I'm no stranger to being awake for a 24-30 hour straight shift, but last night the sleepy delirium hit me in the middle of writing my admission note. During these wakeful-sleep moments, my brain tends to move from relevant thoughts to far off tangents. If my hands are on a computer keyboard when that happens...well, you'll see:
59 yo M with history of IPF admitted with dyspnea
1. Dyspnea - not likely IPF flare as able to wean very quickly. Would get an ICU overflow bed
- CT chest to evaluate nodule seen on CXR
- Sputum, blood cultures
- continue O2
- PRN albuterol-ipratropium
- continue prednisone/albuoterl as a guest speker
- would also like to add rifaximine.
2. Lower extremity swelling - inadequate dose of lasix vs hypotension. dkl;
- will give IV vanc at 116%
3. Cor Pulmonale - Will get RHC, orthostatics, and WBC count together day?
4. SIADH - stable, serial BMP
5. Compression fracture - will continue home medications for pain.
FEN/GI - Will give patient 3 g 5 CHO diet, low Na
Dispo - Hpatient iwth risk of rincreased infection to due low of be louie s
What is really scary is that I knew I was sleepy and was actually making "corrections" to my mistypes. I can only imagine what kind of plan I would have had if I hadn't edited it.
Needless to say, a fellow resident caught my note in the morning, and I rewrote the whole thing.