GREAT RESOURCES FOR RESIDENCY
INTERN SURVIVAL GUIDE
Download print version here.
INDEX
Hypothermia
Hyperthermia/fever
Hypertension
Hypotension
Bradycardia
Tachycardia
Hypoxia/tachypnea
GENERAL SURVIVAL TIPS
General advise/rules
When in doubt, go to the bedside.
If you get a call from a nurse more than twice about the same thing, go to the bedside.
If the nurse tells you to come to bedside, you should go.
Other reasons to go to bedside: CP, SOB, change in mental status, patient fell, hemodynamic/respiratory instability or anything that worries you.
ALWAYS call your senior resident about changes in patient conditions.
Even if you know what you are doing, seniors need to know
If someone changes status to intermediate/ICU/dies, always let your attending know.
Learn which patients are sick vs. not sick.
One of the most important lessons you can learn from your intern year is knowing who is sick vs. not sick. ALWAYS see the sick patients.
If you’re busy with another sick patient, ask your senior for help.
Listen to the nurses when they have concerns.
Remember that the nurses are with the patients for longer periods of time than we are. If they’re calling you worried about a change in status, take it seriously and go and see the patient.
Always have your own working diagnosis with a differential and a plan.
Never hang your hat on the ED diagnosis. They make the initial assessment of whether the patient is sick enough to be admitted – your job is to figure out why the patient is sick.
Document, document, document! Document all patient encounters.
If it’s not documented, it NEVER happened.
Date and time it. Document why you were called to the bedside, what you saw, your physical exam (including vital signs), pertinent labs/imaging/procedures. In your assessment and plan, document your thought process, differential, and outline your plan.
BE NICE!
The entire care team (nurses, social workers, case managers) is working hard to help the patient, so make sure you acknowledge their efforts
Even if you get woken up at 4am to tell you that someone’s potassium is 3.7, simply reply with, “Thank you.”
Answer pages as soon as you get them.
Keep the sign-out updated DAILY.
You’ll succeed (or fail) as a team if you work as a team
Help out your fellow intern.
EVERY PATIENT ON THE TEAM IS YOUR PATIENT.
Stay organized!
Develop a system to make sure you complete all tasks
Be mindful of time.
Each admission should take about 60-90 min including seeing the patient (30-45 min), staffing with the senior (10-15 min), putting in the orders (5-10 min), documenting (15 min) and adding the patient to the sign-out sheet (3 min)
This is a rough estimate- cases may be easier or more complex.
Stay hydrated.
Don’t forget to eat.
There are saltines, graham crackers, peanut butter, and coffee at the nutrition stations on each floor
You can take a shower if you want. There are showers in most call rooms
Remember to have FUN. Laugh once in a while! We have the best job in the world.
Phone Numbers
- Phone numbers within UAB are 5 digits (x-xxxx)
The full stems of those numbers are:
934-xxxx à 4-xxxx
975-xxxx à 5-xxxx
996-xxxx à 6-xxxx
801-xxxx à 1-xxxx (Kirklin clinic)
Operator 0 or 4-3411
IT Help Desk 4-8888
MICU 4-3399
Tinsley (S9) 4-6050, 4-2302
- Phone numbers within the VA have 4 digits (xxxx)
To call the VA from UAB:
Add 12-xxxx before the 4-digit extension
Call the VA operator at 933-8101, press 1, then dial the 4-digit extension
Food
North Pavilion Cafeteria: 2nd floor, North Pavilion
7d a week, 6am-7:30pm
Au Bon Pan: 2nd floor, North Pavilion
Mon – Fri 6am-12am
Sat – Sun 6am-10pm
Starbucks: 2nd floor, North Pavilion
Mon – Fri 5am-11pm
Sat – Sun 6am-8pm
Subway: 2nd floor, Jefferson Tower
GiGi’s Coffee Kiosk: 1st floor, West Pavilion
Mon – Fri 6am-2pm
Children’s Hospital (24 hrs)
Resident Lounge: BDB 302
Open 24/7
Refrigerator with drinks, occasional snacks
VA lounge: 3rd floor
DISCHARGE SUMMARIES
At UAB: Complete the PowerNote entitled “Discharge Summary”
At VA: Discharge summaries are dictated over the phone. You will be given a card with instructions on what number to call and how to dictate. Please use the following format as your guide:
This is _____ dictating a discharge summary for patient ______.Last 4 (of their social security number) are ____.
