"Look away if you have a weak stomach..."
Look away if you have a weak stomach…

How does one identify a train wreck?  GomerBlog polled 1,000,000 health care providers in the last 48 hours and the general consensus is that, of the following, 1 MAJOR plus 2 MINOR criteria are sufficient to make the diagnosis of train wreck:

Signout from a colleague on the patient takes more than 5 minutes
– At least 6 consultants on board, one of which is Infectious Diseases or Palliative Care
– Someone utters “I have no clue what’s going on”
– Someone utters that the patient is a “train wreck”

– 75% of vital signs and lab results in red (or abnormal) font
– Dyad of coded and Full Code
– Triad of renal failure, atrial fibrillation requiring a drip, and anemia requiring a transfusion
– At least 5 organ systems affected, with at least one still worsening
– At least 5 hospital days spent in the ICU
– At least 3 foreign bodies in place (Foley, central line, NG tube, PICC, drain, etc.)
– At least 2 active infections, one of which is MRSA or C. diff
Another service should really be the primary team, but are not
– Patient without decision-making capacity AND family nowhere to be found
– Patient’s length of stay > 15 days OR his/her age
– Social Services has given up on a post-hospital plan of care



  • Dr. 99

    First there was Dr. 01, the first robot physician, created to withstand toxic levels of burnout in an increasingly mechanistic and impossibly demanding healthcare field. Dr. 99 builds upon the advances of its ninety-eight predecessors by phasing out all human emotion, innovation, and creativity completely, and focusing solely on pre-programmed protocols and volume-based productivity. In its spare time, Dr. 99 enjoys writing for Gomerblog and listening to Taylor Swift.

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