Hospital Medicine
- Should my elderly hospitalized patient with acute onset of altered mental status undergo stat head CT?
Clinical acumen and use of delirium scoring tools help narrow the range of possible causes for the individual patient and guide decisions on the need for further testing and imaging.
- What is the optimal approach to infiltration and extravasation of nonchemotherapy medications?
The immediate response is warm or cold compression and assessment of the severity.
Endocrinopathies from checkpoint inhibitors: Incidence, outcomes, and managementA review of the incidence and severity of each immune checkpoint inhibitor-related endocrinopathy, factors related to toxicity risk, and principles of management.
- 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.