Plan: Cardiac enzymes, ECHO, Neuro consult, work up different etiologies, perfusion scan, CHF, empirical coverage antibiotics, Hyperthermia protocol. Tube feeding isotonic formula, multiple disease DDX. Sympathize with the family on DNR/advanced directive. Honor wishes of the family or the word of what the family says the pt wishes are when the patient is incoherent.
When we do our ID Rounds, I always tell relatives not to get anxious with so much medical jargons... this is pretty much obviously seen in one of the relatives' faces as the asst. physician was presenting the case.
The physician assistant was communicating / presenting the case to the team, not the family. Her language and use of medical terminology were appropriate. The HPI used common jargon, but the PEx naturally used medical terminology. I did not detect anxiety in the faces of the family. They were reassured when the RN manager spoke about DNR status that can be activated if the patient's prognosis is poor.
Long history of lung TB and Kidney TB, with nephrectomy patient, so this is important. Thanks family! Everyone has been in contact with no precautions.
The Respiratory Therapist was disappointingly shallow with his portion. With the given ABG the PaO2 was 146 (normal range 70-100) ; the current vent settings are clearly resulting in hyeroxygenation. The PEEP or Fio2 should be titrated down. Also, vent settings should always be brought up in rounds to demonstrate how the patient is doing from a pulmonary perspective (high settings = poor pulmonary health and vice versa). Also, are you doing breathing trials or weaning him to get him off the vent? Now I understand that this particular patient is critically Ill and DNR is being discussed, however if the purpose of this video is educational then it would be beneficial to cover more ground.
@Kevin Prima Irrelevant, useless comment. You really should ask yourself why you feel the need to try and point out over multiple comments that the PA in the video is not a doctor. Most people are aware that a PA is not a medical doctor. The whole point of the video is to demonstrate that very sick people require a multi-disciplinary team to provide the best care possible for the patient. I doubt you could give as concise of a report on the patient as did the PA in the video.
I never liked those "educationnal rounds' in teaching hospitals, most students are intimidated and acting like robots, plus most patients get confused, plus i don t believe it is teh best way to teach medecine, because teaching should be more personnalized, and finally, many students get humiliated in those rounds that becomes exam rounds rather then educationnal rounds... so yes i believe in a futur change in this educational paradigm of medecine...still i don t know how, maybe by the use of technology?
These rounds that include family are so impersonal, cold and interrogatory for families. There’s no way the lay family understands most of what was said during rounds.
That is an obviously narrow minded and shallow opinion. Nothing can be better than involving family members during rounds and plan of care. And nothing can be better in knowing that an entire team is involved in the very aspect of that patient’s care. This is how we do it here in the United States. We call it interdisciplinary plan of care. And just because you don’t see anyone smile or hug and touch family members, doesn’t mean, callousness. The patient is getting the best care possible.
@@RS-ig1zr I don't think the issue is involving the family. The issue is all the medical jargon. Not to speak for OP but that's my interpretation of their comment.
Are you dumb, this is how they do rounds. Every hospital does rounds so the healthcare team updates each other and it is also how they teach students and residents.
INTERNS MUST GO TO SOUTH KOREA TO LEARN . THERE ARE GOOD DOCTORS IN USA BUT, SOUTH KOREA HAVE OUTSTANDING DOCTORS AND MODERN HOSPITALS.. LOOK LIKE SCHOOL IN FRONT OF SICK PATIENT . TERRIBLE !
I never saw anything done like this ! This is wonderful .
This is great. It's literally impossible to find this kind of round in many hospitals.
Hey... where is the physical therapist?
Great!
Just one notice; post thyroidectomy & didn't hear a word about his compliance on Levothyroxine (Synthroid) or TFT!!
Plan: Cardiac enzymes, ECHO, Neuro consult, work up different etiologies, perfusion scan, CHF, empirical coverage antibiotics, Hyperthermia protocol. Tube feeding isotonic formula, multiple disease DDX. Sympathize with the family on DNR/advanced directive. Honor wishes of the family or the word of what the family says the pt wishes are when the patient is incoherent.
