The Washington Manual Internship Survival Guide

The Washington Manual
^®
Internship Survival Guide

Fourth Edition

The Washington Manual
^®
Internship Survival Guide

Fourth Edition

Executive Editor

Thomas M. De Fer, MD

Professor of Medicine

Washington University School of Medicine

St. Louis, Missouri

Written and Edited by

Eric M. Knoche, MD

Fellow

Division of Hematology/Oncology

Washington University School of Medicine

St. Louis, Missouri

Gina N. LaRossa, MD

Instructor in Medicine

Division of Hospital Medicine

Washington University School of Medicine

St. Louis, Missouri

Heather F. Sateia, MD

Instructor in Medicine

Washington University School of Medicine

St. Louis, Missouri

Senior Acquisitions Editor:
Sonya Seigafuse

Product Manager:
Leanne Vandetty

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Benjamin Rivera

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Steve Druding

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Katie Sharp

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© 2013 by Department of Medicine, Washington University School of Medicine

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Third Edition © 2008 by Department of Medicine, Washington University School of Medicine

Second Edition © 2006 by Lippincott Williams & Wilkins

First Edition © 2001 by Lippincott Williams & Wilkins

All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China

Library of Congress Cataloging-in-Publication Data

The Washington manual internship survival guide / executive editor, Thomas M. De Fer ; written and edited by Eric M. Knoche, Gina N. LaRossa, Heather F. Sateia.—4th ed.

p. ; cm.

Internship survival guide

Includes index.

ISBN 978-1-4511-4324-9—ISBN 1-4511-4324-9

   I. De Fer, Thomas M. II. Knoche, Eric M. III. LaRossa, Gina N.

IV. Sateia, Heather F. V. Washington University (Saint Louis, Mo.). Dept. of Medicine.

VI. Title: Internship survival guide.

[DNLM: 1. Internal Medicine—Handbooks. 2. Internship and Residency— Handbooks. WB 39]

616—dc23

2012045665

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.

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Contributing Authors

The Basics of Effective Sign-out

Thomas Ciesielski, MD

Medicine Resident

Barnes-Jewish Hospital

St. Louis, Missouri

EKG/Cardiology

Prashant Atri, MD

Medicine Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Critical Care

Chad Witt, MD

Pulmonary and Critical Care Fellow

Barnes-Jewish Hospital

St. Louis, Missouri

Dermatology

Donna Hepper, MD

Dermatology Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Kara S. Nunley, MD

Assistant Professor of Dermatology

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

General Surgery

Jason D. Keune, MD

General Surgery Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Mary E. Klingensmith, MD

Professor of Surgery

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Neurology

Erica Patrick, MD

Neurology Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Richard Sohn, MD

Associate Professor of Neurology

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Obstetrics and Gynecology

Mallika Anand, MD

Obstetrics and Gynecology Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Diane F. Merritt, MD

Professor of Obstetrics and Gynecology

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Ophthalmology

Ian Pitha-Rowe, MD

Ophthalmology Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Morton Smith, MD

Professor Emeritus of Ophthalmology

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Orthopedic Surgery

Kathleen McKeon, MD

Orthopedic Surgery Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Martin Boyer, MD

Associate Professor of Orthopedic Surgery

Washington University School Medicine

St. Louis, Missouri

Faculty Advisor

Otolaryngology

Robert Nason, MD

Otolaryngology Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Ravindra Uppaluri, MD, PhD

Associate Professor of Otolaryngology

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Patient Safety

Jeff Parker, MD

Instructor in Medicine

Washington University School of Medicine

St. Louis, Missouri

Psychiatry

Kimberly Chik, MD

Psychiatry Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Daniel W. Haupt, MD

Instructor of Psychiatry

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Radiology

Elizabeth Sheybani, MD

Radiology Resident

Barnes-Jewish Hospital

St. Louis, Missouri

Kristopher W. Cummings, MD

Assistant Professor of Radiology

Washington University School of Medicine

St. Louis, Missouri

Faculty Advisor

Risk Management

Emily Fondahn, MD

Instructor in Medicine

Washington University School of Medicine

St. Louis, Missouri

Preface

This is the fourth edition of the highly successful, pocket-sized companion “survival guide” written and edited by former Washington University residents. It is meant to complement the
Washington Manual
^®
of Medical Therapeutics
and the
Washington Manual
^®
of Outpatient Internal Medicine
and provide concise and practical information for those learning the basics of practicing clinical medicine. It is written assuming knowledge of basic pathophysiology and data interpretation. The target audience is primarily those beginning their internship, but this guide may be useful for medical students, residents, and anyone else on the front lines of patient care.

The fourth edition has been updated to be consistent with the most current medical practices. The pace of inpatient medicine stresses efficiency and time management, especially in our work-hour regulated environment. In keeping with the purpose of a pocket book, a deliberate attempt was made to keep the format succinct so that common workups, cross-cover calls, procedures, and other practical information would always be in a rapidly accessible format. There are also essential sections about “what not to miss” and “when to call for help” for common clinical scenarios. It is written assuming that a standard textbook of internal medicine, the
Washington Manuals
®, a
Sanford Guide, Physicians Desk Reference
, and Internet access (as well as your resident) are available nearby for reference. Furthermore, we have included a newly revised rapid-access, pocket-sized card detailing procedural skills and techniques. This card is detachable and can travel with you through the course of your residency and beyond.