Attending physician:
Primary Diagnosis: Condition(s) primarily responsible for admission – BE SPECIFIC.
Secondary diagnoses: All other conditions addressed during current hospitalization – DO NOT LIST THE ENTIRE PMH.
Procedures/Imaging/Micro: SUMMARY STATEMENT of invasive &/or diagnostic procedures that changed or affected management & the result – including any positive microbiology data.
Consultation: List all pertinent consulting services and a brief reason for consultation.
HPI: An abbreviated HPI based on your knowledge of the patient and their hospital course (Typically 1-2 sentences – DO NOT RE-LIST PMH IN THE HPI).
PMH/PSH; FH/SH; Allergies: List (self explanatory).
Medications on admission: List Home Meds & Transfer Meds
ROS: Omit from discharge summary
Physical exam: Dictate vitals; otherwise, only include pertinent admission exam findings
Labs: ALL PERTINENT LABS relating to Primary & Secondary Dx. Not just admission labs, make note of particular sendout tests, etc as it relates to care. Can be summary (Ex: BMP unremarkable, CBC significant for normocytic anemia w/ hct 33%).
Hospital course: Brief problem-based summary that only addresses significant diagnoses (No need to fully explain the rationale behind every treatment decision).
Discharge Condition / Disposition: Name of where patient was discharged (Specific nursing home; rehab facility, home, home health, hospice, etc)
Discharge Instructions: List specific diet, activity level, special instructions (Home O2, Home IV Abx, PICC line, indwelling foley, PT, etc), pending tests at discharge, restrictions, etc.
Discharge medications: The complete list of medications patient is discharged on WITH DURATION OF ANTIBIOTICS & note all changes made to medications (Do not just say “Continue home meds with the following exceptions...” Dictate the entire list.)
Follow-up: Detail follow up dates, Recommendations for the Primary MD following D/C, etc. (Include tests & pending labs and instructions given to patient). CC a copy of the discharge summary to the primary care or referring physician.
Specify who to CC:
CALLING CONSULTS
Before calling the consult:
Know the patient.
Have the name, MRN, room number available
Understanding their clinical condition
Know what your question is.Example: Rather than just knowing you need to call Cardiology, know specifically what question you need the Cardiology team to answer.
Calling the consult:
Introduce yourself: name, rank (PGY-1), and what service you are calling from
Patient name and MRN
It’s often nice to text page them this information up front when you call the consult initially
Give a short, ONE sentence summary of the patient including relevant background and reason for admission
Ex: 68 year old female with multiple cardiovascular risk factors, and no known CAD admitted for chest pain
Tell the consultant your question.
This is the most important part of the consult!Have a clearly defined question that you want the consultant to answer
Summarize any relevant data that has been collected or any interventions that have been performed (labs, imaging, medications, etc)
Communicate the acuity of the consult - Is this someone they have to see RIGHT NOW?
Give them a person to contact with recs (which is typically YOU!)
Tips about what makes a great consult
Be concise
Call before noon. You can call a consult at any time, but your consultants will be much kinder if you call them as soon as possible
Have a clear question for your consultant that they can answer
PRONOUNCING DEATH
Respectfully ask the family in the room if you may perform an exam
Exam:
Listen for heart sounds in all four quadrant
Feel for carotid pulses
Listen for breath sounds anteriorly and assess for any signs of breathing
Assess for pupillary response
Pronounce of time of death (communicate to nurses for documentation)
You (not nurses) must ask the next of kin:
If the patient is an organ donor
If the family would like an autopsy
Complete necessary documentation
At UAB:
Search “Death Note” under the Encounter Pathway tab
It is important that you accurately complete the following:
Attending of record (that will sign the death certificate)
Date and time of death
Cause of death and timing. Do not include physiologic descriptions such as brain death, asystole, cardiac arrest, respiratory failure. Instead, include a description of the disease process believed to be the primary cause (such as myocardial infarction, septic shock, pneumonia).
Manner/Autopsy
Search “Death Summary” under the Encounter Pathway tab
This effectively serves as your discharge summary
At the VA:
Search “Death Note” and complete the template
You must also dictate a brief discharge summary
VITAL SIGNS PROBLEMS
Hypothermia (Temp < 95)
Rectal temps are the most accurate, when in doubt obtain one
Sepsis - check for hypotension, tachycardia, RR and treat accordingly
If otherwise hemodynamically stable, order a warming blanket
Hyperthermia/Fever (Temp >100.4)
Check their vitals! Make sure BP and HR are stable.
