OSH

So here is that story....this may or may not be true, all names have been changes ect. in accordance with HIPAA.... yadda yadda yadda

So I took my very first outside hit (OSH) on Friday. A hit is any patient that is sent to us from an outlying hospital when they decide they can't deal.

I'm talking to the nurse over the phone and the conversation when a bit like this::

Me: "Hi."
OSH: "Hi."---pause for 2 min to cough--"sorry, I should be home now."
Me: thinking...yeah, you should, stop coughing on my patient! "what do you have for us?"
OSH: gives various details..."Patient became combative, brought into the ER, we intubated."
me: thinking...you intubated an alert patient...hmmm.."What are her vent settings?"
OSH: "O2 100%" gives various other settings
me: "100%!, is a PEEP set?"
OSH "no PEEP"

::time out:: realize that at this point my head is screaming, you did what!!!!!!! my preceptor is frantically looking between me at the attending who is standing over my shoulder (nerve wracking..a bit) trying to figure out what is going on and what we should do
Back to conversation

Me: "Access?"
OSH: "Two PIV, one with 0.9NS, one with D5W and propofol"
Me: "Turn off the D5w" (don't worry, I had an order)
OSH: "our pharmacy says you have to run D5w with prop"
Me: "if you have to turn off the prop to turn off the D5W that's fine, but turn off the D5W"

::time out:: at this point you have to realize something about neuro, something I didn't know until recently and then maybe you'll realize my frustration. The brain likes glucose and water, so giving it D5W is giving your brain directly the fuel it needs which in theory is good. In practice it means that the cells in your brain swell up. So any edema that the patient is already experiencing can be doubled by giving them D5w.

Me: "Any neuro exam"
OSH: "PEERLA"
Me: "anything else?"
OSH: "she's medically paralyzed."
Me: "no exam prior to that?"
OSH: "Don't know, she wasn't my patient."



WHAT????!?!?!?!?!?!?!
Are you kidding me?? I'm getting report from somebody that didn't even have this patient? Wow, that is something..To say the least we got the patient to our unit ASAP and got the story straightened out.....It was an interesting experience.
Most the unit was laughing from the time I hung up the phone until the patient rolled up, it wasn't particularly funny, just trying to deal with another bad situation.

Gotta love it!