SHITSTORM Red Flag Phrases During Patient Turnover

“Wait, what did you just say about that patient?”

DJIBOUTI, DJIBOUTI – The 5th annual Seminar of Hospital Internists Technologists Surgeons Traumatologists Others RNs and More (SHITSTORM) convention resulted in the drafting of a landmark document detailing the most common phrases heard in the middle of patient turnover right before a grade 5 or higher shitstorm happened. Here are some of the highlights:

  1. Anesthesia – Female in labor, epidural in, kinda working sort of well. Probably not going to need a c-section. Translation: shitty epidural, c-section by morning more likely than not.
  2. Anesthesia – Female in labor, needs an epidural. Should be super straight forward. Translation: 400lb epileptic with prior T4-Sacrum spinal fusion.
  3. Anesthesia – Super easy airway, put in a LMA because it’s just a quick case. End tidal CO2 has been a bit squirrelly. Translation: Mallampati 4, rammed an LMA in with no CO2 return, currently inflating the stomach which has a burrito in it about to come up, patient in lateral for an ortho shoulder scope with 30 parts new chief resident doing the case.
  4. ER – Board is pretty much clear, one patient left should be super simple. Translation: Active MI requiring transfer to another hospital due to insurance issues, only speaks Slavic, translators and social workers are gone for the night.
  5. Gen Surg- SBO, mostly resolved. Translation: 10th SBO for this patient, has had 32 prior abdominal surgeries all open, NG not working, H&H 4/13, Jehovah’s Witness.
  6. Gen Surg – Chip shot appy almost classic story, no imaging needed. Translation: 4 months of left upper quadrant pain, just perforated a duodenal ulcer, actively trying to die.
  7. Internal Medicine – Super sweet lady with just a touch of hypotension doing a lot better with a liter, small cough. Translation: 90 yr old with pneumonia and early sepsis about to crump.
  8. Neurosurgery/Ortho Spine – Postop 2 level ACDF, little bit of a cough. Translation: developing hematoma about 30 minutes from obstructing their airway, sutures are buried monocryll with no escape stitch, no scalpel or scissors within 100yrds of patient.
  9. Nursing – Very nice patient postop hip replacement. A couple allergies. Translation: Demanding fibromyalgia patient in 17/10 pain allergic to every pain medication but Dilaudid, ortho refusing to write for a PCA, prepare to do PRN dilaudid verbals every 8 minutes until the sun comes back up.
  10. Ortho – Both bone forearm fracture, ready for sedation soonish. Chip shot. Translation: Kid with ADHD, weighs 250lbs, currently eating a Big Mac, very unstable fracture, cast tech called in sick, and the ER sedation nurse doesn’t feel comfortable going higher than 1mg/kg in any circumstances.
  11. Peds – Cute little kiddo with a tiny cough. Translation: RSV with horrible stridor stating 74% on 6L. History of cleft palate repair, being worked up for Cystic Fibrosis.
  12. Psychiatry – 18 yr old male, suicidal ideation, a bit of an odd duck but seems fine. Translation: not yet diagnosed schizophrenic about an hour from withdrawing from Heroin and ecstasy