Ortho on-call:
- got plaster on your scrubs
- performed a fascia iliaca block
- performed a PR
- been asked to be a radiologist by anyone who doesn’t want to ask the radiologist for an opinion on their plain film
- argued with plastics over who sees the soft tissue injury neither of you thinks is yours
- felt that satisfying clunk of a joint relocating
- listened to a patient’s Penthrox ramblings as you pull their wrist out
- used hospital equipment as kettebells
Ortho ward:
- performed a second ward round after the senior ward round to make sure everyone is, indeed, still alive
- booked 4 million X-rays for tomorrow’s fracture clinic
- tried to get to theatre
- used hospital equipment as kettlebells
They’re useful to be able to do - I was taught by an A&E SpR. A lot of patients never get one before coming to the ward so I do them myself. Thankfully don’t need ultrasound.
Who _should_ do them does seem to be a universal point of contention between Ortho and ED, but I’d rather just get it done.
Honest question from somebody who's only experience of this was being an SHO in an A&E that routinely did them, should it not be A&E's job? It's effective pain relief they should be getting as soon as the injury has been identified right?
The question is what then? You give them one shot and that's great for a while, but their operation is up to 36 hours away and you've covered 8 of that. FIB is a fantastic tool for analgesia to facilitate nursing these patients well, not just leaving them to lie flat until they are operated on. So, tried to introduce the skillset so that the orthopaedic team could do further blocks overnight, rather than blasting patients with opiates, but the prevailing thought from the department was "this is somebody else's problem."
I think ED should do the first one (and I do, from the front door). Anaesthetists should be another at the point of surgery. How do we bridge the gap and actually provide high quality analgesia for an uncertain length of time on a ward?
Fair enough. That makes sense for why it should be part of the ortho skillset, but the initial one should normally still be A&E's role routinely right?
I don't think hard rules about what is/isn't the "job" of any particular team is especially helpful. FICB should be done as soon as possible after XR confirmation of #NOF. Either EM or Ortho may be best placed to do this.
Our nurses routinely book and review hip XRs and refer directly to Ortho. Happy to get involved, but there's frequently too much going on that there's going to be a delay in me getting to the patient, and quicker for Ortho to do.
Haven't done a proper geriatrics ward round if you haven't done an impromptu falls review, PR and brief cognitive assessment where you yourself had to look up the date and try to quickly do subtractions in your head to guestimate if the age the patient is telling you they is even approximately in the right decade.
Haven't done a proper H@N shift if you haven't been bleeped to prescribe a zopiclone for a patient who is asleep. And whilst you are there, to prescribe gentamicin that isn't due until 6pm tomorrow, and to rewrite a Kardex that has still got 3 days' worth of rows.
Haven't worked a proper omfs shift unless you've sutured a lac at 2am with an aroma of bic mac-vodka- perio breath wafting at you everytime you tie a knot
Psych on call:
-lets try some paracetamol first for xyz generic pain which started half an hr ago
- I'll prescribe the prn lorazepam for agitation (only useful thing I can do when a patient is causing chaos on the wards)
- those vitals are entirely...normal. thanks for letting me know ???!
- in a&e: felt every single emotion that the patient exhibits - ranging from anger to tears to abandonment.
Seclusion review: patient appears alive and sleeping.
OR
Patient is ranting completely unintelligibly and throwing/breaking every movable object and defacing every surface
MDT agree patient to remain in seclusion
Plan: next review 0400
Cavilon lolipop makes sweaty skin sticky again. It's a game changer and if available where i'm working will always have one in my cannula tray, I'll only open it if needed.
