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120 OTHER INFORMATION TOP TEN INTERN TIPS 1. Be sure when you admit a patient, you ask the admitting attending how often they want to be contacted, and update them as they request. 2. If you plan on discharging a patient, call the attending first thing in the am (esp TPC) so they can plan on seeing the patient early prior to discharge. If you can’t reach anyone from TPC and the patient has been set for discharge based on prior days’ attending, make sure to leave a message on the main line letting them know you plan on discharging the patient at X time unless you hear otherwise. ALWAYS CALL BEFORE YOU DISCHARGE. 3. Dictate in a timely manner and review dictations/electronic signatures often so your attending does not end up on the B list and lose their admitting privileges. Go to medical records and have cookies and juice and review your dictations if you need to find a happy place! 4. When you order an echo, write who needs to read it: Heart Place, CCT, or NTC. Look back at old echos and have the same group read it as did before. 5. If you are waiting for a read on a radiologic study, look on centricity and see if it is dictated. If so, dial 2-XRAY and enter your user name/password to hear the dictation. 6. Review the nurses notes from the previous night as well as PT/OT/Respiratory notes (located under a separate tab). Nutrition leaves notes at the back of the physician progress note section. 7. Help out your other interns: Write prns on your admission orders and then sign cross-cover verbal orders when you round in the am so they don’t have to have them appear on their ESA’s and sign them electronically. 8. If you need to call a patient from your cell phone or home phone, dial *67 and then the number. 9. If you need to obtain medical records from an outside facility, write an order and the clerk will fax the request with the help of the nurse. Follow-up if the records do not come in a few days. 10. Live, laugh, and learn … take the best care of your patients that you can and you will make it with flying colors!
121 DUEWALL’S FAVORITE MNEMONICS • Pancreatitis: GET SMASHED Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bites Hypercalcemia/triglyc eridemia ERCP (post-ERCP) Drugs (azathioprine, thiazides) • ACS treatment MONA BASH Morphine, Oxygen, Nitroglycerin, Aspirin, B-blocker, ACE- Inhibitor, Statin, Heparin • Alt. Mental Status MOVE STUPID Metabolic (Hypothyroid, Hepatic encephalopathy) Oxygen (hypoxia) Vascular (stroke) Electrolytes (Hypercalcemia, Hyponatremia) Seizure Trauma (subdural hematoma, epidural hematoma) Uremia Porphyria Infection (Meningitis, Encephalitis, Sepsis, specifically urosepsis in elderly) Drugs • Ranson’s Criteria: At admiss.: GALAW Glucose >200 Age >55 LDH >350 AST>250 WBC >16,000 • At 48 hours-C HOBBS Calcium 10% Oxygen: PaO2 5 mg/dL Base deficit >4 mEq/L Sequestration of fluid >6L • TTP (FAT RN) Fever Anemia (Microangiopathic hemolytic anemia) Thrombocytopenia Renal Failure Neuro changes (AMS) +if suspect TTP, it is an emergency to get patient to plasma exchange • Acute Dialysis Indications-AEIOU Acidemia, Electrolyte disturbances, Intoxication, Overload (volume), Uremia • Fractional excretion of Sodium (FENa) “UNaP over UCraP” (Urine Na x Plasma Cr)/(Urine Cr x Plasma Na) • Kinds Of Tumors Leaping Primarily To Bone Kidney Ovarian Thyroid Lung Prostate Testicular Breast • Drug Induced Lupus Agents- SHIPS drugs Sulfasalazine, Hydralazine, Isoniazid, Procainamide, Statins • Causes of Atrial Fibrillation I SMART CHAP Infectious (endocarditis, myocarditis, sepsis) Surgery (Post-CABG) Medications (caffeine, theophylline) Artheroclerotic CAD Rheumatic Heart Disease (MS or MR) Thyrotoxicosis Congential malformation (ASD) Hypertensive heart disease Alcohol (Alcoholic CM, Holiday Heart Syn) PE • Anion Gap Metabolic Acidosis GOLD MARK or KUSMALE Glycols Oxyproline L-lactate D-lactate Methanol Aspirin Aspirin Renal Ketoacidosis Ketones Uremia Salicylates Methanol Acetaldehyde Lactic Acidosis Ehtylene Glycol
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BUMC BASICS
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• Status Epilepticus • Stroke m