When we do our ID Rounds, I always tell relatives not to get anxious with so much medical jargons... this is pretty much obviously seen in one of the relatives' faces as the asst. physician was presenting the case.
Kevin Prima i don’t think it’s that big of a deal
great point! we don't want to scare them or cause them any more anxiety than they already have!
she wasnt an assistant physician, she was a physician assistant smh
The physician assistant was communicating / presenting the case to the team, not the family. Her language and use of medical terminology were appropriate. The HPI used common jargon, but the PEx naturally used medical terminology. I did not detect anxiety in the faces of the family. They were reassured when the RN manager spoke about DNR status that can be activated if the patient's prognosis is poor.
@@radicalbarrel2729 .cmn evvvdcvygtvtjttbgrb rcj vvvcbbcvmbfkcrnbb cebvc
These rounds are amazing!
Excellent presentation by the PA!!
@Kevin Prima What is your point?
Limit Bass Fishing 😂😂😂
@@limitbassfishing2733 you not playing with they asses, let them know to stop throwing unnecessary shade towards medical professionals
yes especially the uhms and ehms after every 5 words was really insightful
And the janitor?
In my country does not have same rounds in this video. But may rounds in school of medicine hospital. I live in Thailand.
Long history of lung TB and Kidney TB, with nephrectomy patient, so this is important. Thanks family! Everyone has been in contact with no precautions.
It was decades ago.. and not all TB needs special precautions, only active laryngeal TB with evidence of positive AFB stain from sputum.
@@alifaras693 Right. And if one was concerned about TB, one could always get a Quantiferon-TB blood test from their provider.
The Respiratory Therapist was disappointingly shallow with his portion. With the given ABG the PaO2 was 146 (normal range 70-100) ; the current vent settings are clearly resulting in hyeroxygenation. The PEEP or Fio2 should be titrated down. Also, vent settings should always be brought up in rounds to demonstrate how the patient is doing from a pulmonary perspective (high settings = poor pulmonary health and vice versa). Also, are you doing breathing trials or weaning him to get him off the vent? Now I understand that this particular patient is critically Ill and DNR is being discussed, however if the purpose of this video is educational then it would be beneficial to cover more ground.
Wow this is a very good point.
Well done! Good Rounding presentation.
Yes, this is how it should be done Thank You so much 🙏 3:16
At least they introduce themselves. In our state hospitals you are basically a nothing.
That PA is very sharp.
@Kevin Prima Irrelevant, useless comment. You really should ask yourself why you feel the need to try and point out over multiple comments that the PA in the video is not a doctor. Most people are aware that a PA is not a medical doctor. The whole point of the video is to demonstrate that very sick people require a multi-disciplinary team to provide the best care possible for the patient. I doubt you could give as concise of a report on the patient as did the PA in the video.
I never liked those "educationnal rounds' in teaching hospitals, most students are intimidated and acting like robots, plus most patients get confused, plus i don t believe it is teh best way to teach medecine, because teaching should be more personnalized, and finally, many students get humiliated in those rounds that becomes exam rounds rather then educationnal rounds... so yes i believe in a futur change in this educational paradigm of medecine...still i don t know how, maybe by the use of technology?
Point on
great ! It’s quite helpful
well presented
uhm no physiotherapist?
WHy is the PA presenting the patient and the residents are standing around doing nothing. Pneumonia, CHF and PE is that all you can think off?
Very good!
No precautions droplets were mentioned AFTER the family informed of TB status.
it has been long ago tb above one year doesn't have contageous effect and it shoud be either larygeal or pulmonary tb
hes in with a ?pneumonia so i dont think reactivated pulmonary TB is a crazy suggestion
Please can I get Help from the Team 5:50
In real life, this patient would take another 5-10 minutes. Things never go this smoothly
Wonderful round
pharmacist did great
Where is the chaplain?!
