Slept 2 hours last night. Feel like a total zombie now; this is what we call the postcall syndrome. Kinda half jetlag, half drunk. Recently, the attention has shifted to resident work hours in the USA, after that article was published in the NEJM showing an inverse relationship between medical errors and the number of sleep the interns get (duh!). I remember thinking at 10am today after having been on duty for 27 hours; how can one expect to NOT make mistakes. I had trouble remembering my phone number, and I had to use a calculator to count someone's anion gap (a simple X - (Y+Z), something a kid could do in seconds). Anyway... it's obvious that we don't function as well with no or little sleep.

Varied patients last night:

• Non ST elevation MI's
• Patient's AICD firing due to intermittent runs of SVT (automated implantable cardioverter/defibrillator, something that costs more than my car. Clear mortality benefit in patients with ischemic cardiomyopathy and low EF)(MADITT trial)
• CHF with pulmonary edema
• Bilateral pulmonary embolism
• Symptomatic junctional bradycardia
• A-fib with RVR (rapid ventricular response)

I learned a few lessons too:

• Even if the intern is good and tells you the patient has a new left bundle branch block, look at the EKG yourself. I almost activated the cardiac cath team for a post-op patient with a non STEMI acute infarct. Until I realized the QRS was 102 milliseconds
• Orthopods can be dumb, or lazy. My medical colleagues did a PAME on one of their high-risk patients and suggested pre-op beta-blockade. They disregarded our recommendations. Patient infarcts post-op.