Monday, April 9, 2012

Case #3: Get Your Phones Out


Sometimes on off-service morning table rounds, I like to close my tired eyes and focus my ears past the voice of the attending to hear the chorus of hundreds of pieces of paper flipping, shuffling, crinkling, and folding.  It's one way to pass the time when surgeons debate over issues they don't already know the answers to. Another is to get your phone out, and help answer the questions with them.

Web 2.0 Resource used:
Surgeon 1: She's breast feeding.
Surgeon 2: She's on zosyn.  Can she breast feed?  Is that safe?
S1: I don't know.
S3: Let's ask ID.
S1: We're not consulting ID for such a simple question.
S2: We'll curbside them.
S1: Ok, call them after rounds.
Me: The WHO says it's safe.  (Micromedex)

S1: The staph culture is pan-sensitive.
S2: Give her augmentin.
S3: She has a PCN allergy - anaphylaxis.
S1: I don't give keflex to anaphylactic reactions to PCN.
S3: We can't use levaquin or bactrim because she's on coumadin especially because this will be long term.
S1: So what do we use?
S2:  Let's ask ID.
S1: Ok, I'll call ID today.
Me: You can use doxycycline -  no listed interactions with warfarin (Micromedex)
S1: Okay, but make sure you follow her INRs closely.

S1: Her ostomy output is through the roof.
S2: We can't keep up with it.  Replacing her cc per cc with IV fluids.
S3: Maybe it's the daptomycin.  Is dapto like erythro? Does it give you diarrhea?
S2: I don't know.
Me: 6-12% have diarrhea. (Micromedex)
S1: 6-12% days of the week I have diarrhea too.  Keep her on the dapto.

EM residents are already valued on off-service rotations for their superhuman abilities to insert IVs and use ultrasound machines.  Now, we can facilitate morning rounds with our smart phones too.

Thank you to Dr. Michelle Lin for posting this entry on her blog, Academic Life in Emergency Medicine

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