things not to do intern year #2

I've been learning by the mistakes of others and haven't myself done these things.  There's no names in this post.

1. Do not give an arbitrary dose of naloxone to someone who is reasonably arousable and able to protect their airway.  This happened and someone vomited uncontrollably and aspirated and went to the ICU.

2. Don't give antibiotics before you draw blood cultures

3. Know your SIRS and sepsis criteria.  A fever alone isn't sepsis, so don't keep writing that in your notes.

4.  Don't copy paste your notes.  You'll be busy and "Event X yesterday" keeps popping up and it'll look like that patient coded everyday.  Don't embarass yourself.

5.  Don't give antibiotics without knowing guidelines.

6.  Don't give fluids if you don't know someone's cardiac or renal status.  I've seen people with EFs of 20% get slammed with fluids then people backpedal with diuresis.

7.  Don't DRE a neutropenic patient

8.  Don't rely on hand sanitizer to keep you or your patients safe.  Wash your terrible gross hands

9.  Don't go by the ER's H&P.  I guess its so busy down there that things often go missed.

10.  Don't make your patient feel rushed during pre-rounding, but don't spend so much time with them that the service starts falling apart.  Sorry.

11. Don't take things personally.  

12.  Don't do something you feel is unsafe for a patient.  Ask for help.  It might seem cool for a while that you're independently doing things, but you should rather ask than be dangerous.  I saw a patient with a slightly elevated potassium get insulin and their BG tanked and they had to get called back into give them D50 amps.  Bad doctoring.

13. Don't think that you can diurese forever without AKI.  An increase in serum creatinine 0.3 or higher means you probably caused AKI.  If creatinine keeps going up you can hold diuretics if the patient is stable and asymptomatic.  No need for a nephrology consult unless there are things complicating the picture.

14.  Don't start feeds at a high rate if someone's on pressors.  The gut will go ischemic and that'll be your fault.  Be sure to know when to start feeds.  Discuss with our team.

15. Don't forget to provide sedation breaks for patients in the ICU when indicated.  It cuts down on sedation days.

16.  Don't forget to talk to family members.  If you have time, stop by again and answer questions/provide updates.

17.  Don't forget to to involve nurses.  They feel like order robots so give them updates, be nice to them, order multiple blood draws for testing at the same time instead of one lab test at this hour and anothe rone an hour later.