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Sorry, Doc. It doesn't work that way.
  #1  
Old 02-14-2012, 10:41 PM
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Default Sorry, Doc. It doesn't work that way.

A HIDA (gallbladder function test) order came down from the floor this morning. When we called the floor, we found out the patient had pain meds. Heavy-duty pain meds screw with the test and if you really want to know the technical reason, I'll gladly explain. So we'll just wait a few hours and do the scan in the afternoon.

A V/Q lung order came down. Same patient. Another call up to the floor to see which one they really wanted cuz we can't do both today. The tracers interfere with each other. The floor decided to do the V/Q first and see about the HIDA tomorrow afternoon if the V/Q tracer has washed out by then (I kinda doubt it will, but whatever).

A Gallium order came down. Yup. Same patient. Now I'm wondering if this doc got his degree from a Cracker Jack box (more likely it's multiple docs on the same floor who obviously don't read the chart). Yet another call up to the floor to see WTF is going on. If they want both, fine, but we can't do them at the same time. And because Gallium's half-life is 78 hrs (as opposed to the 6-hour half-life of the Technetium-based V/Q and HIDA stuff), we will HAVE to do the HIDA first.

Not only is the floor ordering every Nuc Med scan they can think of, but the patient has also had several regular X-rays and CT scans. I for one am really not comfortable exposing the patient to so much radiation in so short a time. Yes, she is really sick and they don't know why. But that much radiation can't be good for her.



Then there was another patient who had a stress test today and the floor ordered a V/Q. Again, folks, we can't do them the same day! Really, we're not trying to be difficult or duck out of doing our jobs; the tracers interfere with each other and we can't see lungs when the heart is lit up. Inevitably, there's a bowel loop sitting right under the heart and/or over a lung. And since the liver and bowel suck up so much of the excess tracers, we can't see through that until it washes out. And since this patient's had upwards of 45mCi of Cardiolite, that might take a couple days.
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  #2  
Old 02-15-2012, 12:46 AM
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And you can't send the notes back saying "Yalls did this test before, it won't work, patient is messed up. Please RTFM"
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Old 02-15-2012, 02:33 AM
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Even this HSD knows that a 6 hour half-life does not mean that you can run another test in 6 hours!
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Old 02-15-2012, 03:05 AM
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Given a VQ scan and a HIDA scan are evaluating totally different body systems I would want to know the following:

What are the ABGs like?
CBC?
Basic Metabolic Panel (specifically the Liver Functions?)

Because if the patient has a PE, they should be in a state of metabolic acidosis and have a pulse ox and O2 sat of crapola.

Gallbladder/liver, I would expect to see ALT/SGOT etc up the whazzoo.

It sounds to me like a med student who doesn't know his ass from a hole in the ground yet.
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Old 02-15-2012, 03:28 AM
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Quote:
Quoth Panacea View Post
pulse ox and O2 sat of crapola.

<snip>

ALT/SGOT etc up the whazzoo.
Those the technical terms?

Quote:
Quoth Panacea View Post
It sounds to me like a med student who doesn't know his ass from a hole in the ground yet.
You mean they're supposed to eventually figure out the difference?
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Last edited by jedimaster91; 02-15-2012 at 03:32 AM.

  #6  
Old 02-18-2012, 03:56 PM
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Quote:
Quoth jedimaster91 View Post
Those the technical terms?
Close enough. Labs that are part of the liver functions.

Quote:
Quoth jedimaster91 View Post
You mean they're supposed to eventually figure out the difference?
In theory. Most do. I know a few who need to go back to med school
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Old 02-19-2012, 10:26 PM
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Quote:
Quoth Panacea View Post
It sounds to me like a med student who doesn't know his ass from a hole in the ground yet.
Or as I've seen it in some places: "Burro vs. burrow - know the difference".

Quote:
Quoth Panacea View Post
In theory. Most do. I know a few who need to go back to med school
For those who not even a trip back to med school would help, please don't recommend truck school as an alternative. There are already too many "steering wheel holders" in the industry, and that's what those "stethescope holders" would turn into.

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Old 02-19-2012, 11:07 PM
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Sheltered workshop?
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3. Deal with the situation you have now, however it occurred.
4. Accept the consequences of your decisions.

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Old 02-19-2012, 11:19 PM
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Quote:
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Sheltered workshop?
Here we slaved to put you through med school and you're a passenger on the short bus?!?!

We told you and told you not to let them find out!
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  #10  
Old 02-20-2012, 11:06 PM
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Quote:
Quoth Panacea View Post
Close enough. Labs that are part of the liver functions.
I was talking about "crapola" and "wazoo."
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