Ask a Surgical Intern, Part 2

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He’s back!  The Surgical Intern is answering the mailbag once more.  Let’s begin!

Dear Surgical Intern,

I’ve been having this kind of crampy pain on my right side under my ribcage.  It only comes around when I eat, could it be gallstones?

– In Pain in Portland

8044318423_4a467bb06d_cDear In Pain,

No, KCl, 40 milli-equivalents PO Q4 times three. No, not IV.  No, not 4 doses.  Yes, yes, I’m aware that you can’t give that much IV through a peripheral line, that’s why I said PO.  PEEEEE OOOOOOOO.  No, not three doses at once.  How are you not getting this?!  Okay, this is what I want you to do.  I want you to go get a physician phone order sheet.  I want you to write KCl 40, then write an m, then e, followed by a q.  Then, I want you to write a capital letter P and then an O.  Then I want you to put a capital Q, and then put the number 4, then x, then 3.  Please don’t ever page me again. Her magnesium is low too? …….Crap.

Dear Surgical Intern,

I’ve tried to control my weight for several years by diet and exercise, but nothing works. What do you think about the lap band?

– Overweight in Omaha

Dear Overweight in Omaha,

Alright, this is Dr. Me dictating a discharge summary for… I don’t know, the medical record number is 05436782, just get it from that.  Date of admission is… Ummmmm… November 23rd.  Date of discharge is whatever today is.  What?  Yeah, sign the patient in by 6:45, got it.  Okay, patient was admitted due to a pneumothorax sustained in an motor vehicle crash.  Patient was stable on admission and brought to the floor for chest tube manageme… No, he can’t eat.  Did I write NPO in the chart?  Then I meant NPO… chest tube management, it was initially placed to low wall suction. Chest x-ray the following morning showed no signs of… Yeah, I know, I’ve got 10 minutes.  The OR’s a floor down, I’ll have them signed in, lordy.  No signs of residual pneumothorax.  The chest tube was d/c’ed without incident that morning, and the patient’s pain was well controlled on PO pain… Yeah, I don’t know why, my senior wanted it.  I could care less.  Yeah, just put attending approved.  PO pain control.  The patient will follow up in clinic… (BEEP, BEEP) Crap, pre-op. (Click.)

Need some more advice?
Ask a 4th-Year Med Student (Who’s Checked Out for the Year)
Ask a Hospitalist
Ask a July 1st Medicine Intern
Ask a Surgical Intern, Part 1

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