由买买提看人间百态

boards

本页内容为未名空间相应帖子的节选和存档,一周内的贴子最多显示50字,超过一周显示500字 访问原贴
Medicalpractice版 - 致新Intern: erroneous zones in OTHER'S order sheet
相关主题
大家怎么治疗高血压?周末挖坑---关于hospice
【Case Conference】Proposal for weekly case discussion版主删帖不对吧!(Aplusplus)他作弊拉选票竞选十大版主。
心血管疾病的预防— 介绍Life’s Simple 7A joke on election day.
【征文活动】消化科的一天8几个医生被淘汰的常见病
周末娱乐,为什么医生不能海归?美国家庭医生专科权威机构
M.M.I. is about the People Skills年轻无病史的同学忽然高烧出疹昏迷广州中山医院无策求助!
各抒己见: 医生为什么不海归?医学必须是生意, Part II
入学前被学校要求打肝炎,脑炎预防针, 打还是不打?请教版上各位专家,由糖尿病引起的头晕有什么好的治疗方法吗
相关话题的讨论汇总
话题: other话题: abx话题: intern话题: lp话题: 致新
1 (共1页)
L*****r
发帖数: 722
1
Dr. Aplusplus (Hakuna Matata):Good decision-making comes from experience,
and experience comes from bad decision-making.
Dr. Lexian (蒙古大夫):ideally, get your experience from OTHER'S bad
decision making :-)
1. When you order cultures, please write “before antibiotics are given”;
while order starting antibiotics, please write “after blood and urine
cultures are collected” . 因为用抗生素会显著影响细菌培养的结果;
注意有些特殊情况,尤其要考虑先取材培养,再上抗生素。
(1)怀疑骨髓炎,应该先probe the bone to get deep tissue culture, since
superficial culture of an infected wound is useless --- all contaminations.
(2)怀疑脑膜炎,一定争取先腰穿。
(3)血培养阳性,尤其是1/2, 一定先重复血培养,然后再上抗生素,因为极大的可能
是污染。
2. For anemia patients, write"please collect blood samples before
transfusion" ,especially anemia workup, 因为输血会显著影响检查结果--你查的
是病人和输血者的混合结果了;
3. Holding parameters for antihypertensive medications: 一般人的写法是:hold
metoprolol, lisinopril, clonidine and HCTZ if SBP<100. 但是这样的话,很可能
患者的血压就会飙到天上去。所以最好的写法是加上一句 call MD,你去看了病人,再
相应的给药。
4。stat as stat: intern 刚开始,会经常忘记加 stat,结果是检查就可能给约到第二
天或是第三天。如果是CT-angio for PE, 或是lipase R/O pancreatitis 一类, 阳性结果就
是延误诊断了。
5。写医嘱一定要具体,因为护士忙起来常常顾不上动脑子替你着想。譬如 "EKG+
cardiac ensymeX3 Q6h",开了多半等于没开,因为护士不会去给你计算6小时之后会是
几点钟。必须写清楚:“EKG+cardiac ensymeX3 Q6h, stat now, 10pm and 4am ”
先想到这么多,请大家补充。
t*********m
发帖数: 360
2
be careful for meningitis. it is medical emergency.
usually, abx soon after lp asap. but, if you want to send pt for CT before
LP, give abx first, as consequence is grave if treatment delayed.
or ask your attending/ or ed attending, if you can't decide. it can be just
a judgement call.
A*******s
发帖数: 9638
3
A great post.
For 4 and 5, I would talk to the nurse IN PERSON about the orders.
m*********6
发帖数: 609
4
Thanks a lot.

【在 L*****r 的大作中提到】
: Dr. Aplusplus (Hakuna Matata):Good decision-making comes from experience,
: and experience comes from bad decision-making.
: Dr. Lexian (蒙古大夫):ideally, get your experience from OTHER'S bad
: decision making :-)
: 1. When you order cultures, please write “before antibiotics are given”;
: while order starting antibiotics, please write “after blood and urine
: cultures are collected” . 因为用抗生素会显著影响细菌培养的结果;
: 注意有些特殊情况,尤其要考虑先取材培养,再上抗生素。
: (1)怀疑骨髓炎,应该先probe the bone to get deep tissue culture, since
: superficial culture of an infected wound is useless --- all contaminations.

s********e
发帖数: 1596
5
for meningitis, always abx first! No delay!

【在 L*****r 的大作中提到】
: Dr. Aplusplus (Hakuna Matata):Good decision-making comes from experience,
: and experience comes from bad decision-making.
: Dr. Lexian (蒙古大夫):ideally, get your experience from OTHER'S bad
: decision making :-)
: 1. When you order cultures, please write “before antibiotics are given”;
: while order starting antibiotics, please write “after blood and urine
: cultures are collected” . 因为用抗生素会显著影响细菌培养的结果;
: 注意有些特殊情况,尤其要考虑先取材培养,再上抗生素。
: (1)怀疑骨髓炎,应该先probe the bone to get deep tissue culture, since
: superficial culture of an infected wound is useless --- all contaminations.

A*******s
发帖数: 9638
6
LP, 5 mins; preparation of ABX, 10 mins. It should work out. :)

【在 s********e 的大作中提到】
: for meningitis, always abx first! No delay!
t*********m
发帖数: 360
7
you are talking about IM intern or Dr. Lexian? *_*

【在 A*******s 的大作中提到】
: LP, 5 mins; preparation of ABX, 10 mins. It should work out. :)
s********e
发帖数: 1596
8
well, you can always start ABX in 10 minutes, but not always get LP done in
5-10 minutes:)
What I am saying is that ABX should never be held because of LP.

【在 A*******s 的大作中提到】
: LP, 5 mins; preparation of ABX, 10 mins. It should work out. :)
1 (共1页)
相关主题
请教版上各位专家,由糖尿病引起的头晕有什么好的治疗方法吗周末娱乐,为什么医生不能海归?
怀孕其间的巨细胞贫血? (转载)M.M.I. is about the People Skills
有包子!求macrocytic anemia 的鉴别诊断各抒己见: 医生为什么不海归?
Case discussion- A 33 y/o male with multi-organ dysfunction入学前被学校要求打肝炎,脑炎预防针, 打还是不打?
大家怎么治疗高血压?周末挖坑---关于hospice
【Case Conference】Proposal for weekly case discussion版主删帖不对吧!(Aplusplus)他作弊拉选票竞选十大版主。
心血管疾病的预防— 介绍Life’s Simple 7A joke on election day.
【征文活动】消化科的一天8几个医生被淘汰的常见病
相关话题的讨论汇总
话题: other话题: abx话题: intern话题: lp话题: 致新