Morning guys. I'm Siobhan, a second year medical resident. I just got to the hospital.
It's a good old Saturday and I'm starting a 26-hour call shift.
So honestly, I'm gonna be spending most of the day in this room. As a senior resident
I'll be doing all the consults coming from the emergency department
getting admitted to the internal medicine service. So at this point it's a waiting game. Whenever the emergency department calls,
I'll go see their patients.
So it's 10:30, I've been here for an hour and a half and I've had no pages from the emergency department.
None. So I feel like this is the calm before the storm. I feel nervous. Something big is coming, I'm sure of it.
Anyway, in the meantime
I've had a chance to look at patients' blood work and just catch up on what's going on upstairs in the ward.
So for now
I guess I'm gonna go up and see if the medical student and the junior resident upstairs need any help and
just kind of wait. It makes me uncomfortable, aaaah.
Hey guys. How's it going? Good, how are things up here?
Not too bad. Yeah, we've just seen all our patients for the day. Are you ready to review?
Yeah, man, you guys were efficient. That's awesome. Yeah, let's review it. How is the emerge?
Actually, not that bad. I've had no new consults, which is really bizarre.
And so I figured I come up here to try to help. So I saw six patients today.
First one was in the critical care unit, so she's a sicker
patient. Yeah, yeah. And as you know main thing for her has been the volume status. What do you want to do for her today?
So I think for her today, we'll keep her at the same dose of her
diuretic.
Because she is improving and we don't want to go up too high on that medication, because then some of her kidney markers will go up.
Yeah, sounds very good. I'll be popping in on her later, so I'll text you if there's anything to change.
I have just haven't seen her yet today. Okay. So it's 11:30 now,
still no page. I'm legitimately wondering if my pager is broken.
So I'm gonna go down to the emergency department and just make sure that nobody's looking for me. And then otherwise,
I don't know, maybe I'll study. What do I do? Get lunch? This so bizarre, this has never happened before.
Hey, this is Siobhan, the SMR, returning a page. No, no, no. Actually
that patient is admitted under nephrology. So you're actually gonna need to call
nephrology.
Yeah, sorry. Okay, thanks. Okay, bye. So to put this in context: Last weekend from 9:00 a.m
until 5:00 p.m
I had 12 consults to do on my own. So 12 sick patients in the emergency department to see, it was crazy.
This is why I am so
confused by the situation.
Anyway, I'm gonna enjoy it. Let's see what happens.
Do you guys think it's gonna be a consult? I do, I kind of recognize the emerge number.
Hey, this is Siobhan, the SMR, returning a page.
Sure. Holding, they're getting the emerge doc.
Hey yeah, it's Siobhan, the SMR, returning a page.
Thanks, okay. Bye.
So we've been consulted by the emergency physicians to come and see a patient from a nursing home who has a pneumonia.
Just looking at the blood work here. It looks like this patient may be already a bit dehydrated.
Sodium is elevated, their creatinine and the urea are elevated, so markers of kidney function.
So we'll go and do a physical exam and make a decision about antibiotics and fluids.
Sounds like this patient needs to be admitted to the hospital though.
So unfortunately this patient isn't able to give me much of a history
herself. I was able to find out that there's been a big change in her behavior in the last three days
or so and certainly been coughing more.
But I definitely need to be calling the nursing home to be able to get the full details and the medical side of things.
Hi, I'm hoping to speak with one of the nurses.
One of your residents just came into the emergency department and I'd like to get a little bit more information about how they've been recently.
So that was very helpful.
It sounds like this patient has been often coughing when they're eating and has had multiple
pneumonias in the past couple of years, so I'm gonna go online and try to find
previous x-rays and be able to see if it looks similar. Maybe there's a pattern here.
Hey, this is Siobhan the SMR, returning a page.
Sure. Yeah, yeah. Ehm, have you guys already had a chance to call psychiatry?
Great.
Yeah, I'll come and see in like 10 minutes or so.
Perfect. Thank you, bye.
So this is a consult for a patient who's had an overdose and it sounds like overdose only on tylenol.
Psychiatry has been consulted to help determine: Was this on purpose or not?
And to help do a risk assessment to make sure the patient will be safe in hospital. And then also when they leave.
From our side, we need to help manage the medical part.
So tylenol is very toxic to the liver at high doses and the antidote is called NAC, so
N-acetylcysteine and the patient is already getting that right now.
Whenever there's an overdose
I always want to make sure that we're not missing anything else that person could have taken that we can help reverse.
So anything like aspirin, heart medications, alcohols, homemade alcohols and we'll do a bunch of blood work to make sure
there's nothing else that we can help reverse to make them feel better.
Hey, I can take your pager. Oh wow, it's 5 o'clock already!
You know, honestly it has not been bad. I just got one consult just now, so I'm working on it. Amazing.
Yeah. Well, hopefully that's how the night is. I agree, yeah.
Amazing. This is amazing, I can smell it.
This is a spread of feast for a Saturday night.
Hey.
Hey, thanks for coming up.
What's up? We have a lady with severe abdominal pain. I've ordered some labs.
Do you mind if we take a look at them together? Yeah. I'm worried about how she's doing. Absolutely, let's do it. Great,
thank you. Okay, so let's take a look at what we've got here.
So we've got our VBG, the lactate is a little bit up,
white blood cell count is a bit up. So you're kind of worried about infection at this point? Yeah, I think so. Yeah and
is this patient on antibiotics already? She is, she's on antibiotics already. Okay, alright.
Okay,
so why don't we go and take a look and
feel their belly and decide what we think. And you can tell me what you want to do and we can decide together.
Sounds great. Awesome. Thank you.
Okay, so I think we've got a plan.
We're concerned about an obstruction. So that may be the bowels aren't actually passing,
which can be an emergency. I don't think in this case it is, but let's get an x-ray to start.
Let's follow up on it like next 30 minutes. It should get done and then you want to let me know? Yeah, that sounds great.
I think that's great. Yeah, okay.
So the patient had lost a pulse,
but the nurse was right there when it happened. And so CPR started right away
and we were actually able to get the patient back, get a pulse back.
And so they've now been transferred down to the ICU to continue their care there. So the ICU physicians take over at this point,
but I'm really really glad that that worked out well.
Okay, so that code was on the other side of the hospital, really far.
But luckily when I got there, there were tons of people already there.
And in this case
it was a pre-code, a code blue was called to get resources, get people to this patient, because it looked like
their blood pressure was going down, heart rate was going down and looked like they were very very sick.
Luckily we were able to sort of
fix up the situation and get the patient to a more monitored setting and the patient is doing much better now,
but we're gonna have to watch closely.
But before heading back to sleep I just want to check on the blood work for a couple of the patients.
All right got my stuff from the call room
and now I'm heading down to meet up with the staff physicians who come in the morning.
We tell all about the patients that we admitted,
tell them about anything that happened on the ward and
that's effectively our handover to prep the morning team for their day.
Hi, just to return the... Thank you. Thanks.
Good morning, guys. How was the night? I haven't seen you in a while. Pretty good. Yeah, did you guys all get to sleep? A little bit.
That's amazing. Good call karma is at the best team.
Done for the day. Ah, I always love that feeling when you come outside, you haven't actually had fresh air in 24 hours. Feels good!
Successful night, not busy on the consult front, but quite a bit of acuity with both those codes.
Anyway, you can never predict the night.
So if you want to see lots more videos like this,
don't forget to subscribe and then comment, because I actually love hearing from you guys.
Otherwise, I'll be chatting with you next week. So bye for now!