The Washington Manual® Internship Survival Guide Fourth Edition 43249_fm_pi-xii.indd 1 14/12/12 11:29 AM This page intentionally left blank. 43249_fm_pi-xii.indd 2 14/12/12 11:29 AM The Washington Manual® Internship Survival Guide Fourth Edition Executive Editor Thomas M. De Fer, MD Professor of Medicine Washington University School of Medicine St. Louis, Missouri Written and Edited by Eric M. Knoche, MD Fellow Division of Hematology/Oncology Washington University School of Medicine St. Louis, Missouri Gina N. LaRossa, MD Instructor in Medicine Division of Hospital Medicine Washington University School of Medicine St. Louis, Missouri Heather F. Sateia, MD Instructor in Medicine Washington University School of Medicine St. Louis, Missouri 43249_fm_pi-xii.indd 3 14/12/12 11:29 AM Senior Acquisitions Editor: Sonya Seigafuse Product Manager: Leanne Vandetty Vendor Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Senior Marketing Manager: Kimberly Schonberger Design Coordinator: Steve Druding Editorial Coordinator: Katie Sharp Production Service: Integra Software Services Pvt. © 2013 by Department of Medicine, Washington University School of Medicine Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com Third Edition © 2008 by Department of Medicine, Washington University School of Medicine Second Edition © 2006 by Lippincott Williams & Wilkins First Edition © 2001 by Lippincott Williams & Wilkins All rights reserved. This book is protected by copyright. No part of this book may be repro- duced in any form by any means, including photocopying, or utilized by any information stor- age and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data The Washington manual internship survival guide / executive editor, Thomas M. De Fer ; written and edited by Eric M. Knoche, Gina N. LaRossa, Heather F. Sateia.—4th ed. p. ; cm. Internship survival guide Includes index. ISBN 978-1-4511-4324-9—ISBN 1-4511-4324-9 I. De Fer, Thomas M. II. Knoche, Eric M. III. LaRossa, Gina N. IV. Sateia, Heather F. V. Washington University (Saint Louis, Mo.). Dept. of Medicine. VI. Title: Internship survival guide. [DNLM: 1. Internal Medicine—Handbooks. 2. Internship and Residency— Handbooks. WB 39] 616—dc23 2012045665 Care has been taken to confirm the accuracy of the information presented and to describe gener- ally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regula- tions, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsi- bility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638- 3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 43249_fm_pi-xii.indd 4 14/12/12 11:29 AM Contributing Authors The Basics of Effective Sign-out Mary E. Klingensmith, MD Professor of Surgery Thomas Ciesielski, MD Washington University School of Medicine Resident Medicine Barnes-Jewish Hospital St. Louis, Missouri St. Louis, Missouri Faculty Advisor EKG/Cardiology Neurology Prashant Atri, MD Erica Patrick, MD Medicine Resident Neurology Resident Barnes-Jewish Hospital Barnes-Jewish Hospital St. Louis, Missouri St. Louis, Missouri Critical Care Richard Sohn, MD Associate Professor of Neurology Chad Witt, MD Washington University School of Pulmonary and Critical Care Fellow Medicine Barnes-Jewish Hospital St. Louis, Missouri St. Louis, Missouri Faculty Advisor Dermatology Obstetrics and Gynecology Donna Hepper, MD Mallika Anand, MD Dermatology Resident Obstetrics and Gynecology Resident Barnes-Jewish Hospital Barnes-Jewish Hospital St. Louis, Missouri St. Louis, Missouri Diane F. Merritt, MD Kara S. Nunley, MD Professor of Obstetrics and Assistant Professor of Dermatology Gynecology Washington University School of Washington University School of Medicine Medicine St. Louis, Missouri St. Louis, Missouri Faculty Advisor Faculty Advisor General Surgery Ophthalmology Jason D. Keune, MD Ian Pitha-Rowe, MD General Surgery Resident Ophthalmology Resident Barnes-Jewish Hospital Barnes-Jewish Hospital St. Louis, Missouri St. Louis, Missouri v 43249_fm_pi-xii.indd 5 14/12/12 11:29 AM vi Contributing Authors Morton Smith, MD Psychiatry Professor Emeritus of Kimberly Chik, MD Ophthalmology Psychiatry Resident Washington University School of Barnes-Jewish Hospital Medicine St. Louis, Missouri St. Louis, Missouri Faculty Advisor Daniel W. Haupt, MD Orthopedic Surgery Instructor of Psychiatry Washington University School of Kathleen McKeon, MD Medicine Orthopedic Surgery Resident St. Louis, Missouri Barnes-Jewish Hospital Faculty Advisor St. Louis, Missouri Radiology Martin Boyer, MD Elizabeth Sheybani, MD Associate Professor of Orthopedic Radiology Resident