Hospital Medicine
- What are my obligations to my incarcerated patient?
A court order authorizes a blood transfusion, but the incarcerated patient refuses the transfusion. As the caregiver, am I obligated to follow the court order against the patient’s wishes?
- Which patients hospitalized with alcohol withdrawal syndrome should receive high-dose parenteral thiamine?
The authors briefly outline risk factors for Wernicke encephalopathy and when high-dose parenteral thiamine is indicated.
- Test ordering: Balancing the good for the many with the good for the one
Three articles this month address how we order clinical tests, one on the question of treating the patient with asymptomatic bacteriuria, the others on the advantages and disadvantages of standing orders for “daily labs” for inpatients.
- Should ‘daily labs’ be a quality priority in hospital medicine?
Evidence shows that unnecessary daily testing is only a minor contributor to anemia and healthcare costs for most inpatients. The effect on patient experience has not been definitively established.
- Laboratory stewardship should be a priority in every hospital
Considerations include indirect costs, downstream testing or other workup based on minor abnormalities uncovered during daily testing, and shortages in staff and supplies.
- Does my patient need to be screened or treated for a urinary tract infection?
When patients present with symptoms that suggest but are not clearly diagnostic of urinary tract infection, urine studies should be obtained.
On the horizon: Extracorporeal carbon dioxide removalExtracorporeal carbon dioxide removal to treat hypercapnic respiratory failure has been studied in acute respiratory distress syndrome, chronic obstructive pulmonary disease, asthma, and other conditions.
- When should antithrombotic therapy be resumed after gastrointestinal bleeding?
The timing should be individualized after considering factors related to the bleeding event, thromboembolic risk, and patient comorbidities.
- Decongesting heart failure with diuretics: Easier to prescribe than to fully understand
Digging deep into the pathophysiology of diuretic resistance reveals complex interacting pathways. But none of these pathways can fully explain or be used to safely reverse diuretic resistance.
- How do we maximize diuresis in acute decompensated heart failure?
The initial goal is to maximize loop diuretic therapy using urine output or urinary sodium for guidance. Combination therapy can be used when patients respond poorly to escalating loop diuretic doses.