Assorted Notes

You have three hours from when stroke symptoms start to treat the patient successfully.

Obstetric Sepsis is a leading cause of maternal mortality and is clinically hard to detect. 23% of maternal deaths in the hospital. 63% are preventable with early recognition of signs and symptoms! (Hall et al. 2020; Hensley et al. 2019; Plante et al. 2019)

GI

• NSAIDs reduce the protective effects of the mucosa in your muscle. This is why you get reflux when you take them.
• The colon is very vascular. Screening for polyps happens starting 45 yo. When it’s far gone, you’ll have blood in your stool. Get screened.
• Diverticula are “caves” in the big or small intestines. These are fucking horrifying to look at. Here, Laplace’s Law applies: pressure is inversely proportional to the diabeter of a tube. This is why the sigmoid colon is a very common site for diverticulitis! Stress on intestinal walls is a big thing. EAT FIBER (watch the sugar in the fiber bars).

GI as a Subway Map

By Jack Anderson

Source Unknown

Pack Years

• 1 pack per day x 30 years = 30 pack years
• Half-pack per day x 20 years = 10 pack years

Complete Blood Count

Blood test used to evaluate your overall health and detect a wide range of disorders, including anemia, infection and leukemia.

• Red blood cells, which carry oxygen
• White blood cells (WBC) which fight infection
• Hemoglobin (Hbg or Hb), the oxygen-carrying protein in red blood cells
• Hematocrit (HCT), the proportion of red blood cells to the fluid component, or plasma, in your blood
• Platelets (Plt), which help with blood clotting

How this is recorded:

Basic Metabolic Panel

Chemistry panel where multiple chemistry tests are grouped as a single panel for ease of ordering

Hepatic Function Panel

info

Comprehensive Metabolic Panel = Basic Metabolic Panel + Hepatic Function Panel

Hepatic Function Panel (HFP), also known as liver function tests (LFTs), is a group of seven tests used to evaluate the liver for injury, infection, or inflammation.

7 Components of HFP:

• Alanine aminotransferase (ALT)
• Albumin (Alb)
• Alkaline Phosphatase (AP)
• Aspartate aminotransferase (AST)
• Direct Bilirubin (DB)
• Total Bilirubin (TB)
• Total Protein (TP)

Culture

It used to be that residents basically lived at the hospital with very little handoff. See the case of Libby Zion. It was a culture thing. Attendings would go home. It was called “being a Gunner”. Hustle culture but for physicians. Things were a bit different back then: you lived at the hospital if you were a resident. You couldn’t call the attending unless the patient was actually dying (“Code Blue” = Stopped Breathing).

I-PASS the BATON - Handoffs

These happen in person with a laptop. Printouts may be involved. Some things involve the EHR (like EPIC) and some are done verbally.

• You and the person need to show up with notes, lists and not do this from memory.
• You need to do this in person.
• You need to go through each patient.
• You need to set apart dedicated time to do this. Administration needs to help here.
• Try not to do it towards the end of the day when you’re raring to GTFO of there.

Letter	Section	Description
I	Introduction	Introduce yourself and your role/job (include patient).
P	Patient	Name, identifiers, age, sex, location.
A	Assessment	Present chief complaint, vital signs, symptoms and diagnosis.
S	Situation	Current status/circumstances, including code status, level of (un)certainty, recent changes and response to treatment.
S	Safety	Critical lab values/reports, socioeconomic factors, allergies and alerts (falls, isolation, etc.).
B	Background	Comorbidities, previous episodes, current medications and family history.
A	Actions	Explain what actions were taken or are required. Provide rationale.
T	Timing	Level of urgency and explicit timing and prioritization of actions.
O	Ownership	Identify who is responsible (person/team), including patient/family members.
N	Next	What will happen next? Anticipated changes? What is the plan? Are there contingency plans?

Tachycardia and Heart Rate

Happens a lot: you measure a high heart rate bu in the PE (Physical Exam) it may be noted as normal because that’s the default on the form.

Really Random

Nursemaid Elbow - Wild.

Subdural Hematoma — scrollable CT Scan. Subdural, Epidural, Intraparenchymal, Subarachnoid harmorrhage. Not everyone gets a Head CT (check for kind of fall, etc). Can cause bias: if you miss a bleed (you’re human), you will keep ordering everyone a head CT.

“See One, Do One, Teach One”