Sharing successes, challenges and daily happenings in the Department of Medicine
Q: Should I always order a whole blood when there is concern for hemolysis? The Bottom Line: No. During analysis of whole blood, instruments do not have the functionality for spectrophotometric hemolysis measurement.. Serum potassium measurements are recommended for most clinical situations. Whole blood potassium should be ordered in the following scenarios: for immediate management, such […]
Q: How often should I order a type and screen for my patients? The Bottom Line: A single type and screen upon admission is sufficient for most patients who are at low risk of bleeding, are not pregnant and have not had a prior positive antibody screen. Context: A type and screen (T&S) determines ABO […]
Updates in C Diff: Rapid Review of the 2018 IDSA Guidelines Q: Should I send stool for C. difficile testing for all my inpatients with diarrhea? Should I retest within 7 days if the first test is negative, and should I send a test for cure? The Bottom Line: NO! Don’t test your patient for C. diff if […]
Q: Should you test folate levels in your anemic patients? The Bottom Line: Do NOT routinely test folate levels in your anemic patients. Context: Folate deficiency is a well-described cause of macrocytic anemia. The American diet has been fortified with folate from a variety of food sources since 1998. This has led to near-elimination of […]
Q: Should I routinely obtain a urine culture from my asymptomatic inpatients? What if the urinalysis indicates the presence of both bacteria and white blood cells? What if my patient has a chronic indwelling catheter? Context: Urinary tract infections (UTIs) are the most commonly encountered bacterial infections in the ambulatory, inpatient and long-term care settings. […]
Q: Should cardiac monitoring be routinely ordered for non-ICU in-patients with concern for clinical deterioration to provide early indication of worsening status? The Bottom Line: Cardiac monitoring is indicated for specific patient populations at high risk for life-threatening arrhythmias and should not be used in place of or as an adjunct to close clinical observation. […]
Q: Should I test my patient with a provoked deep vein thrombosis (DVT) for hereditary thrombophilia? Context: The Centers for Disease Control and Prevention estimates that between 300,000 and 600,000 Americans are affected by venous thromboembolism (VTE) yearly. Of these, roughly 60,000 – 100,000 Americans die of VTE yearly, with 25% of deaths occurring within […]
Q: Should we always use fractional excretion indices in the evaluation of acute kidney injury? The Bottom Line: Do not order urine electrolytes to calculate fractional excretion indices as part of the initial evaluation of acute kidney injury. These indices may be helpful in differentiating pre-renal azotemia from acute tubular necrosis in oliguric patients, but […]
Q: Should I treat my inpatients with asthma and COPD with bronchodilators via nebulizers or metered-dose inhalers? The Bottom Line: Patients with asthma and COPD admitted to the hospital should be given aerosolized medications via MDIs with spacers and diskus inhalers as soon as they are medically able, as these therapies are equivalently efficacious as […]
Q: Should I bother to find generic alternatives to brand-name drugs for my patients? The Bottom Line: Prescribing generic alternatives to brand name drugs reduces costs for your patients and may result in improved adherence and clinical benefit. Context: The U.S. healthcare system generates more than 4 billion prescriptions annually (more than 13 prescriptions per […]