New fever:
Go see the patient! Perform an exam looking for a possible source
General workup for source includes blood cultures x2, urinalysis, CXR
If you can ascertain the source, initiate empiric antibiotic coverage
Recurrent fever:
Consider if you need additional blood cultures or other studies to find the source
If they are already on antimicrobials, consider expansion of coverage
Fever on cross-cover:
Look at the checkout! Did the team give you any instructions?
If not, proceed as outlined above
Hypertension
What not to miss: hypertensive emergency!
Noted by end organ damage – MS changes, papilledema, angina (MI), pulm edema, renal insufficiency. If present, pt will need ICU transfer for management.
If patient is asymptomatic, can treat conservatively. Options include:
Give an additional dose of a scheduled medication
Start an additional PO agent
If you want the BP to go down more quickly:
Nitropaste 1 or 2 inches applied to chest wall PRN
Clonidine 0.1 mg PO PRN
IV Meds: Hydralazine 10 mg IV, Labetalol 10 mg IV
Hypotension (MAP <65, systolic BP < 90)
What not to miss: septic shock, acute GI bleed, pulmonary embolism, arrhythmia, cardiogenic shock, anaphylaxis
Over the phone: obtain vitals, 02 sat, consider EKG
Almost always bedside exam
Consider checking BP manually (large cuff can be inaccurate)
Assess for signs of end-organ hypoperfusion (altered MS, cool extremities, etc)
Review the chart, order diagnostic studies
Check labs for signs of end-organ hypoperfusion (UOP < 30 cc/hr, lactic acidosis, etc)
Explore your differential – Are they bleeding? Are they infected? Order the appropriate tests to work up your differential.
If truly hypotensive, consider a bolus of NS (sodium chloride 0.9%)
However, if pt has CHF, ESRD or ARF, try 500cc boluses initially and watch for fluid overload (if not hypoxic, tachypneic, and lungs are clear, fluids will likely not hurt – and if profoundly hypotensive fluids are your only option on the floor.
REMEMBER: If BP does not immediately stabilize, escalate care (call your upper level, call a MET, etc)
Bradycardia
Step 1: Get the patient’s other vital signs
Compare to previous heart rates
If they are unstable, escalate care
Step 2: Get an EKG
** If you’re unsure about the EKG, don’t be afraid to page the Cardiology fellow. If the patient is stable, you can also go by the CCU workroom.
Step 3: Look at their med list and make sure there aren’t any meds that could be slowing their heart rate (beta blockers, calcium channel blockers)
Tachycardia
Step 1: Get the patient’s other vital signs
If they are unstable, escalate care
Step 2: Get an EKG
** If you’re unsure about the EKG, don’t be afraid to page the Cardiology fellow. If the patient is stable, you can also go by the CCU workroom.
AFib with RVR
Is the Afib new? If so, why? (MI, PE, Infection, volume, drugs)
Stable vs unstable? – If unstable, consider MICU or stepdown for cardioversion
Meds (call resident before giving any)
Metoprolol 5mg IV push q 5 min x 3 dose
Good in CAD, be careful in CHF
Push while on monitor/ EKG
Diltiazem (0.25 mg/kg) ~ 15mg IV push
Good in COPD where you won’t want BB, don’t use with bad EF
Amiodarone 150mg over 10min (1mg/min)
Best for patients that are hypotensive
Digoxin 0.25mg q 2 hrs up to 1.5mg
Good if CHF or hypotensive, bad in renal failure
Whichever med breaks the RVR, continue that po or drip if needed (most drips have to be given in the step down or ICU)
Sinus Tachycardia:
Treat underlying cause (sepsis, PTE, volume depletion, thyrotoxicosis, etc)
Do not slow down with rate controlling agent listed above because the tachycardia is compensating for something else
PSVT:
Valsalva maneuvers, carotid massage
Adenosine (6mg, 12mg, 12mg) – have an upper level present, pacing pads intact (code cart in room), and a rhythm strip recording the event
VTach/VFib: Escalate care!
