Every hospital has its own night shift “metaphysics”. From not being able to drink Red Bull and eat mangoes to having to “worship” apples, everyone has gone to great lengths to gain the favor of the gods of the night shift.
So, how can we spend the rest of the “shift” as smoothly as possible without buying apples? This article tells you today!
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5 Factors to Keep an Eye on Unstable Night Shift
To deal with the unstable night shift, we must first analyze the 5 major sources of instability.
- Newly admitted patients on the night shift (force majeure)
- Patients in critical condition
- Patients with today’s daytime revenue and patients with recurrent daytime conditions
- Perioperative patients
- Patients with sudden changes in condition
Except for the first one, which needs to be favored by fate, the three middle ones are all the cases mentioned in the 18 core systems of the handover system (if you don’t know why the 18 core systems, please make up for it yourself, you have to take the test! . Here we analyze one by one, how to face the night shift phone ringing frankly.
- Newly admitted patients on the night shift
Several major diseases in cardiology, such as hypertension, coronary artery disease, heart failure, arrhythmia, etc., belong to the high incidence of nighttime, with the initial screening and initial treatment of the emergency department, the patient should be a relatively stable state after coming to the ward.
But! Always keep in mind that the medical history must be re-interrogated by yourself and the physical examination must be rechecked by yourself. It is not that emergency medical records are unreliable, but as a general practitioner it is impossible to ask such detailed questions about a specialist condition.
The trigger, number and duration of seizures and how to relieve them must be clearly understood by yourself, and the signs of cardiopulmonary examination, such as heart rate and rales, may change at any Time, so you must have first-hand information so that you can compare and contrast when the condition changes.
If there is a need to review the blood and urine routine, arterial blood gas analysis, electrolytes, troponin, electrocardiogram and other tests initially checked by the emergency department, it is likely that these indicators have changed before the condition changes.
Another task at this time is to explain the condition of patients admitted to the hospital in an emergency, and must be very careful and detailed to explain the various risks to the patient, and must not end until the other party “really understand” the answer, if necessary, you can write a record of the conversation.
If necessary, you can write down a record of the conversation. Without further ado, a physician with independent on-call qualifications should not make too many mistakes in the treatment of symptoms.
- Patients in critical condition
For a patient in critical condition, he must have some aspect or aspects of poor control of his condition, so when handing over the shift, he must pay attention to the patient’s mental status, vital signs, fluid intake and output, the amount of medication for a certain disease (furosemide for heart failure patients, nitrate for coronary heart disease patients, metoprolol for arrhythmia patients, etc.) and key parts of the body check (heart rate, rales, edema, etc.).
If the physician on the shift does not know enough about the condition, then promptly communicate with the supervising physician on the phone. If you do not understand what is critical about him when you take over the shift, then continue to nag the supervising doctor until you understand.
- Today’s daytime admissions and patients with recurrent daytime conditions
(1) Daytime newly admitted patients, mostly outpatients, often some tests have not yet been completed, and the results may even be released during the night shift.
And you, who are on duty, will need to project the potential risk factor of this patient based on the electrocardiogram that is currently available (must have), the lovely first-time course of illness written by your lovely colleague (don’t trust him too much), and the test results that have been returned.
If you are really unsure, you can run in person and ask again, check the individual, and prescribe a test to check. No matter what, don’t take a chance. There is a famous law of duty that if you worry in your mind that something is going to happen, then it will happen.
2) Patients with recurrent daytime conditions should generally be relatively stable after joint management by the supervisor/duty physician and the supervising physician, with attention being paid to some medications that need to be given continuously due to blood levels.
Of course, if you feel that the patient is not stable enough after taking over the shift, then it is perfectly acceptable to treat the patient as a critically ill patient and to communicate fully with the supervising doctor and the patient successively and give more adequate treatment.
- Perioperative patients
The most variable is the perioperative patient, and here we focus on the most common perioperative patient of coronary angiography.
Those who are going to have an angiogram tomorrow are likely to have angina tonight because they are nervous; those who had an angiogram today are dazzled by bandages all over their hands and legs; those who had an angiogram and intervention yesterday still feel uncomfortable today ……
1) For preoperative patients, the electrocardiogram during seizures and at rest should be understood, and the antithrombotic coronary expansion to lower the heart rate of the drugs given enough to understand, if it is judged to be a high-risk stratified NST-ACS, again ask the operator to change to emergency surgery is also in line with the indications.
(2) For patients who are operated on the same day, the situation of the puncture site, the location and extent of intraoperative vascular lesions, the location of interventional treatment, any intraoperative accidents, and the drugs that need to be given intravenously continuously after surgery are all important to grasp.
The changes in the electrocardiogram before and after the operation, which are normal and which are abnormal, also need to be figured out.
(3) have done interventional treatment, after mastering the vascular situation should focus on comparing the ECG changes when postoperative discomfort, and if so, hurry up and ask the operator; otherwise, you can try to carry out psychological counseling ……
- Patients with sudden changes in condition
A teacher said very well, “There is no sudden change of condition, only our sudden discovery”.
This kind of “sudden discovery” occurs because the disease progresses to the “last straw that breaks the camel’s back” and the organism loses compensation after a major change.
Our job, however, is to find this straw and make it fall more slowly and gently.
If you are totally unprepared for the bed number and name said by the nurse after sleeping dazedly, it is most timely to call the higher-level physician and the consultation physician of the relevant department while dealing with the emergency.
In short, the god of night shift only favors those who are prepared. To nip hidden problems in the bud requires careful thinking, caution, and an adequate amount of sedative medication (not for yourself).
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