New AHA Hypertension Practice Guidelines: A Resident’s Personal Struggle on Night Float

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The American Heart Association 2017 Hypertension Practice Guidelines has just recently come out with new guidelines, changing the standard definition of hypertension from 140/90 to 130/80. Per a recent news article, nearly 100 million Americans will now have hypertension–nearly half the population!

Dr. Hyperman, PGY-2 Internal Medicine resident rotating on the general medicine night float service at University Hospital was asked to comment on these new changes. “This is the first time in 14 years that the AHA has updated its guidelines, and man did I feel it tonight. Of course they have to update their guidelines when I’m on service.”

Dr. Hyperman was reported to receive more than 80 pages overnight just regarding the issue of HTN. “I had so many pages, I had to start writing them down so that old pages weren’t constantly being deleted with new pages,” he said. “I could hardly keep up.” Examples of pages he received from the nursing staff included “HR 65, RR 18, SpO2 100% RA, BP 131/80. Please come to bedside to assess patient.”

Another included the following: “2 AM vitals: HR 62, RR 18, SpO2 100% RA, BP 122/81. Family at bedside and wants to talk to you about their father’s diastolic HTN (new diagnosis).” Dr. Hyperman said after he examined countless patients and talked with numerous family members overnight such as the ones above, and didn’t prescribe treatment, the nurse would say, “so doctor, you’re not going to do anything for this patient?” He said the nursing staff have been very unsupportive of him “not doing anything.”

After getting through all 80 pages, Dr. Hyperman commented that he then received a slew of more pages for “insomnia.” Ironically, Dr. Hyperman noted that these pages were the same patients that he just awoke to do a complete history and physical on for newly diagnosed hypertension! “This is just ridiculous,” he commented. “One problem leads to the next.” Dr. Hyperman commented that he’s never written for so much Ambien, Lunesta, or Sonata, in one night.

Dr. Hyperman said he was researching the side effects of these sleep aids and one of the common ones was constipation. “I can just see it – tomorrow when I’m back here on night float, I’ll get all these pages around 2 AM for all the patients who didn’t have a bowel movement during the day. It’ll be these same patients. I just know it. I’m getting a headache just thinking about it now.” Dr. Hyperman was unable to admit the 15 patients ER called him with because he was too busy controlling blood pressures on the floor. Admitting diagnosis for 14 of them was “HTN.”

Dr. Hyperman was seen apologizing during sign out at 7 AM to all his co-residents that he could not see any of the new HTN admissions. Due to a bad headache, Dr. Hyperman asked one of his colleagues to check his vitals. Sure enough, his BP was 132/80. He was asked to report to employee health such that he could receive treatment prior to his next night shift.

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