Hypoxia/Tachypnea:
Step 1: Ask for vitals and oxygen saturation over the phone
Step 2: Go to the bedside (almost always required)
If patient in distress, escalate care (call your upper level, call a MET, etc)
Step 3: Workup
Pt is hypoxic (sats <90%): Obtain CXR and probably ABG, start O2 as appropriate
Amount of O2 (from lowest to highest): Nasal cannula up to 6L à then 40-60% open face mask à then 100%NRB à BiPAP/intubation
Pt is wheezing: Give albuterol/ipratropium nebs (usually 2 back-to-back then q4h and PRN) and consider PO or IV steroids
Pt is volume overloaded:
Acute pulmonary edema (LMNOP) à Lasix, nitrates (SL NTG 0.4mg or NTG paste 1inch, if BP okay), 02, position (sit upright)
Furosemide dosing à 1mg IV = 2mg PO. Give IV dose, reassess UOP in 1 hr, if < about 750mL UOP, double dose given.
**Don’t forget metabolic acidosis and/or sepsis as an etiology of tachypnea
ELECTROLYTE PROBLEMS
Hypokalemia
General rule: Give 10 mEq for every 0.1 the level is below 4
Exception: Patients with abnormal renal function!
PO replacement is preferable (IV is painful for the patient)
Immediate release: Liquid, tastes gross but works quickly
Sustained release: Tablet, no taste but works slowly
Always order Mg and replete if low
Always recheck K after repletion (max 80mg given before recheck)
Hyperkalemia
Use the hyperkalemia PowerPlan as your guide!
Get an EKG. If changes noted (PR prolongation, P wave loss, T wave peaking, wide QRS, sine wave) or K is > 8 à give 1 amp of calcium gluconate stat & call upper level
How to get rid of K
Temporizing measures to shift K intracellularly
10U reg insulin IV + 1 amp D50
Albuterol nebs
Measures to increase K excretion
Kayexalate (30-45gm PO/PR)
Furosemide (can give with normal saline if you’re worried they’re too dry)
Dialysis
Hypocalcemia
Don’t forget to correct for albumin. Check ionized calcium to ensure accuracy.
Usually not an urgent problem
If acute drop to <7.5, or symptoms (paresthesias, tetany, prolonged QT) à 4g (1 amp=1 g) calcium gluconate in 100 mL NS/D5W over 2h
Hypercalcemia
Fluids, fluids, fluids (NS). If this does not result in adequate diuresis, furosemide 20-40mg IV can be given only after adequate volume expansion
Pamidronate or Zometa are often used to tx hypercalcemia in cancer pts. Discuss this with your upper level or fellow before starting.
Hypomagnesemia
Level 1.5 – 2:
Cardiac (more emergent) patient: Given 1-2g IV
Non-cardiac patient: PO 400-800mg MgOxide BID-TID (causes diarrhea)
Level 1.1 – 1.5: Give 2g IV
Level <1.1: Give 4g IV
Hypophosphatemia
Level 2.3 – 3: Give 0.16 mmol/kg
Level 1.5 - 2.3: Give 0.32 mmol/kg
Level < 1.5: Give 0.64 mmol/kg
*Be aware of the other electrolytes included along with the phosphorous
PO option: Neutra-phos (potassium phosphate) 1-2 packets QID
Contains 8mmol phos and 14.2 mEq potassium
IV options:
Sodium phosphate: Contains 4 mEq Na for every 3 mmol pho
Potassium phosphate: Contains 4.4 mEq K for every 3 mmol phos
COMMON COMPLAINTS / NURSE CALLS
Decreased urine output (oliguria)
Oliguria = < 30cc/hr UOP or <0.5mL/kg/hr
In middle of night, get other vitals, and r/o obstruction (in/out catheter, flush foley, bladder scan)
If pt is volume contracted (if unsure can check weight and/or orthostatics) à IVF’s as appropriate.
