Competence: Does not automatically come with doctors

The other day we went to a clinic for nausea and vomiting. We noticed some preloads on the counter in the exam room. Epi and Atropine preloads.

“That’s odd.”

“He was hypotensive. I gave him Atropine and Epi sub-Q.” The physician said, matter-of-factly, and pointed at the patient’s left deltoid.

“What???”

And this guy had a functioning non-demand pacemaker to go along with his zipper.

Some months ago, we went to a different clinic for a patient who had an “allergic reaction to iron” during her iron infusion. Iron is supposedly an essential nutrient.

“We gave her 3 Epi-pens.”

“What??? Over how long?”

“In 7 minutes.”

Three Epi-pens in seven minutes??? Why???”

“She said her throat felt funny. We were worried about an allergic reaction.”

The patient looked fine, other than the sustained 140 beats per minute. Worse, she’s a nurse. I wonder what kind of nurse would allow anyone to administer an Epi-pen to him or her under these circumstances, let alone three.

“Did you even break out in hives or feel short of breath or something?”

“Not really. I was just anxious. I’m still very anxious.”

“Umm… you think? You do know that a bunch of Epi is not good for you, right?”

“I guess…”

Even worse, when we got to the ED, one physician actually said, “You can keep giving people Epi without a problem.” He was not referring to dead people.

“What???”

Am I in the Bizarro World?

3 thoughts on “Competence: Does not automatically come with doctors”

  1. Yep, 0.3mg IM epi times three is not really going to bring the house down . . . but poor form, all the same.

    Important to realize that what you do is emergency medicine . . . it’s specialized. Leaving aside critical care docs and trauma surgeons, most other docs don’t really deal with emergencies much and aren’t very good at ’em — just like adult docs aren’t great wish kids and non-derm people aren’t great with rashes. Most aren’t stupid, just inexperienced in our field.

    I remember a case in residency when I responded to a code on the floor for a sweating, altered patient with a glucose of 15. Amp of D50, naturally. So the nurse asks me if I want half an amp. I say no, if a glucose of 15 doesn’t get you the full amp, nothing will.

    Of course the endocrinology fellow at the bedside who had ordered the half-an-amp prior to my arrival gave me a funny look. But that’s life. He knows many things about endocrinology I will never know. Everybody looks dumb outside their comfort zone.

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