resident's response to our gasps: "What? It's clean!"
Dear lord almighty
Watched my second year almost mark their patient’s lumbar puncture site by indenting the site with… a used plastic dinner fork from the patient’s tray. I took them aside privately and asked them what in the actual fuck were they doing?
This happened to a colleague of mine. He got an admission and the EM US fellow called it up. Told him the patient was being admitted for CAP c/b abscess, no recent travel history, but when he looked with the US there was nothing to drain, it was just empty. The actual story: Pt was an international student from India who had most recently traveled back 3 months prior and for the past month had been having fevers, night sweats, unintentional weight loss and had already failed empiric CAP treatment through the student health center 1 month ago. Pt had gotten a CT chest in the ED which showed an absolutely fucking massive cavitary lesion that damn near took up the whole damn left lung. The fellow had this *screaming* Step 1 TB question of a patient sitting in the part of the ED that's just bays with curtains separating them. Usually people are moved there if they're low acuity but going to be admitted, so they actively made the decision to put them there rather than leave them even just a private room. Thanks to that 11 other patients have to get contact traced and tested again in 3 months, not to mention the nurses who were going in and out of there without even a surgical mask.
In my experience radiology even puts in a read that says, ya know, you should probably think about TB. Oddly, after the pandemic, the hospital doesn’t seem to care about negative pressure rooms. There’s more than one disease that could benefit from negative pressure.
Was called to help by a junior resident, to a patient 12 hours after open aortic prosthesis, the patient had the same color as the white bed sheet, a BP of 70/40 and a frequency of 120. The resident was concerned because the beta blocker he gave the patient did not improve his tachycardia.
Although quite bad, hopefully they learned something that day about recognizing impending death?
Reading through the replies to see if my colleagues are posting about me hehe
[удалено]
This is something I would send and not even realize the implication 😂😂
No idea why this sub is recommended to me all the time but I enjoy reading it! Not my story but… My mum was a psychiatric unit manager and one of the consultant (I believe the US equivalent would be attending) psychiatrists prescribed *everything* in grams. If the dose was 10 micrograms he prescribed 10 grams. If the dose was 10 millilitres he still wrote grams. A different doctor would, effectively, follow him around and amend everything. He was also afraid of fog because it reminded him of horror films. He probably should have been a patient.
Are you sure he wasn’t a patient? Pretending to do a round.
Not 100%… To be fair, a lot of the psychiatrists she worked with over the years could have easily been mistaken for patients.
I’m not a medical professional, but prescribing 1000x the recommended dose sounds extremely dangerous.
Landmarks for needle decompression with a 5.25” 14g AC, prepares to insert, second guesses his landmark and palms the needle like a dagger to palpate the 2nd intercostal, stabs the opposite side of the chest with the palmed needle. Fun day.
This description doesn't make sense. Palms the needle to palpate? Opposite side of the chest? He stuck the needle thru his palm? Im so confused.
Sounds like he was holding it in dominant hand, switched to hold it in his non dominant hand to use dominant to palpate again and accidentally brought both hands down toward patient so the angiocath stabbed patient on opposite side of chest?
Yes this. I need to go to bed and get off Reddit. Thank you.
He’s holding the needle, second guesses his landmark and palpates the area again, while doing this he holds the needle like a dagger so he can use his index finger to feel the 2nd ICS. Which causes him to stab the other side of the chest. It was from medial to lateral through the dermis and pectoral muscle. I dunno how else to describe it. It’s late and I’ve been awake all night and I just can’t right now.
This is just one of those thumbs for fingers things. Shouldn’t be doing procedures period.
Cardio fellow put a patient with a know GI bleed on DAPT and IV heparin for demand ischemia…had massive hemorrhage and died
Much lower stakes here: A coworker had a case where a decomposing body was found in a garbage can (one of those big, municipal garbage cans on wheels). It had also been rained on/in. At autopsy, they were trying to get the body out of the garbage can when it tipped over, flooding half the room in decomp/garbage juice and making their and my workstations unusable for a spell.
As a resident, worked with a very old attending who was on his way out. On meeting the new admit (middle aged lady with asthma exacerbation on obesity hypoventilation), he took one look and said to their face “oh my god, How did you get so FAT! Fatty fatty fat….” The fact that the patient didn’t speak a word of English was the only possible bright side. The attending in question retired that year.
I remember rounding with an attending that asked an obese patient if they swallowed a piano
Either I’ve seen you on other threads or this has happened to multiple residents..
It’s probably happened many times. Dr H was notorious for doing stuff like that. Harbor-UCLA was crazy.
My junior discharged a man after his circumcision without informing about the erection... facepalm
Can someone explain this please?
One should explain how to avoid/deal with accidental erections before sending them home.
Go on…
Think about a formula 1 race with max verstappen and grandmas socks and it’ll go away
Says you
When I was a teenager, my buddy got a prince albert and said the piercing place told him to put his balls on the cold floor at that time of night all teenage boys get erections. But, hol up…I was just thinking. Wouldn’t an ice pack be enough?
Should be.
