Read on Twitter
This thread reminds me of an incident that went down during my MS3 year. Surgery rotation, cushy private hospital, mostly elective surgery. Saturday, so it’s an R1 and an M3 covering everyone.
1/ https://twitter.com/em_resus/status/1343242697117724672
1/ https://twitter.com/em_resus/status/1343242697117724672
New-grad RN: “Hey doc—“
Me: “Med student! :)”
RN: “Right! Ms. ___— her vitals are fine but she’s acting a lil’ funny... maybe baseline?... but she’s a little tachy, not eating well... can you see her earlier rather than later today?”
Me: “Sure!” *marks list*
RN: “Thanks!”
2/
Me: “Med student! :)”
RN: “Right! Ms. ___— her vitals are fine but she’s acting a lil’ funny... maybe baseline?... but she’s a little tachy, not eating well... can you see her earlier rather than later today?”
Me: “Sure!” *marks list*
RN: “Thanks!”
2/
Two minutes later, I hear her talking to another RN. “I’m so stressed. She looks like shit. Her vitals are all fine but something’s clearly is up. I sent all her labs STAT. Idk what else to do.”
3/
3/
I hadn’t been in medicine long, but I knew what a worried RN sounded like. I dropped my task (transcribing labs or some crap) and popped into her room.
4/
4/
Vitals? All fine. Heart rate in high 90s, NBD. But ... she looked terribly sick. Delirium that was clearly -not- her “baseline.” Slowly increasing work of breathing. Abdomen slightly distended.
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5/
My intern was still on his way in, but I briefed him over the phone. I remember I drew a little sad face next to her name on my list, and wrote “sick”—as a memo of sorts.
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6/
He came in, we talked, he frowned a bit in confusion... but then he saw the little sad face & note on my list, and said, “Oh shit, you’re really worried about her, aren’t you. Okay, let’s go see her together now then.” We went in to see her together.
7/
7/
The next few hours were a blur. Lots of fluids and abx and pressors and a CT that showed way too much air in all the wrong places. She was rushed to the OR. When they opened her incision, pus squirted across the room.
8/
8/
That day, a new, inexperienced RN’s gut prompted recognition of a patient’s evolving criticality. An inexperienced-by-definition MS3’s gut said the same. None of us could articulate it well. But, I listened to the RN, my R1 listened to me, and our attending listened to him.
9/
9/
No one’s right all of the time. Sometimes, there are false alarms. But, as an ICU attending now, the lesson hasn’t changed: Listen carefully to your teammates. Don’t l dismiss anyone’s concerns without careful consideration. If you’re not on the same page, figure out why. F/