Richard Hoffman maybe they're atheists.
Thank You
These rounds that include family are so impersonal, cold and interrogatory for families. There’s no way the lay family understands most of what was said during rounds.
That is an obviously narrow minded and shallow opinion. Nothing can be better than involving family members during rounds and plan of care. And nothing can be better in knowing that an entire team is involved in the very aspect of that patient’s care. This is how we do it here in the United States. We call it interdisciplinary plan of care. And just because you don’t see anyone smile or hug and touch family members, doesn’t mean, callousness. The patient is getting the best care possible.
@@RS-ig1zr I don't think the issue is involving the family. The issue is all the medical jargon. Not to speak for OP but that's my interpretation of their comment.
@@mckaylamurphy126 arent they actors?
You always use medical terminology when on rounds. It has nothing to do with whether the family understands the terms used.
The family are essential element in the process of getting patient better
Excellent goob round
We neither one want a whole bunch of people in there with us. Have our own doctor come in and talk with us privately. Very uncomfortable to us.
Thanks 👨👩👧family
Ffs turn off the vent alarm!
WOW!!
Subjective information gathering from the family. Objective were presented first, maybe due to ER arrival.
That's useful reference for me to attend ICU rounds
They should be acting like they are talking to the patient as well, very robot like
PT OT ??
Mark Robbins what is Pt going to work out on your vented patient?
Nebur Nynhs they can do bedside therapy. Possible splints and or multipodous boots. Good suggestion mark Robbins.
@@neburnynhs9394 Read up "Physiotherapists role in ICU". Great suggetion mark robbins and RS!
turn off the vent alarm!!
DNAR. Do not attempt resuscitation.
Where’s the clerk? 😂😂
sweet
So rude someone playing a gameboy in the background.
👍
Impressive
Fudu a tuc thag
TALKING TOO MUCH IN FRONT OF PATIENT. UNDERSTAND INTERN NEEDS TO LEARN BUT, LOOKING BAD IN FRONT OF FAMILY AND PATIENT..
excellent
Ahhhh, the patient is not responsive and you can’t assess pain because he is hypothermic and PARALYZED! Jesus.
Ask yourself, when was the last time you felt pain when you were asleep? Not woken up by pain, but pain felt while resting?
Translate
Skip right over the social worker 🤦🏻♀️
obchud doktorze na glowe to wszyscy
Where's the emotion? They are so unhumanlike .. Robots
To deal with the situations they come in contact you must take your emotions out of it. You cant be an emotional trainwreck and caring for patients.
They're at work
Pneumonia PE, DDx...
These doctors sound so robotic
They sound so knowledgeable and caring to me. Differences of opinion but at the end of the day, that patient is getting the best possible care
Awesome presentation very knowledgeable they are trying to give the best care possible. Very impressive.
What a waste of time. This is what happens when MBAs control doctors and dictate how things should be done.
Are you dumb, this is how they do rounds. Every hospital does rounds so the healthcare team updates each other and it is also how they teach students and residents.
And that's another classic example of why mid level providers have no role inside the hospital.
Why do you say this?
3 years later and your comment is still ignorant as it was when you wrote it.
Um, um, um, um, um, I swear that is a spirit...of fear, uneducated/uncertain and anxiety,
It's a sign that someone is processing information. It's very normal for people to say um and uh when they are working and presenting
INTERNS MUST GO TO SOUTH KOREA TO LEARN . THERE ARE GOOD DOCTORS IN USA BUT, SOUTH KOREA HAVE OUTSTANDING DOCTORS AND MODERN HOSPITALS.. LOOK LIKE SCHOOL IN FRONT OF SICK PATIENT . TERRIBLE !
History taking not good
How would you improve?
Come to my clinic
@@ashishkatiyar4240 I don't visit sub par physicians