Hospital Med Flashcards
What are the hospitalist procedures?
Central lines
Intubation
Paracentesis
Thoracentesis
Lumbar puncture
Ultrasonography
Arthrocentesis- depending on the hospital. Ortho or rheum also involved
What are basics of hospital medicine?
Admitting patients
Rounding on admitted pts
Discharing
what should you get when admitting patients
- How does the patient get to the hospital: Ambulance, direct clinic admissions, urgent care, direct hospital admissions
- Admission orders –> “ADC Vandalism”
- H&P Note
- Hand Off
what should you get when rounding pt
- Daily vitals, labs, imaging, and consultants
- Progress note
- Hand off
What should you do when discharging pt
- Discharge summary
- Discharge order
- Discharge Instructions- including follow up
Admit to floor vs ICU?
Ventilator, BiPAP
Central line, pressors, drips
Nursing needs
Risk of decomp
Hyperglycemia (>400) without anion gap, ICU or floor?
Floor
DKA but pH > 7.2 and resolving anion gap, floor or ICU?
PCU
DKA with multi-organ dysfunction, pH < 7.2, ICU or floor?
ICU
If pt needs lab draw earlier than every 2h, where do they go?
ICU
What are the vitals for floor?
Stable hemodynamics (HR 50-130, SBP 85-200, RR 10-30)
What are the vitals for ICU?
Hemodynamically unstable; hypertensive emergency; IV antihypertensives
for renal failure, they are Chronic hemodialysis/ non-emergent
floor
Renal failure, Emergent dialysis, CRRT, K > 6.0 with EKG changes, any K > 7.0
ICU
Resp, Chronic stable NPPV overnight (CPAP for OSA)
floor or ICU?
Floor
NIPPV (BiPAP, CPAP); intubated; impending respiratory failure; threatened airway. ICU or floor?
ICU
Whats the impt or obs rule?
- Two-midnight rule
- “Complex medical judgment”
- “Generally, a patient is considered an inpatient … with the expectation that he or she will require hospital care that is expected to span at least two midnights”
- “However, the decision to admit a patient is a complex medical judgment which can be made only after the physician has considered a number of factors
whats important to get during admit?
code status
What should you do during discussion for code status
- Normal statement
- Education/explanation
- Further steps if pt interested
- Most have forms
What happens during the hospital stay
- Daily (at least) re-evaluation of patients
- Adjustment of treatment plan
- Communication with consultants
- Discharge planning / longer-term plan
whats do case managers do?
Arranging logistics/finances of:
- Home health
- Outpatient IV antibiotics
- Wound vacs, durable medical equipment
- Transfer to outside hospital
- SNF or LTAC referrals/placement
What do social workers do?
- Homelessness
- Uninsured
- Undocumented
- Substance abuse
- Adjustment to illness counseling
- Complex social issues Legal issues/guardianship
- Utilization Management
- Medical necessity review
- Inpatient vs. OBS
Team based - OT
Occupational Therapist
- Assess/improve ADLs, mobility
- Cognitive screens, MOCA
- “Just because you’re walking around doesn’t mean you’re safe to go home”
Team based - Resp therapist
Respiratory Therapist
- Ventilator and NIPPV management
- Home oxygen evaluations
- Nebulizers, chest PT
- OSA screens
- Sometimes intubate (hospital-dependent)
Team based - RN
RN
- Patient assessment
- Medication administration
- Care coordination
- Front line for patient/family interaction
- Discharge logistics and education
Team based care - Pharmacy
- confirm of all inpt order
- Clarify orders with providers
- Prep meds
- RRT/MET/code involvement
Team based care - Consults
-
What are the discharge detail include?
Discharge summary
Follow up scheduled
Discharge Order
Coordinating DC meds
