Van Bockern - Intro to Hospital Medicine

Question 1

what does ABC VANDALISM stand for

Answer 1

admission orders:

admit to
diagnosis
condition
vitals
allergies
nursing orders
diet
activity
labs
IV fluids
special studies
medications

Question 2

indications for ICU admit (7)

Answer 2

ventilator
biPAP
central lines
pressors
drips (ex insulin/heparin)
eye drop administration
risk of decompensation (ex threatened airway)

Question 3

floor vs ICU guidelines based on hyper/hypoglycemia

Answer 3

floor: BG> 400 without anion gap
PCU: DKA but pH > 7.2 and resolving anion gap
ICU: DKA w. multiorgan dysfxn, pH > 7.2

Question 4

lab draw guidelines for floor vs ICU

Answer 4

floor: daily, bid
PCU: q 2 hr
ICU: < q 2 hr

Question 5

floor vs ICU renal failure guidelines

Answer 5

floor: chronic hemodialysis/non-emergent
ICU:
emergent dialysis
CRRT
K > 6.0 w. EKG changes
K > 7.0

Question 6

floor vs ICU hemodynamics guidelines

Answer 6

floor:
HR: 50-130
SBP: 85-200
RR: 10-30

ICU:
hemodynamically unstable
HTN emergency
IV hypertensives

Question 7

ICU vs floor respiratory guidelines

Answer 7

floor: chronic, stable NPPV overnight (CPAP for OSA)
ICI:
NIPPV (BiPAP, CPAP)
intubated
impending respiratory failure
threatened airway

Question 8

what determines inpatient vs obs status (2)

Answer 8

2 midnight rule: considered inpatient if stay is expected to span at least 2 midnights

complex medical judgment

Question 9

what do you think when you see a pt with: elevated ddimer, right axis deviation, and tachycardic

Answer 9

PE

Question 10

do not forget to ask this question before admitting patient

Answer 10

code status

Question 11

what form is used for code status

Answer 11

MOST form

Question 12

what other specialties are involved in hospital team based care (5)

Answer 12

case manager
PT/OT
respiratory therapist
bedside RN
pharmacy

Question 13

2 responsibilities of OT/PT

Answer 13

assess/improve ADLs
cognitive screens (MOCA)

Question 14

5 responsibilities of respiratory therapy

Answer 14

ventilator/NPPV management
home O2 eval
nebulizers/chest PT
OSA screens
+/- intubate

Question 15

5 responsibilities of bedside RN

Answer 15

pt assessment
meds administration
care coordination
front line for pt/fam interaction
d/c logistics/education

Question 16

3 responsibilities of pharmacy

Answer 16

confirmation/clarification of all inpt med orders
med prep
RRT/MET code involvement

Question 17

what do consultants contribute to care (3)

Answer 17

procedures
advice on work up
advice on treatment

Question 18

what should you do if you see any new findings on a head CT (2)

Answer 18

do a neuro exam
call consultant (NSGY)

Question 19

important consideration of imaging in hospital medicine

Answer 19

don’t forget to do baseline imaging

Question 20

pt presents w. LUE cellulitis and has a hx of IVDU - he is hypotensive and tachy what should you do initially

Answer 20

-baseline US
-find out what abx he’s on
-figure out why he is hypotensive and tachy - concern for sepsis

Question 21

baseline EKG for previous pt shows fluid pocket and he becomes more hypotensive and tachy - what do you do (5)

Answer 21

blood cultures
switch pt to broad spectrum - vanco
IVF -> for hemodynamic stability
call gen surg
go see pt

Question 22

you take over 68 yo pt with COVID PNA and he is not looking great - hypoxic on 6L, tachy - what do you do

Answer 22

find out code status
has he desated throughout the day?
is he taking RDV or dex?

Question 23

you get a CXR for the previous pt and see diffuse ground glass opacities - O2 sat is < 90% on 6L - what do you do (3)

Answer 23

get pt to prone
increase O2 to heated high flow
call ICU

Question 24

what happens when a rapid response team is called (2)

Answer 24

1. pt stabilized
2. pt transferred to ICU

Question 25

4 discharge details

Answer 25

discharge summary
schedule f/u
d/c order
coordinate d/c meds

Question 26

3 biggest indicators of synthetic fxn of liver

Answer 26

albumin
alk phos
platelets