How many times have you ordered a TSH/T4 on a hospitalized patient? If the test returns abnormal, it may have you wondering what to do – is further testing needed, or should you start the patient on levothyroxine? This Journal of Hospital Medicine article addresses the nuances of inpatient thyroid function testing. Key Points: Nonthyroidal
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Over the past few years, U.S. Preventive Services Task Force (USPSTF) recommendations have expanded screening criteria for several types of cancer. In most of these cases, screenings are now recommended at an earlier age. These changes reflect new research as well as trends that show increasing rates of cancer in younger age groups. Here are
Why is hypokalemia dangerous? Symptoms can manifest below a K of 3.0 mEq/L, with severe symptoms (muscle weakness, rhabdomyolysis, respiratory weakness, ileus, nausea/vomiting, and arrhythmias) not usually developing until K <2.5 mEq/L In patients with cirrhosis, hypokalemia is associated with worsening hepatic encephalopathy In patients with structural heart disease, heart failure or taking antiarrhythmics, they are
Should we use sliding-scale insulin as monotherapy for hospitalized diabetic patients? Slide-scale insulin (SSI) is a method to correct hyperglycemia through frequent dosing of short acting insulin based on a patient’s blood glucose and pre-set rubric. When blood glucose is low little or no insulin is given and when blood glucose is elevated higher doses
What happens when you file a NETS report? Risk department will review the case Will advise on any legal exposure and claims. Help with family disclosure. Advice with documentation regarding the incident. Clinical Care Evaluation Committee and Chief Medical Officer will review the case. Perform root cause analysis. Suggest systemic fixes and provide staff education.
Does metformin need to be routinely held in the hospitalized patient? Metformin is a widely prescribed oral medication used in the management of type 2 diabetes mellitus. It is routine practice to hold metformin in the hospitalized patient due to risk of metformin-associated lactic acidosis (MALA). A recent publication by the Journal of Hospital
In the process of every admission , Epic requires the admitting provider to select the method of venous thromboembolism (VTE) prophylaxis or a contraindication before the orders can be signed. Further, VTE prophylaxis is on many of our admission checklists as topics that must be addressed prior to completing the admission. However, in these low-risk
A Choosing Wisely: Things we do for no reason article addresses the use for antipsychotics and when they are appropriate. Highlights below: Approximately 25% of hospitalized patients experience delirium during their stay. 10-30% of hospitalized patients are prescribed antipsychotics. A systemic review from the Journal of the American Geriatric Society (2016) by Neufeld et al. included 19
Your patient has end-stage renal disease (ESRD) and is anuric on chronic hemodialysis (HD). He receives angiography while admitted for concern for ACS. Despite having his regularly scheduled HD the day prior and showing no signs of volume overload or metabolic disturbances after, he receives emergent HD post-procedure. Is this necessary or could he have
Do you need to place a central line in every patient requiring initiation of vasopressors A very common scenario we see in the hospital is a patient in shock during which the decision to start vasopressors is made. Is central venous catheter (CVC) placement necessary in all of these patients? A recent “Things We Do