当前在线人数15200
首页 - 博客首页 - 美国医学教育博客 - 文章阅读 [博客首页] [首页]
gomer: things will be important as an intern/resident
作者:USMedEdu
发表时间:2009-07-03
更新时间:2009-07-03
浏览:1076次
评论:1篇
地址:24.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

发信人: gomer (gomer), 信区: MedicalCareer
标 题: Re: 我的intern第一天
发信站: BBS 未名空间站 (Fri Jul 3 14:18:11 2009, 美东)

things i think will be important as an intern/resident:

1. find a good bathroom, no matter where you are, always know which bathroom
is clean and private and less visited(especially least visited and lowest
risk of contamination), i used to have an intern that hides in the bathroom
when we round with a very tough attending,

2. know how to intubate and put in a central lineand know your acls well, so
in case patient crashes, you can at least pretend you are doing something
that seems to be helpful; or you can do what my friend does, shows up very
late for the code and ask, how long has it been? 20 minutes? let's call it,
time of death...

3. always know where the cute nurses are, my recommendation is ICU, that's
where most young new graduates are, and hence better chance of finding
somebody attractive that will sooth your day after a long call night,

4. when you get caught speeding by the police, just show your badge and say,
i'm sorry sir it's not a truly a medical emergency but i really have to get
to the hospital, like now, would you please just give me a warning this
time?

5, try your best not to touch your patient, or smell them, especially after
you just eat, throwing up during the round in front of your attending will
not get you a very good evaluation,

6. the more allergies to medications there is, the crazier the patient, if
some patient has allergies to 20 different medicines, you pretty much don't
have to listen to her at all(most often it's a her, not him),

7. more consults a patient gets, less the chance the patient will walk home,

8. if the chart has been thinned twice, or more, the patient most likely
will not make it out alive either,

9. if more than 3 body orifices are occupied by a cather of some sort longer
than 7 days, you can write "the prognosis is poor" in your note,

10. when you intubate, always ask for a straight blade, not only because it
works better than curved but also it makes people think you are more
experienced,

11. when you do a central line, make sure the nurse has bed raised high
enough or you will get a bad backpain,

12. some of you will do ER rotation, you have to understand it's a shift
work, like 7am to 7pm or something like that, so on the day you are suppose
to work, just show up at 6am, pick up a bunch of patients, and when 7am
rolls by and new interns and attending takes over, just find your fellow
intern, wipe your forehead, and say, whew, man, it was a tough night, good
luck, and hand your list to him, then you can safely go home,

but seriously, residency is lots of work, but still could be lots of fun,
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 70.154.]

[上一篇] [下一篇] [发表评论] [写信问候] [收藏] [举报] 
 
共有1条评论
1   [USMedEdu 于 2009-07-06 12:54:45 提到] [FROM: 140.]
发信人: diarrhea (二餅), 信区: MedicalCareer
标 题: Re: 我的intern第一天
发信站: BBS 未名空间站 (Sat Jul 4 20:45:14 2009, 美东)

To gomer (gomer),

Unfortunately, I don't agree most of your input.

>> 2. know how to intubate and put in a central lineand know your acls well,
so in case patient crashes, you can at least pretend you are doing
something that seems to be helpful; or you can do what my friend does, shows
up very late for the code and ask, how long has it been? 20 minutes? let's
call it, time of death...

Lots of PG3 or Internist don't know how to put a central line or intubation.
Now IM is calling medicine, Call fellow to put line and call Ane- to
intubate. Lots of our CMG never had any procedure experience. What are you
taking about?

>> 10. when you intubate, always ask for a straight blade, not only because
it works better than curved but also it makes people think you are more
experienced,

The key point is: do you see the cord?

>> 11. when you do a central line, make sure the nurse has bed raised high
enough or you will get a bad backpain.

That is your job. Nothing about nurse. For central line, position is the
first and the most important thing.

You are talking about procedures to new IM interns. That's not true. Unless
you will go to Critical care GI or Cardiology, ACGME has changed the policy
about required procedures.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 173.3.]


发信人: usmle ( ), 信区: MedicalCareer
标 题: Re: 我的intern第一天
发信站: BBS 未名空间站 (Sat Jul 4 21:01:37 2009, 美东)

我也听说了现在IM resident越来越少做procedure了。一个PGY2告诉我他一个central
line都没做过。我现在在ICU,也还木有机会做。。。。。插管也都是呼吸师插的。现
在分科是越来越细了,你不qualify就不让你做。
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 207.58.]


发信人: gomer (gomer), 信区: MedicalCareer
标 题: Re: 我的intern第一天
发信站: BBS 未名空间站 (Mon Jul 6 12:37:16 2009, 美东)

to answer diarrhea,

it is true that nowadays they don't require many more procedures as they
used to, which is sad, depends on what you plan to do in the future, if you
just want to be a clinician and see patients in clinic everyday and it
probably will be ok not to know how to do procedures,

if you plan to be a hospitalist, then you should at least know how to
intubate and how to place central lines,

if you subspecialize, i think endocrine doesn't have any procedures, but
almost every other specialty requires certain procedures,

personally i like to avoid as many procedures as i could, i have not done a
LP since second yr in residency, have not done a thoracentesis or
paracentesis since third year, i've never done an arthrocentesis,

for central line i've only done one subclavian and that i caused a pneumo,
so given the chance i'll go IJ or femoral, for intubation, i have done
plenty, and many times i DID NOT see the cord at all, come to think of it,
it's a 50-50 shot, if you intubated the esophagus, just leave the ET tube in
and put it another, since the first tube already occupied the esophagus,
the second tube HAVE to be in the trachea since there is no other hole in
there, right?

you will find a lot of fat people, short necked people, and many of them the
cord is very much anterior, a curved blade will have difficulty visualize
the cord, in that sense, straight blade works better,

anyway, as much as i hate doing procedures, i still think it's essential to
have the skills of placing central line and be able to intubate, so that in
case you have no help right away, at least you can stablize the patient, put
them on vent and start the pressors, something in that manner,

just my 2 cents,
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 70.154.]


【 在 usmle ( ) 的大作中提到: 】
: 我也听说了现在IM resident越来越少做procedure了。一个PGY2告诉我他一个
central
: line都没做过。我现在在ICU,也还木有机会做。。。。。插管也都是呼吸师插的。现
: 在分科是越来越细了,你不qualify就不让你做。


you can ask respiratory therapist that if you could give a first try to
intubate, be humble and let him or her teach you, just remember purely by
chance you will get it right in 50% of time, so no worries,

i think for every residency training program, there will always be
opporunities to do more if you desire so, if you started out in icu, there
bound to have a patient with fever and central line already in place, a good
opportunity to switch the line out and culture the tip if you ask your
upper level or attending, you can get a new line, or switch it out through a
guidewire, you don't have to be really good at it, but just know how to do
it and each step so in case you have to do it you won't be struggling, good
luck with your training!
--

 
用户名: 密码:
发表评论
评论:
[返回顶部] [刷新]  [给USMedEdu写信]  [美国医学教育博客首页] [博客首页] [BBS 未名空间站]
 
Site Map - Contact Us - Terms and Conditions - Privacy Policy

版权所有BBS 未名空间站(mitbbs.com) since 1996