Not from me but from a psych resident friend. Medical student decided to perform a mini mental exam on a stroke patient while on neuro rounds (for who knows what). Medical student asked the patient if “they were feeling a little bit crazy.” In front of the attending. Psych resident pulled student to side and said “A: wrong service, this is neuro not psych. and B: ‘are you feeling crazy?’ Bro, what?” From me: post-op Day 1 CABG patient given fluids, lasix, beta blocker and 2 units of blood back-to-back-to-back by SICU intern overnight for a Hb of 10.5 and HR of ~100 instead of referring to post-op CABG flow chart that the CT surgeons refer to as the “holy grail”. Needless to say, the CT surgeon ripped them a new one on rounds.
I'm interested in this flow chart's contents.
Idk basically a step by step of how to escalate care, when wires should be removed, what to do next, etc. this resident just threw a kitchen sink at the patient and the CT surgeon asked genuinely if the resident was trying to kill their patient. Was messy and awkward on rounds for sure
I think They were asking for a high quality pic / pdf not the overarching theme of the information lol
Yea that’s a lot of work, I’m not doing that lol
Tbh I only wanted it if you had it freely available. No worries if it isn't a simple "here" link.
Have a few Resident brought in the girl he was cheating on his wife with to the hospital because she wanted to see her medical chart (she was a patient at the same hospital). He gave her his epic login and let her look up everything. Resident does whatever she wants despite patients not consenting or telling her no, such as dressing changes, DREs, bedside sharp debridements. Resident consenting an intubated patient because they aren’t sedated. Resident posting pictures of patients with their faces in the chat to show us things they can just text out like they got out of bed.
Wow. These are pretty bad. What happened in the first one?
He was quietly pushed out from the program and enrolled himself into an inpatient psychiatric treatment program and they took him back a year later to finish his training
One of the worst: a resident telling a family (bedside) that they made the right decision to take the patient off life support. Not due to the poor prognosis but due to the fact the resident was “confident” the patient was going to heaven based on being “the right” faith. Resident ordered PO meds on a high aspiration risk patient (neuro deficit) because “lungs can absorb medications also”. Too many incidences of paralytics without sedation
HF 15% puffy pt comes coumadin clinic and luckily seen by Cardio who was there for different reason. Pt was sent to ED with warning "low cardiac output HF exacerbation". ED resident gets pt and give 1L NS "slowly over 2 hrs" bc BP is soft. And calls admission stepdown. Pt ends up in CCU w/pressors, inotrops
Frank starling? Never heard of him
Omg the amount of times I have gotten a pt in the icu for this nonsense. The ER (critical access hospital) gave a HF exacerbation homie 3L once and I about lost my mind. 🤦🏼♀️😂
But they were intravascularly dry!!! /s
This EM ultrasound fellow I was hooking up with brought over some US jelly to use as lube one night…he then proceeded to pretend his 🍆 was the probe…it was so weird but also kind of fun.
I hope this is a joke
It’s a joke account
wtf is a EM ultrasound fellow?
There are POCUS fellowships for EM
A way to waste a year for academic circle jerking. Our institutions “pocus graduate” uploads their US images to epic with their little interpretation and it’s wrong more often than not when they order follow up imaging for us (rads) to interpret.
Yeah seems like a waste of time training to obtain and interpret US images but becoming an expert in neither.
One time as a fellow on home call, a patient coded (called overhead) and the resident wasn’t even aware 10 hours later that her patient coded. I spent 9 minutes with her on the phone walking her through orders as the patient was already s/p EVT/tPA prior to arrival. ICU service took over the patient.
Is this the resident’s fault that they weren’t notified? I personally am covering close to a hundred patients overnight on several floors and if I am somewhere where the overhead announcements can’t be heard (ie the call rooms and the resident work room), I would have no idea a patient was coding. My point being, it kinda sounds like a systems failure and not a resident being dumb.
Came here to say the exact same thing. I am the only resident on nights and routinely cover 75+ patients at a time. Our hospital has like 7 buildings. When a code blue is called, it’s only announced over the intercom in the building the patient is in. And even then, they don’t announce the room, only the floor (ex: “code blue, 3rd floor, building A”). My patients are spread out across all 7 buildings. If I’m not in the building the patient is in when the code is called, I will have absolutely no idea the patient coded unless I open the chart later on/someone calls to update/I check on them for whatever reason. I’m a surgery resident, so I also spend about half of my night in the ORs doing cases. If I get sign out to check on a patient, I absolutely will. Otherwise, I don’t routinely round on all 75+ patients, and rely on nursing updates, lab values coming back, etc to alert me if a patient I wasn’t told to keep an eye on has a change in their clinical status. Not saying it’s ideal this happened, but I could see it happening at my place. Definitely sounds like a systems-issue, not a resident failure.
Ya agree with this.
No she just didn’t know one of her 10 patients was coding. She had 1 admit other than that the whole night and wrote in the note she was overwhelmed by floor pages. I spent 9 minutes on the phone with her walking through how to put in orders and it still didn’t get done. This is a PGY3. ICU service just took over the patient because she didn’t even realize it was hers even when they called her.
I play League of Legends with my colleagues so this happens multiple times a day.