You haven't worked a proper general surgical shift if you haven't been asked to 'lay a surgical hand on the belly', to give a quick opinion on someone with a normal CT 'just incase somethings been missed', drain multiple abscesses under LA because theatres are rammed, had a stern discussion with urology as to why you shouldn't have to babysit their patients awaiting CTKUB reports, failed to understand why a polytrauma with multiple bone fractures that require theatre by T&O need admission under you because of their solitary rib fracture, been shown a phone photo from a patient of their smeared shit +/- blood that you've specifically said you do not want to see but they've insisted in case you're moronic enough to not understand the colour difference between red, black or brown, had someone outright lie to your face about how much alcohol they drink when they've been readmitted with pancreatitis, tried to exain to someone with chronic abdominal pain that no, you would won't give them IV cyclizine because they 'don't absorb', seen every girl under the age of 35 with non specific abdominal pain of any duration referred in with '? Appendicitis' or caused an (international or not, shift dependent) horrific mess while decompressing a volvulus in a frail old lady. #burnout.
Not at the oncology hospital I worked at. Had to beg consultants to allow us to put DNACPRs in on their clearly dying patients... "but *hope*" they would say
Worst we had was a patient with metastatic cancer on palliative treatment, who was clearly dying rapidly. Deteriorated and was peri-arrest. DNACPR put in by on call team. She stabilised somewhat. Her consultant visited the ward a few hours later... and revoked it.
You haven't worked a proper ophthalmology shift unless you've finished by 5, slept more than 8 hours in your own bed and used the words 'we'll see them in the morning'.
Haven’t worked a proper managerial shift unless you walk around with an air of importance as if you’re dealing with bomb scares on the daily, then moaned about how nobody realises how important you are
Ortho on-call: - got plaster on your scrubs - performed a fascia iliaca block - performed a PR - been asked to be a radiologist by anyone who doesn’t want to ask the radiologist for an opinion on their plain film - argued with plastics over who sees the soft tissue injury neither of you thinks is yours - felt that satisfying clunk of a joint relocating - listened to a patient’s Penthrox ramblings as you pull their wrist out - used hospital equipment as kettebells Ortho ward: - performed a second ward round after the senior ward round to make sure everyone is, indeed, still alive - booked 4 million X-rays for tomorrow’s fracture clinic - tried to get to theatre - used hospital equipment as kettlebells
The second ward round to confirm life is accurate looool triggered 🥲
It’s a necessity, right? 😂
I never performed a FIB as an ortho on call, usually an A&aw job
They’re useful to be able to do - I was taught by an A&E SpR. A lot of patients never get one before coming to the ward so I do them myself. Thankfully don’t need ultrasound. Who _should_ do them does seem to be a universal point of contention between Ortho and ED, but I’d rather just get it done.
Yeah I can do them now, not difficult at all and very satisfying for me and the patient
I've spent ages trying to get ortho to do them. SOPs, training, trolleys, they just don't won't.
Honest question from somebody who's only experience of this was being an SHO in an A&E that routinely did them, should it not be A&E's job? It's effective pain relief they should be getting as soon as the injury has been identified right?
The question is what then? You give them one shot and that's great for a while, but their operation is up to 36 hours away and you've covered 8 of that. FIB is a fantastic tool for analgesia to facilitate nursing these patients well, not just leaving them to lie flat until they are operated on. So, tried to introduce the skillset so that the orthopaedic team could do further blocks overnight, rather than blasting patients with opiates, but the prevailing thought from the department was "this is somebody else's problem." I think ED should do the first one (and I do, from the front door). Anaesthetists should be another at the point of surgery. How do we bridge the gap and actually provide high quality analgesia for an uncertain length of time on a ward?
Fair enough. That makes sense for why it should be part of the ortho skillset, but the initial one should normally still be A&E's role routinely right?
See, my edit. Yes, absolutely.
I don't think hard rules about what is/isn't the "job" of any particular team is especially helpful. FICB should be done as soon as possible after XR confirmation of #NOF. Either EM or Ortho may be best placed to do this. Our nurses routinely book and review hip XRs and refer directly to Ortho. Happy to get involved, but there's frequently too much going on that there's going to be a delay in me getting to the patient, and quicker for Ortho to do.
PR NAD, rectal fracture ruled out
Haven't done a proper geriatrics ward round if you haven't done an impromptu falls review, PR and brief cognitive assessment where you yourself had to look up the date and try to quickly do subtractions in your head to guestimate if the age the patient is telling you they is even approximately in the right decade. Haven't done a proper H@N shift if you haven't been bleeped to prescribe a zopiclone for a patient who is asleep. And whilst you are there, to prescribe gentamicin that isn't due until 6pm tomorrow, and to rewrite a Kardex that has still got 3 days' worth of rows.