Altered mental status / Agitation
Consider possible etiologies: hypercapnea, hypoglycemia, sepsis, psychosis, DTs/withdrawal states, delirium
Sundowning is common and responds best to reorienting the pt. Sedatives often worsen confusion in the elderly. Look for meds that may be contributing to the delirium and stop them (Benadryl, Benzos, anticholinergics, etc)
Assess vitals and labs to make sure agitation is not a sign of underlying pathology
What to do:
Avoid medications and physical restraints if at all possible
Create a soothing environment – turn lights off, put the patient in bed
Move the patient to a room close to the nurses station so they can be watched more closely
Can try to get a sitter, but rarely able to unless the pt is suicidal
If necessary, can try medication
Atypical antipsychotics (Seroquel, Risperdal) if pt can take PO (watch QTc)
Low dose Ativan (0.5mg – 2mg PO/IM/IV)
Low dose haloperidol (0.5 - 5mg PO/IM)
Do everything you can to avoid using restraints, as this will often make the patient more agitated
Chest pain
Ask for vitals with oxygen saturation over the phone
Go examine the patient
Consider the seven deadly causes of CP: MI, tension pneumothorax, PTE, Boerhaave’s, dissecting aortic aneurysm, pericarditis with tamponade, and pneumonia
If the history is worrisome for ACS (substernal, radiating to the arm or neck, nausea, vomiting, etc):
Obtain EKG. Compare with an old EKG. If you see acute changes, call your upper level
Cardiac markers do not need to be ordered on all CP pts, but are appropriate if a cardiac cause seems possible (and don’t forget to follow them up if you order them!)
If pain seems musculoskeletal (reproducible by pressing, localized) try pain meds as discussed later.
If pain seems GI-related, try Maalox 30 mL PO or a GI Cocktail (viscous lidocaine, Donnatol, Maalox). Elevate head of bed.
GI bleeds
Upper GI (variceal, ulcer) vs Lower GI (diverticular, AVM, colonic)
Obtain vitals over the phone
Go see the patient and look at the bowel movement yourself (don’t trust nursing to describe it to you)
If patient is unstable, alert your upper level
While waiting for them:
Ensure that 2 large bore peripheral IV’s are in place.
Order stat CBC, PT/PTT, type and screen
If pt is hypotensive, start fluid boluses (NS)
Nausea/Vomiting
Look for underlying cause (obstruction? GI illness?). If cause is unknown, treat symptoms and ensure proper hydration.
Meds:
Ondansetron (Zofran) 4-8mg IV/PO/SL (usually first line, beware of QT)
Promethazine (Phenergan) 12.5mg, 25mg PO/PR or IM (also beware of QT)
Metoclopramide (Reglan) 10 mg PO/IV if you think the patient has poor gastric motility (also beware of QT)
Lorazepam if you think nausea is related to anxiety
Constipation
Things to consider:
If you don’t know the pt well, it is often better to avoid aggressive PO meds
If you suspect obstruction, obtain KUB
If you suspect impaction, order a fleets or tap water enema before giving anything PO
The patient can usually tell you what they need/want, so ask!
Consider the following
Stool softener (gentler approach, can be given daily without risk of dependence)
Colace 100mg BID
Stimulants (stronger)
Bisacodyl 10mg PO/PR
Other laxatives:
Milk of magnesia 30cc q8h
Magnesium citrate
Lactulose 30cc q4h
Diarrhea
Usually not a problem that requires emergent intervention. Make sure that the patient is not dehydrated.
If having multiple, watery bowel movements, consider checking a Cdiff toxin. Only check it is the stool is truly watery and they’re having at least 3-4 bowel movements
NO loperamide if there is any chance the patient has Cdiff!
Cough
Try to identify the etiology and make sure hemoptysis is not present
CXR usually appropriate
Treat symptomatically:
Guaifenesin/Dextromethorphan (Robitussin DM) 10mL PO Q4h PRN. Can also use formulations with Codeine
Tessalon Perles 100-200mg PO TID
Insomnia
Trazodone 25-50 mg PO
Benadryl 25 mg PO – ONLY in young patients with no contraindications
AVOID zolpidem
PAIN
Mild Pain (use these first)
Acetaminophen 650mg Q4-6h PRN
Ibuprofen 400-800mg Q6-8h PRN (not in renal failure, acute ACS, GIB, etc)
Gabapentin (neuropathic pain) Start 300mg PO TID
Moderate Pain
Norco (Hydrocodone/Acetaminophen) 1-2 tabs Q4-6h PRN
Tramadol 50-100mg PO Q4-6h PRN
Ketorolac 30-60mg IV/IM x 1
Severe Pain (try to avoid as cross cover if patient is not already on it)
First step: PO, short acting:
Oxycodone
Second step: PO long acting
OxycontinSustained release morphine
Fentanyl Patch
Last resort: IV breakthrough
Morphine
Dilaudid (1mg dilaudid ≈ 7mg morphine)
