Clinical Orientation Manual - University of Kansas Medical Center

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Fluids: 500cc D5LR (list here the amount and type of fluids given during the procedure, eg. NS, blood, albumin, etc. You can find this by looking on the anesthesiology record or by asking the anesthesiologist or surgical nurse.) EBL: 50cc (This is the estimated blood loss during the procedure, as shown on the anesthesiologist’s record.) Tubes/Drains: NG to low intermittent sxn, JP drain in RUQ Specimens: Gall bladder sent to surgical pathology Complications: None Condition: To PACU in (good, fair, stable, poor, critical) condition *There is a good template in the EMR for both pre-operative and post-operative notes. They are generally very basic. Post-Op Orders: Medical students are currently unable to write orders in O 2, so you will probably not have the opportunity to write post-op orders if you are at KUMC for the entire Surgery rotation. The EMR at the VA does allow medical students to write orders that must be cosigned by a resident or attending, and you may have the opportunity to write orders if you are on a rural rotation. Some services still use paper forms for post-op pt instructions which you may be able to help fill out. Post-Op Orders 1) Procedure: (eg. S/P cholecystectomy) 2) Allergies: (eg. NKA ) 3) Disposition: (eg. Return to 5120 when stable, admit to ICU, etc.) 4) Vital Signs: (This determines how often vitals will be taken after the patient leaves the RR, eg. Vitals Q15 minx 8, Q30 min x4, Q4 hrs x 6, then Q shift.) 5) Diet: (eg. NPO, advance diet as tolerated, etc.) 6) Activity: (eg. Bedrest, bedrest c BRP, etc.) 7) Tubes/Drains: (eg. NG to low intermittent Gomco, foley to DD, etc) 8) Resp. Care: (eg.TC&DB Q2 hrs x 24 hrs, incentive spirometry, 02, etc.) 9) Meds: (eg. Reorder patient’s pre op meds if appropriate, Antibiotics, IV fluids, etc.) 10) Call HO if: (eg. Call HO for temp >38.5) Remarks: Residents and staff appreciate initiative. This means being an active seeker of knowledge. Recognize that the flow of information is from you to the intern, intern to the chief resident, and chief to the attendings. Do not say you have lecture when you do not. If you have broken scrub on a case to attend lecture, it is considerate to return to the OR after lecture to make sure the surgery has ended or you are excused to go home. Advice: On your first day, talk to your chief resident about what duties he/she expects you to perform. One of the keys to a good clinical performance evaluation is teamwork and helping things run smoothly for the residents. If you know you are going to scrub out of a case early for class, let it be known at the start of the case. Keep the patient list up-to-date – ask your resident about this on the first day as this is vital to rounding/chief resident. 38
Always have an up-to-date list copied for all team members when rounds begin. Be interested and helpful, but be genuine – Most attendings and chiefs can tell if you are not sincere. Know the anatomy of the procedure you’re about to perform – most pimping questions stem from anatomical structures encountered during the course of an operation. ************************************************************************ A note about resident work hours vs. medical student work hours: Legislation for residents: Interns are not allowed to work more than 16 hours in a row while 2 nd year residents and beyond are restricted to 30 hours; 80 hour work week maximum. This legislation does not apply to medical students. On most of your rotations, you will not come close to these hours, but there may be some exceptions with some call schedules, particularly surgery and OB. It is necessary to know that just because your resident is required to leave at a certain time, this does not apply to you. However, most rotations and physicians are sensitive to student hours. 39
Page 1 and 2: Kansas City _______________________
Page 3 and 4: UNIVERSITY OF KANSAS SCHOOL OF MEDI
Page 5 and 6: INTRODUCTION Welcome to your clinic
Page 7 and 8: LIST OF BOOKS As you will find, rea
Page 9 and 10: center. Take advantage of your expe
Page 11 and 12: Geriatrics Full overview: Course Di
Page 13 and 14: since the last geri clinic encounte
Page 15 and 16: Title of course: Internal Medicine
Page 17 and 18: Medicine notes are usually fairly l
Page 19 and 20: even 1300h depending on the attendi
Page 21 and 22: v. Extinction (light touch on symme
Page 23 and 24: ounds, but all students attend both
Page 25 and 26: Discharge Orders *Follow-up in ____
Page 27 and 28: Service Breakdown: Inpatient Peds:
Page 29 and 30: Shelf Prep: The peds Shelf is one o
Page 31 and 32: will not be assigned a resident or
Page 33 and 34: Title of course: Surgery Course Dir
Page 35 and 36: 2. Atlas of Surgical Operations: by
Page 37: another student and are typically n
Page 41 and 42: laboratory results. Many attendings
Page 43 and 44: ORDER WRITING Order writing refers
Page 45 and 46: 2. Follow-up Care: Include with who
Page 47 and 48: AV A-V A-VO2 BI&II BBB BE BKA BMR B
Page 49 and 50: I&D I&O ICU ID IDDM IHSS IM IMV IPP
Page 51 and 52: PUD PVC PVD PZI Q RA RAD RAE RAP RB
Page 53 and 54: A few abbreviations to avoid: Abbre
Page 55 and 56: On each rotation there are differen
Page 57: PDA/Smartphone Resources: 1. http:/

Clinical Orientation Manual - University of Kansas Medical Center

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