Your Priorities Overnight

1. Keep patients alive

2. Handle acute decompensations

3. Manage drips and ventilators

4. Plan for morning labs, ABGs

5. Keep things stable for rounds

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Common Night Emergencies & What to Do

1.  Hypoxia (SpO₂ drops)

1. Check patient → airway, secretions

2. Look at vent alarms

3. Suction if needed

4. Increase FiO₂ temporarily

5. CXR if concerns

6. Call fellow if persistent

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2. Hypotension

1. MAP < 65?

2. RUSH exam (if trained)

3. Check drips → norepi/vasopressin

4. Consider fluids if not overloaded

5. Lactate if new concern for sepsis

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3. Arrhythmia

• Unstable: shock immediately

• AFib RVR: rate control (amio, BB depending)

• VT: amiodarone → lidocaine → cardioversion

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4. Delirium/Agitation

• Check pain → hypoxia → urinary retention

• Use dexmedetomidine if possible

• Avoid benzos unless alcohol withdrawal

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5. Ventilator Issues

• High peak pressures: bronchospasm, mucus plugging, biting tube

• High plateau: ARDS, decreased compliance

• Auto-PEEP: prolonged expiration, COPD

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Renal/Electrolyte

• Treat K > 6 immediately

• Replete Mg > 2

• Replete Phos > 3

• Notify fellow early for anuric AKI or rising K