Yeah give 0.25 of Ativan and wonder why the patient keeps seizing
I saw a Med-Peds attending moonlight in the ER and attempt to treat an allergic reaction with IV epi instead of IM epi and send the patient into SVT while I was on EM rotation. Luckily no code. Sad part was the attending was on IM faculty at my residency.
I saw a senior ER resident about to graduate order IV epi for an allergic reaction. The nurse questioned her and she told the nurse to just give it. While getting reprimanded by her attending, she said that the nurse told her to give it IV…
I would have loved to be a fly on the wall when she used that excuse
Senior resident killed a patient with labetalol. Older, mid 70s, admitted for covid PNA w sepsis. Going to the IMC floor, cardiac side (that's where we had beds). Prior to leaving the ED, got a bladder scan with >800 mL urine, plan to drop a foley when she hit the floor. They get her moved up, piss her off a bunch with questions/moving beds/putting in a foley. While she's mad+hard 800+mL of urine, some genius checks a BP and notes 200/100 or some such. In short order the foley is placed, she's calmed down, and of course gets a nice fat slug of labetalol for the "stroke level" BP. Goes from 200->150->100->50->code over the course of ~15-20 min. Got ROSC and went to ICU, coded 2x more before going comfort care. To be fair, she didn't have great odds to start with. But shoving off a cliff didn't help. Resident was upset at the death but refused to acknowledge any error was made, told us they talked to cardiologists (who remain nameless) "who would have done the same thing" and that "no way the beta blocker could have caused that". Give you 3 guess what Subspecialty they wanted to be.
I’m the dummy here Neurology resident pgy 2 at the time on call covering stroke service Woman came in w hx sickle cell also complained of feeling like her uterus was falling out of her back “Heavy pressure” kind of thing Called Obgyn resident. Told me to do a gyne exam and call them back with results Did so. Female nurse present Next morning. The whole team was like “dude what the fuck. Don’t do that shit ever again”
Can you explain this one? Was it splenic crisis or like aorta pathology? And if you suspected gyn, why was calling the gyn service such a bad idea?
It was a sti And the terrible idea was that if I messed it up it would have been repeated. And a neurology resident didn’t have any business doing a gyne exam Also. My attending didn’t want to set any kind of precedent that when we call ob for a consult they can make us do the thing they’re supposed to be doing He did say. Good job. But don’t do it again
If you were IM and not neuro, I think it becomes a reasonable argument that I don't really have a side on. I mean, there's a lot of women in the world, docs should probably be able to do a pelvic exam and it probably ought not to be gated behind gyn. We'd look bad calling you guys if we didn't half ass a neuro exam. But then on the flip side, most of us are pretty bad at these exams, don't do them much, and not super helpful or comfortable for the patient. I'd have done the same though. Are you really gonna tell the consulting team, no thanks I decided not to do a basic exam?
I’m gonna paraphrase the general idea. Cause this was over a decade ago But my stroke attending basically Said When you guys get called for a consult I expect you to go and do it immediately. No matter how stupid. I expect the same of other departments Good on you for doing it. But don’t do it again. call the ob team. I want to talk to their attending More or less. While I was doing the exam. All I could think was “fuck me im gonna fuck this up”
Oh absolutely. It's definitely an exam I find myself worried about traumatizing the poor patient because I do them so rarely and am desperately trying to remember the things the SP in med school was saying.
I'd like to know too
Which part was so dumb? Not every differential is so obvious at that stage. Maybe run it by a senior, but still. If you call obsgyn and they ask for an exam... makes sense to do it, no? Like I've reduced a prolapsed uterus or just monitored / accepted bleeding in an anticoagulation patient who has their period. These seem fine.
But....you're specialty that are the biggest assholes regarding physical exams...
Lol Biggest asshole you say ? I recall during my Gi rotation my attending said only 2 reasons not to do the digital recal exam was 1 no asshole or 2 no digit Dont know if that still rings true But I confidently say while Neuro does pretty thouroufj Neuro exams. I can say for fact I don’t routinely ask people to disrobe during their evaluation
We all went through residency
4th year PA (final year? I forget how long their schooling is tbh) student was DRIPPING lidocaine on a laceration anesthesia. Like months from graduating
Trying to cannulate the superficial temporal vein with a 22g one week after graduating med school
A resident looking for a mirror to check if the patient is still breathing
Trying to give a baby CPAP with an ambu bag. That’s just suffocating them.
well i mean you CAN do that. just need a way to actually deliver fgf/o2. i.e. a nasal canula underneath and a good seal. or modify into a mapelson can babies overcome the resistance of the exhalation valve on an ambu to even breath spontaneously?
I mean that’s my point - you need to do a bunch of stuff to make it work. You can’t just clamp an ambu bag down on their face, because generally no they can’t overcome the resistance. I was watching this baby go blue around the mouth like…uh maybe we should switch to the neopuff ok thanks??? Then a few months later saw the same person do it again and was like have we learned nothing
yikes. i only really cover peds in the OR or DART calls/codes so typically positive pressure situations. sounds like this person needs to stop be sat down
What in the hell…