Think Before You Consult

Another favorite. So in the hospital, we neurologists are frequently consulted by other doctors to see patients who are having difficulty getting off the ventilator. For example, if they have ruled out a lung process, they may call us to evaluate for a neurologic problem that is causing the patient to stay on the ventilator. A few months ago, I was called by the trauma team for just such a case, and in reviewing the patient's medications in the computer system, I found something interesting and took a picture of the listing:

For the non-medical, 'vecuronium bromide' is a powerful paralytic agent that is often used in anesthesia. Thus receiving this medication would render the patient completely paralyzed and thereby making it pretty difficult for the patient to breathe on his own. 'PRN' is the medical word for as needed, so yes, that is a standing order for the patient to be paralyzed again as soon as he tries to move. The upside I guess is that I was able to tell them why their patient could not get off the ventilator without having to even see the patient.