Surviving Surgical Internship

Admit (23 hours, full admit, service of attending,...)

Diagnosis

Condition ("Stable", "Guarded", etc.)

Vitals (post-op, routine, q 1 hour, etc.)

Allergies

Activities (Strict bed rest, fall precautions, ad lib, bathroom privileges, etc.)

Nursing (Strict I&O's, Daily weights, Call P.R.N. whatever, etc.)

Diet (NPO, Regular, Clears - advance diet as tolerated, 2000 cal ADA, renal, etc.)

IV fluids (D5 1/2 NS c 20 KCL at 110 ml/hr, LR @ 100 ml/hr, etc.)

Meds (scheduled and PRN's)

Labs and x-ray (CBC in AM, PCXR in PACU, etc.)

Note that IV fluids follows Diet. If one writes NPO, then all such patients get maintenance fluids (use the 4-2-1 rule).

Recipe for disaster: writing for non-maintenance fluids without a time limit. E.g., a patient comes in dehydrated because of nausea and vomiting. You write for NS at 150 ml/hour, thinking you are going to change it in the AM. You forget and get called 2 days later because the patient is coding with potaissium of 2.2 Much better to write: NS @ 150 ml/hour x 12 hours then D5 1/2 NS c 20 KCL at 110 ml/hour or whatever maintenance is.)

CBC, Chem 7 - all
Chem 12 - abdominal procedures
PT,PTT - all
Urinalysis - all
EKG - >40 or any risk factor
CXR - >40 or any risk factor
Type and Screen - procedure dependent

General Surgery Tests:

CBC, Chem 7 - all
Chem 12 - abdominal procedures
PT,PTT - all
Urinalysis - all
EKG - >40 or any risk factor
CXR - >40 or any risk factor
Type and Screen - procedure dependent

Cardiac Specific:
ABG
Formal or beside PFT
Preop weight on the chart
Type and Cross - 4-6 units

General Surgery Tests:
CBC, Chem 7 - all
Chem 12 - abdominal procedures
PT,PTT - all
Urinalysis - all
EKG - >40 or any risk factor
CXR - >40 or any risk factor
Type and Screen - procedure dependent

Need Craniotomy?:
Preop steroids
Preop anticonvulsants

Pituitary?:
GH, somatomedin, FSH, LH, TSH, ACTH, Cortisol, Prolactin, Testosterone