Hypertension
Briefly, unless the patient has a specific condition that requires blood pressure management (acute stroke, aortic dissection, etc.) or a change in their clinical status, hypertension in the hospital should not be treated quickly. This runs counter to the old dogma that significantly elevated BP (systolic over 180), needs to be urgently lowered. I would […]
Sodium Abnormalities
It is very difficult to spend a week on a hospital medicine rotation without encountering an abnormal sodium value. Hypernatremia is easy to evaluate and manage, so we will start there. Hypernatremia First, correct the volume status. If you think the patient is volume down, start with a bolus or two of ringers (130 mEq/L […]
Hyperkalemia
Unfortunately, the first symptom of hyperkalemia can be death due to arrhythmia. Severe hyperkalemia, especially with associated EKG changes, should be treated as an emergency. Our Toolkit to Lower the Potassium Level (While we simultaneously treat the underlying issue, which may be evaluation and treatment of kidney dysfunction, stopping implicated medications, and more.) Dilute with […]
Heart Failure
Overview Heart failure is a huge topic. This is a brief overview of the basics with a focus on initial management. Going forward, let’s assume that your patients are not in cardiogenic shock, which is outside the scope of this website and is more of a critical-care topic. First, make the diagnosis. There are many […]
Intensive Care
The ICU (From a Hospitalist Perspective) This section can be used as a reference for caring for your critically ill patient until they have been safely transferred to the care of an intensivist. These are huge, complicated topics, the details of which are outside the scope of this rotation. Below is a basic framework to […]
COPD Exacerbation
Consider a COPD exacerbation in a patient with known or likely COPD (e.g., long-term cigarette use, or coming from the developing world with long-term biofuel exposure while cooking) who has an acute worsening of dyspnea, cough, or sputum production. The Management of COPD Try to figure out what caused the exacerbation (viral infection or bacterial […]