Most bang-for-buck things every intern should know before starting inpatient wards
Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.
Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong
Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.
Pretty thorough review of fluid management on openanesthesia.org
2) Nausea. When to treat, how to treat and at what dose.
3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%
4) โReflexโ antibiotic choice for routine inpatient infections.
http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight
5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).
6) Initial work-up and treatment of oliguria/anuria.
7) A sensible initial approach to suspected ileus.
8) Blood. When, how, why to replace.
9) Pain. Optimal management without inducing narcosis.
Managing cancer pain: Frequently asked questions: CCJM
10) Potassium. When, why and how to shift or replace.
A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld
11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.
12) Resuscitation aka commit the ACLS algorithms to memory.
Current ACLS guidelines. https://www.acls.net/aclsalg.htm
Would love a video series, interactive cases etc.
13) Basic EKG interpretation.
Whole EKG video courses
A whole free youtube EKG video review course by medditโs own u/ericstrong
An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/
I have to admit I havenโt used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.
EKG video cases
Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu
โ If you like Dr. Mattuโs cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.
Practice EKGs with answers
Watching videos isnโt enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.
EKG blogs
I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:
http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)
http://www.ems12lead.com
http://ecg-interpretation.blogspot.is
http://jhcedecg.blogspot.is
EKG resource libraries
Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.
http://www.practicalclinicalskills.com/ekg.aspx /u/collidge
14) Know when to order ABGs and how to interpret them.
Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)
Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg
Bonus 15) Basic CXR interpretation
CXR video lecture course
Again, Dr. Eric Strong has an excellent video course for free on youtube
Step-by-step guides to basic CXR interpretation
The Radiology Assistant: Chest X-ray - Basic interpretation
Radiology Masterclass step-by-step basic CXR
University of Virginiaโs step-by-step basic CXR
All inclusive resources
The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.
UPenns CXR learning website
Loyola Universities excellent CXR Atlas Most outdated look but amazing content.
Checklist approach to CXR
Bonus 16) Overnight o-shit-whatโs-that Head CT interpretation
Midnight radiology: Emergency CT of the head
University of Virginiaโs guide to the Head CT
Hey, self: review before NCLEX. Xo, me.
Oh hell yes
For future reference.
Must. Study.
Scheduled to post right before intern year starts. Gulp.
Reblog to save a life. You got this, bbs.
we need it all
As far as nausea goes, can we just wipe IV promethazine from everyoneโs brain as an option? It has such shitty evidence for efficacy yet for a lot of people the nausea treatment PRNs seem to go ondansetronโ>promethazineโ>??? At the very least you should read this ISMP article before ordering it. The article even includes a plea from a sweet bb intern about how badly it injured someone under their care. Itโs even illegal to administer promethazine via peripheral IV in some locations.
Other antihistamines can treat nausea. So can benzos, some antipsychotics, and sniffing a pad of isopropyl alcohol. All evidence-based options. Pinky-swear that weโre done with IV promethazine, ok? There, interns, youโve got this. And talk to your pharmacist if you need help from someone who isnโt gonna grade you. <3