** Watch for respiratory depression and use naloxone (0.4-2mg SC/IV) if necessary
BLOOD PRODUCTS
Transfusions
Packed red blood cells (pRBCs)
1 unit pRBC increases hemoglobin by 1g/dL
Parameters: Generally transfuse if Hct < 21
Only transfuse 1 unit at a time, then recheck H/H (unless having large volume blood loss)
Large volume transfusions require adding platelets/FFP
1 unit platelets increases platelet count by 30x109/L
Parameters: Transfuse if <10K or if <50K in a bleeding patient
Transfuse if <100 for CNS bleeding
Transfuse if <50 for elective LP, <20 for emergent LP (if suspect meningitis)
Transfuse if <10 for CVL placement
Blood product modifications
Leukoreduced: Remove WBCs à standard at UAB
Use: Prevent alloimmunization (chronically transfused patients, potential transplant recipients, h/o febrile nonhemolytic transfusion reactions)
Irradiated: Causes DNA crosslinks which prevent lymphocyte replication
Use: Prevent transfusion-associated graft vs. host disease (used in patients that might get an allotransplant or those on fludarabine)
Washed: Remove plasma/supernatant
Use: Prevent allergic reactions (IgA deficiency, h/o severe reactions)
CMV negative à standard at UAB
Use: Prevent CMV transmission (pregnant women, transplant candidates/recipients, SCID, HIV)
Premedications (for those with a history of reaction)
Diphenhydramine 25-50mg IV
Acetaminophen 650mg PO
Hydrocortisone 50mg IV (for severe reaction or reaction despite acetaminophen and diphenhydramine)
Meperidine 25-50mg IV (optional, for chills)
Transfusion reactions
Acute febrile non-hemolytic transfusion reaction à presents with fever, need to stop the transfusion and assess possibility of hemolytic reaction.
Hemolytic Reaction à fever, chills, flank pain, hypotension/anaphylaxis. If suspect…
Stop transfusion à start IVF à notify upper level à call blood bank à order Transfusion Reaction power plan
Hypoxemia/dyspnea à consider TRALI (usually 1-6hrs after transfusion) v. volume overload.
Treat volume overload with furosemide, TRALI needs supportive care
Blood bank is very helpful and if you suspect a transfusion reaction you can call through operator. – Can call 24 hours a day
Other blood products
Fresh frozen plasma (FFP) = plasma removed from 1u of blood
Contains all coagulation factors (no RBCs, WBCs, or platelets)
Indication: See chart below
Cryoprecipitate (“cryo”)
Contains 100u factor VIII and vWF, 150-250mg fibrinogen, some factor XIII, and fibronectin
Indications:
Fibrinogen replacement (DIC): 10u cryo increases fibrinogen 60-70mg/dL in 155lb adult
Hemophilia A (factor VIII deficiency), von Willebrand dz
Parameters: For DIC, maintain fibrinogen > 100
PEARLS
If you are called by the nursing staff regarding a pt “who needs a central line because IV access cannot be obtained”, the appropriate response is to politely ask the nurses to keep trying for peripheral access. If access is still an issue, go evaluate the pt for a possible External Jugular line, US guided PIV or attempt peripheral access yourself. PICC lines are also now available at night. It is appropriate to place a central line on the floor if necessary, but these situations are seldom. Of course, if the pt is unstable, skip the above steps and put in a central line.
On your admission orders, try to provide necessary PRN medications if appropriate (ie Tylenol, bowel regimen, pain meds, etc). This will make a HUGE difference in the number of calls your colleagues will field during the night.
A little bit about cross cover:
Minimize what tasks you sign out as much as possible
Update checkout EVERY DAY
Always verbally sign out your pts, in addition to a print out
Give a recommended course of action for potential problems you anticipate
Example: For fever, broaden to vancomycin and pip/tazo
Example: If called about pain, ok to give 2mg IV morphine x1
Always make the on-call team aware of potentially unstable pts
DO NOT leave an unstable pt to the on-call team if at all possible
If called to discuss pt with family, it is appropriate to refer the family’s main questions to the primary team – however, it is often very helpful to obtain contact information for the team. Issues of immediate concern should be addressed with family as appropriate.
Your job as the cross cover intern is to keep the take care of patients overnight and help the primary team in their management of their pt. It is unlikely that you will solve all the pt’s chronic medical conditions or even presenting complaints during the middle of the night. Do what needs to be done for the pt and then let the primary team do their job of treating/managing.