Surgery Barnes-Jewish Hospital Washington University School St. Louis, Missouri Medicine St. Louis, Missouri Faculty Advisor Kristopher W. Cummings, MD Assistant Professor of Radiology Otolaryngology Washington University School of Medicine Robert Nason, MD St. Louis, Missouri Otolaryngology Resident Faculty Advisor Barnes-Jewish Hospital St. Louis, Missouri Risk Management Emily Fondahn, MD Ravindra Uppaluri, MD, PhD Instructor in Medicine Associate Professor of Washington University School of Otolaryngology Medicine Washington University School of St. Louis, Missouri Medicine St. Louis, Missouri Faculty Advisor Patient Safety Jeff Parker, MD Instructor in Medicine Washington University School of Medicine St. Louis, Missouri 43249_fm_pi-xii.indd 6 14/12/12 11:29 AM Preface This is the fourth edition of the highly successful, pocket-sized com- panion “survival guide” written and edited by former Washington University residents. It is meant to complement the Washington Manual® of Medical Therapeutics and the Washington Manual® of Outpatient Internal Medicine and provide concise and practical infor- mation for those learning the basics of practicing clinical medicine. It is written assuming knowledge of basic pathophysiology and data interpretation. The target audience is primarily those beginning their internship, but this guide may be useful for medical students, resi- dents, and anyone else on the front lines of patient care. The fourth edition has been updated to be consistent with the most current medical practices. The pace of inpatient medicine stresses efficiency and time management, especially in our work-hour regulated environment. In keeping with the purpose of a pocket book, a deliberate attempt was made to keep the format succinct so that common workups, cross-cover calls, procedures, and other practical information would always be in a rapidly accessible format. There are also essential sections about “what not to miss” and “when to call for help” for common clinical scenarios. It is written assuming that a standard textbook of internal medicine, the Washington Manuals®, a Sanford Guide, Physicians Desk Reference, and Internet access (as well as your resident) are available nearby for reference. Furthermore, we have included a newly revised rapid-access, pocket-sized card detail- ing procedural skills and techniques. This card is detachable and can travel with you through the course of your residency and beyond. vii 43249_fm_pi-xii.indd 7 14/12/12 11:29 AM Acknowledgments We wish to thank the Washington University residents and faculty for their enthusiastic support of this project, and even more impor- tantly, their ongoing contributions that have served to make this guide immeasurably better. We would also like to extend our thanks to Melvin Blanchard, MD, and Vicky Fraser, MD, whose leadership and support have been vital to the continued success of this book. We appreciate the tremendous support of Thomas De Fer, MD, and Katie Sharp in their coordination of our efforts. From Wolters Kluwer/Lippincott Williams & Wilkins, we are indebted to Sonya Seigafuse, Leanne Vandetty, and Kimberly Schonberger. E.M.K. G.N.L. H.F.S. viii 43249_fm_pi-xii.indd 8 14/12/12 11:29 AM Contents Contributing Authors v Preface vii Acknowledgments viii Abbreviations List xi 1. Objectives � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �1 2. Keys to Survival � � � � � � � � � � � � � � � � � � � � � � � � � � � �4 3. ACLS Algorithms � � � � � � � � � � � � � � � � � � � � � � � � � � �5 4. Books, Web Sites, and Other Resources � � � � � � � � � � �8 5. Useful Formulae � � � � � � � � � � � � � � � � � � � � � � � � � � �13 6. Patient and Staff Relations � � � � � � � � � � � � � � � � � � �18 7. Patient Safety � � � � � � � � � � � � � � � � � � � � � � � � � � � �25 8. Risk Management � � � � � � � � � � � � � � � � � � � � � � � � � �27 9. Triage � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �31 10. Admissions � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �33 11. Daily Assessments � � � � � � � � � � � � � � � � � � � � � � � � �40 12. Discharges � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �44 13. Cross-Coverage � � � � � � � � � � � � � � � � � � � � � � � � � � � �46 14. Other Notes of Importance � � � � � � � � � � � � � � � � � � �49 15. Top Ten Workups � � � � � � � � � � � � � � � � � � � � � � � � � �51 16. Pain Control � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �77 17. Fluids and Electrolytes � � � � � � � � � � � � � � � � � � � � � �83 ix 43249_fm_pi-xii.indd 9 14/12/12 11:29 AM