NOTE THAT AS OF JULY 1, 2018 THERE WILL BE NO MANDATORY RESIDENT VIR CALL!
Time: 1 week starting at 8 am Monday through 8 am the next Monday*For rotation specific information, click here. MOUNT SINAI ATTENDING SCHEDULE/INFO: FELLOW SCHEDULE: FORWARD PAGER - Start forwarding the pager at 8 am on Monday
- During the daytime hours, you can cancel forwarding to avoid being bothered on your rotation or you can return all pages and tell them to call the department
- Pagers:
- SL VIR: 31118
- RH VIR: 36481
- BI VIR: 13215
- Forward pages to yourself
- 212-523-2828 > press 2 to change status > pager number > 5 to forward ("covered by") > new number > 2 to confirm
- Confirm through miTeam paging system
- Cancel forward and make available
- 212-523-2828 > press 2 to change status > pager number > 4 to "refer to another number" > new number (IR dept: 23-4446 or 23-7257) > 2 to confirm
- You can make the pagers status to "available," which will allow the fellows to receive pages (VIR fellows are paged copied to all VIR pagers)
IMPORTANT NUMBERS- IR Dept
- SL IR: 212-523-4446
- RH IR: 212-523-7257
- BI IR: 212-420-3883 (BI control room 20-2002 and 20-2231)
- Operator
- Page Operator: 05 / 212-523-2828
- Operator: 00 / 212-523-5678
ANSWER PAGES & GET INFORMATION
- Answer the pages and take information regarding the case
- Use the IR CONSULT FORM
- Look up info in Prism/EPIC/EMSTAT/PACS when possible
- What to expect?
- 70% PICC problems
- 10% non-emergent consults
- 10% emergent cases
- 10% scheduling (i.e. getting called at 6am for "Can you make sure my patient is first on the schedule today?"
- Appropriate response: “I have no control over the daytime schedule, call the dept at 8 am.”
HOW TO ARRANGE A CASE
- Fellow
- Introduce yourself to the fellow on the first day and ask how best to contact them.
- If there is a possible case, call the fellow first!
- Attending
- Technologist
- There is a technologist covering each site
- Call the RH VIR Dept on Monday (23-7257), ask for the tech on call for RH, and ask them the best way to contact them
- If there is a case at RH, call ahead so the tech has time to get there
- The CT tech overnight at SL is IR certified and you should call them at 23-5383 (CT scanner) or main desk (23-4272) before to tell them there will be a case
- Tech schedule
- Nursing (covering both sites)
- Nursing office number: 212-523-3240 or 212-523-3237; pager 6927
- On the weekend days, tell the radiology supervisor to contact the nurse on call (its a radiology nurse who comes from home)
- Evenings and nights, call the hospital operator for the nursing supervisor (SL or RH)
- Typically they pull a nurse from the ER or ICU which is where the patient usually comes from anyway so I found it easiest to just talk to the nurse taking care of the patient (when you go to see/consent the patient) and ask them if the nurse is available to go with you for the case
- Tell the nurse about sedation meds (you may have to get them yourself from the Pharmacy prior to the case)
- Anesthesia
- For intubated/unstable patients, especially for pulmonary and GI bleeds, anesthesia will have to be part of the case and needs to be called
- They should be called early as they sometimes take a while (eg. A-line, etc)
- Radiation goggles (DO NOT REMOVE OR TAKE OFF SITE)
- There are 2 pairs at each site: one regular and one for wear over glasses
- RH: resident lounge locker (23 / 37 / 31)
- SL: 70 (19 / 21 / 39) click here for location
- Each is in a case, with a cloth and wiping spray
- Please keep them clean and put them back LOCKED UP before you leave for the day (each pair is $$$)
PICCS/MILDLINES - The most common call situation is difficulty removing a PICC
- The primary team will often try to unsuccessfully remove a tunneled PICC right before discharge
- Go see the patient just to make sure it is not an easy fix like they forgot to remove the sutures or they are just too gentle
- If unable to remove it, just tell them it has to be removed with local anesthesia with some blunt dissection if necessary
- The patient has to stay till morning (or till Monday if its the weekend)
- If that does not satisfy them, you can also call the attending, but they will probably tell you the same thing and will not want to come in just to remove a PICC
- PICCs are not emergent. The team will have to place a CVC if they need access over the weekend or after hours.
- PICCs are preferred in patients who are about to be discharged.
- Midlines can only stay in patients for 29 days. If the patient will need antibiotics or treatment for over 29 days, they should receive an alternative line placement.
EMERGENCY CASES - GI bleeds
- If they are slowly dropping the Hgb/Hct, make sure they have at least 2 serial Hgb/Hct
- For most GI bleeds, the attending will ask for a bleeding scan (e.g. CTA r/o gi bleed), which usually delays the case until morning
- Pulmonary embolisms
- Determine the patient's hemodynamic status, troponin levels, presence of heart strain on CTA of the chest.
- IR usually does not intervene in elderly patients
- Bleeds from pelvic fracture
- If patient is hemodynamically unstable after trauma, they should go to OR not the IR table
- For pelvic fractures, they should get a CT to see where the pelvic hematoma(s) are while you are getting the IR team together
- IVC filters
- Septic cholecystitis or abscess
HOSPITAL ACCESS ON CALL - The main entrances are locked at night, enter the hospitals through the ER entrances
- At RH, it’s easiest to go in through the ambulance entrance (the door code is 911)
- Save your cab receipts from call for reimbursement by Maritza
SCHEDULING NON-EMERGENT PROCEDURES FOR THE NEXT DAY
- For urgent procedures referred during on-call hours that that can be safely scheduled for the following morning, the on-call attending can schedule the procedure as a 1st case
- The referral/procedure becomes the responsibility of the IR attending assigned to the site during the following morning (RH, SL, Petrie AM attending)
- Subsequent scheduling changes, cancellations, and communication with the referring service become the responsibility of the IR attending assigned to the site during the following morning
- The on-call attending must contact the on-site IR attending assigned for the next day by e-mail (or telephone, if before 11 pm) upon scheduling the procedure with the referring service
- A follow-up confirmation call must be made to the daytime IR attending assigned to the site the following morning by 6:30 am, if telephone contact was not made the previous evening
- The on-call resident/fellow must contact the resident/fellow on the IR rotation assigned for the next day by e-mail (or telephone if before 11 pm) upon scheduling the procedure with the referring service
- A follow-up confirmation call must be made to the resident/fellow the following morning by 6:30 am, if telephone contact was not made the previous evening
- One exception is at SL, when there is no on-site attending the following morning (typically Tuesdays). These procedures must be completed by the on-call attending before the start of the next workday.
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