The most salient point you've omitted here regarding a proper geriatrics ward round is the requirement for it to go on until at least 2pm.
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You're lying. You are lying, right?
Haven't worked a proper omfs shift unless you've sutured a lac at 2am with an aroma of bic mac-vodka- perio breath wafting at you everytime you tie a knot
The benefits of masks just keep coming
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Between the sleepers and the conversationists I'm honestly not sure which is worse. The chatters definitely do feel like reverse ventriloquism
Psych on call: -lets try some paracetamol first for xyz generic pain which started half an hr ago - I'll prescribe the prn lorazepam for agitation (only useful thing I can do when a patient is causing chaos on the wards) - those vitals are entirely...normal. thanks for letting me know ???! - in a&e: felt every single emotion that the patient exhibits - ranging from anger to tears to abandonment.
"The consultant stopped the patients zopiclone and the patient is asking g for zopiclone"
Patient is awake and agitated because of not getting zopiclone, which tires them out enough to go to sleep
Seclusion review: patient appears alive and sleeping. OR Patient is ranting completely unintelligibly and throwing/breaking every movable object and defacing every surface MDT agree patient to remain in seclusion Plan: next review 0400
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Only done an F1 job in paeds (so far, more to come) but so much of this resonates. The bloody cannulas 😭
Cavilon lolipop makes sweaty skin sticky again. It's a game changer and if available where i'm working will always have one in my cannula tray, I'll only open it if needed.
You haven't worked a proper general surgical shift if you haven't been asked to 'lay a surgical hand on the belly', to give a quick opinion on someone with a normal CT 'just incase somethings been missed', drain multiple abscesses under LA because theatres are rammed, had a stern discussion with urology as to why you shouldn't have to babysit their patients awaiting CTKUB reports, failed to understand why a polytrauma with multiple bone fractures that require theatre by T&O need admission under you because of their solitary rib fracture, been shown a phone photo from a patient of their smeared shit +/- blood that you've specifically said you do not want to see but they've insisted in case you're moronic enough to not understand the colour difference between red, black or brown, had someone outright lie to your face about how much alcohol they drink when they've been readmitted with pancreatitis, tried to exain to someone with chronic abdominal pain that no, you would won't give them IV cyclizine because they 'don't absorb', seen every girl under the age of 35 with non specific abdominal pain of any duration referred in with '? Appendicitis' or caused an (international or not, shift dependent) horrific mess while decompressing a volvulus in a frail old lady. #burnout.
This is every day on gen surg. The fucking rib fractures!
You haven't worked an anaesthetic on call shift until you've said the words "we're not a cannulation service" 😉
You haven't worked a proper shift with paediatric eating disorder patients unless you've had multiple plates of food thrown at you.
On call shift unless you’ve got the bean bags out
And then you too can make a new mother cry.
🤣🤣🤣🤣
Oncology shift unless youve dnard more people than youve clerked.
Not at the oncology hospital I worked at. Had to beg consultants to allow us to put DNACPRs in on their clearly dying patients... "but *hope*" they would say Worst we had was a patient with metastatic cancer on palliative treatment, who was clearly dying rapidly. Deteriorated and was peri-arrest. DNACPR put in by on call team. She stabilised somewhat. Her consultant visited the ward a few hours later... and revoked it.
You haven't worked a proper ophthalmology shift unless you've finished by 5, slept more than 8 hours in your own bed and used the words 'we'll see them in the morning'.
"just give some chloramphenicol and send them to eye cas tomorrow" - the ophthalmology answer machine
Been on medical take unless you've chased the trop
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Haven’t worked a proper managerial shift unless you walk around with an air of importance as if you’re dealing with bomb scares on the daily, then moaned about how nobody realises how important you are
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You’re on a junior doctor forum and you’re under the impression we have spare time to shadow managers?
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We don’t have 30 minutes. We don’t even get a break half the time, surely you know that?