TIPS FOR YOUR ACTING INTERNSHIPS
Your Medicine acting internship is the closest experience you’ll have in
medical school to life as a resident.
Take this month seriously, because you will be counted on to be the
primary caregiver for the patients you cover.
Your residents will rely on you to put in all the orders on your
patients (your residents will have to co-sign them, of course), follow-up on
all test results, and possibly even call in most of the consults.
Cross-coverage is probably the toughest part about being an acting
intern, because we’ve all admitted patients as third year medical
students. However, when you’re on call,
you have to take care of patients you’ve never seen before and know virtually
nothing about, and this can be scary.
1. For each patient that you are checking out,
write the following:
a. A brief synopsis of the patient (61 yowf
with lung cancer, CHF, HTN, DM)
b. Pertinent medications
c. Antihypertensives – dosage, scheduling; do
you anticipate uncontrolled BPs, and if so, what should the person
cross-covering give?
d. Diabetic meds – make sure sliding scale
insulin is ordered if a patient has diabetes.
e. Antibiotics patient is on (and day #)
f.
Drips
(heparin, diltiazem, insulin, dopamine, etc.)
2. Things to watch out for
a. If a patient is getting transfused and they
need a Hct checked, make sure it is ordered by the person checking out to you
before they leave – this goes for electrolytes that have to be checked.
b. Pain control – does the patient have
something scheduled or what can they get?
c. Urine output – will the patient need a
diuretic ordered later that night?
3. Things that are inappropriate to checkout:
a. Having the cross-covering AI or intern
follow up a study and ordering tests based on those results.
b. Hemoccult/rectalizing a patient.
c. Calling in a consult on a patient.
4. Common things that you will get called about
(discuss everything with your resident first!)…
a. Sleep meds – usually a one time dose of Benadryl 25 mg or Trazodone 50 mg
will do the trick; adjust dosage for age.
You will probably be advised against giving something like Ambien.
b. Pain control – always dependent on the patient; if the
patient isn’t on narcotics, try Tylenol or an NSAID like Motrin or Naprosyn; if
the patient is on scheduled meds, you can probably give the medicine ahead of
schedule. Ask the patient what has
worked before and what hasn’t.
c. Chest pain – get an EKG, a set of vitals, and go see the patient. Be concerned if the patient has risk factors
for a coronary event. Let your resident
know – further management (cardiac enzymes, nitroglycerin or nitropaste,
aspirin, etc.) are all dependent on the patient.
d. Fever – get a set of vitals, give Tylenol, and see the patient to
find a source; see if the patient is on any antibiotics or has any recent
previous positive cultures. Unless you
have been told otherwise, get at least one set of blood cultures. Other tests (urine cultures, CXR, etc.) are
as always dependent on the physical exam.
e. High blood pressure – get a complete set of vitals; does the
patient complain of chest pain or shortness of breath, and is the patient on
any anti-hypertensives that can be given ahead of schedule? Clonidine 0.1 mg or an inch of nitropaste
are options – check with your resident first.
f.
The dreaded 4
am call about abnormal electrolytes – this is usually a call about hypokalemia,
in which case you can give KCl, remembering that 10 mEq will raise the
potassium level by 0.1 – it is general practice to not giive more than 40 mEq
at one time.
5.
If you do something
for a patient that is not your own, it is common courtesy to write it down on
the chart and let the AI or intern know what you did in the morning.