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5 Welcome to Baylor University Medi
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7 Rounding on your patients: • Se
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9 2. gloves only. During codes, if
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11 • There is one resident and 3
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Chest pain 13 DDx to consider • M
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SOB DDx • Pneumonia • PE • An
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17 • Heparin • Lidocaine • Ni
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19 TPC (cont’d) Pager Cell Phone
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21 Gen Surgery Neurologists Urgent
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23 OBTAINING A CONSULT AT BAYLOR Ob
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25 • Enter 2 initial zeros and th
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27 • Albuterol/Atrovent nebulizer
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29 CARDIOLOGY CCU IN GENERAL You ar
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31 Unstable Angina/NSTEMI • Can u
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33 Post PCI Complications — In yo
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35 function, elevated troponin T is
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37 **0-1 point non-cardiogenic, 2 p
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39 • Erythromycin • Phenothiazi
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41 Therapy — Therapy is guided by
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43 Nitroglycerine (Onset in 2-5 min
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45 Treatment: • Vasovagal: Recogn
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47 GI/HEPATOLOGY GI CONSULTS AND GR
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49 hepatitis, obesity), then they p
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51 timing and necessity of ERCP for
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53 the liver transplant ICU) where
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55 GI bleeding (**See above under G
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57 • Barium Enema (clear liquids
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59 Pseudomonas: • Piperacillin/Ta
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61 • Neoplasm: Lymphoma, leukemia
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63 mortality. It lowers mortality i
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Pneumonia (immunocompromised) (cont
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67 BRAIN DEATH EXAM • Can order b
Page 69 and 70: 69 SEIZURES Can use BZD ativan IV o
Page 71 and 72: 71 3. Stop anticoagulants and rever
Page 73 and 74: 73 ONCOLOGY THE ACUTE LEUKEMIC “T
Page 75 and 76: Timeline*: 75 Day 0 (admit) — Bon
Page 77 and 78: 77 PALLIATIVE CARE AND CLINICAL ETH
Page 79 and 80: 79 release oxycodone, and hydromorp
Page 81 and 82: 81 • Institutional Ethics and Pal
Page 83 and 84: 83 PULMONARY ARDS Definition: Need
Page 85 and 86: 85 MECHANICAL VENITALTION Oxygen su
Page 87 and 88: 87 • Ineffective respiratory effo
Page 89 and 90: 89 - Daily sedation vacations at 07
Page 91 and 92: 91 • After 1 wk of intubation det
Page 93 and 94: 93 - Sustained changes in the heart
Page 95 and 96: 95 PULMONARY EMBOLUS (PE) Evaluatin
Page 97 and 98: 97 RADIOLOGY RADIOLOGY HINTS IF YOU
Page 99 and 100: Superficial Abscess/Mass Abscess/Ma
Page 101 and 102: 101 RENAL ACID/BASE DISTURBANCES Qu
Page 103 and 104: 103 ACUTE KIDNEY INJURY Acute Kidne
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Page 107 and 108: 107 CHRONIC KIDNEY DISEASE Stage GF
Page 109 and 110: Hypovolemic Hyponatremia EABV low R
Page 111 and 112: 111 fluid pulled off and into the p
Page 113 and 114: 113 Colorectal Surgery, and Plastic
Page 115 and 116: 115 • Social work: Circle Social
Page 117 and 118: Ear Health Antipyrine/Benzocaine ot
Page 119: Magnesium Oxide 400mg tab Prenatal
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