The Washington manual internship survival guide

253 Pages·2013·17.466 MB·English

by  De Fer, Thomas M.;Knoche, Eric M.;LaRossa, Gina N.;Sateia, Heather F

The Washington
Manual® Internship
Survival Guide
Fourth Edition
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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
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© 2013 by Department of Medicine, Washington University School of Medicine
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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-
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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
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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
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bility of the health care provider to ascertain the FDA status of each drug or device planned for
use in their clinical practice.
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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
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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
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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
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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
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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
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