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Intern Cheatsheet Cheat Sheet (DRAFT) by

For IM residents in medicine

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Admissions

STEP ONE: ED Admit Tab -> Order Reconc­ili­ation: Here you will reorde­r/d­isc­ontinue home medica­tions. Be sure to ask patient which medica­tions they are actively taking. Dispense Report is a great tool for this

STEP TWO: Add "Medicine Admission Order Set", important tips below:
- Treatment Team: For overnight admissions "­Med­icine Resident Admiss­ion­s", all others, use the team you are on.
- Code Status: MUST ASK every time you do an admission.
- Diet: Usually regular, however NPO for aspiration risk, renal/Low K for HD pts, DM Liberal for diabetics
- Pain Regimen: Usually 500mg Tylenol q6 is fine. Avoid Tylenol in Liver Failure patients.
- VTE ppx: Lovenox for most EXCEPT those with AKI/CKD (Heparin for kidney patients); SCDs for those with bleeding risk
- Labs, daily BMP/CBCd for most, PT/OT

Important MDCalc to Save

NIH Stroke Scale (NIHSS)
Self-e­xpl­anatory
Corrected QTc
Corrects QT interval for manual calcul­ation.
Wells' Score for PE
Risk of PE
Child-Pugh Score
Cirrho­tics, helps guide tx
Sodium Correction for Hyperg­lycemia
Recalc­ulates Na in hyperg­lyc­emics1
SIRS & Sepsis Criteria
Determine whether meets sirs vs sepsis criteria
1: do NOT correct for Sodium when calcul­ating Anion Gap (ex. DKA)
  

How to Discharge a Patient

M
Med Rec
Cont/Dc home meds, prescribe new meds, call Meds to Beds
O
Discharge Order
Discharge vs Condit­ional Discharge
I
Discharge Instruc­tions
Plain English for patients (not needed for SNF)
S
Discharge Summary
Include hospital course and to-do for OP providers. Can Use .MCDIS­CHARGE at end of default note
T
Time for Appts
Referrals Placed and f/u appts -> Unit Secretary vs msg "CC Virtual Desk"
- Meds to Beds #: 87364. Have patient MRN ready and just confirm new meds.
- Cardiac Monitor #: 85117
- Keep up with SW/PT/OT notes, they help with dispo planning

Electr­olyte Repletion

Electr­olyte
Dose
Δ
Potassium
10 mEq (PO, IV)
+0.1
Magnesium
1000mg (IVPB)
+0.1
- For cardiac patients (A Fib, HF, etc), keep K > 4, and Mg > 2.
- For Potassium, PO tablets are large & hard to swallow, PO liquid has poor taste, and IV can burn.
  

Checklist Prior to Signing Out (NO DUH)

N
Notes
Notes should be signed
O
Orders
Should be done from rounds
D
Discha­rge­/Tr­ansfers
Complete discha­rges, SHARE transfer notes
U
Update Family
Call to update family on major changes
H
Handoff
Update treatment plan and to-dos.
- For handoffs, ANTICIPATE needs of night team in terms of pain contro­l/blood mgmt. Only pertinent to-dos. Actionable follow-ups ONLY (ex. "f/u 10 PM BMP for hypoK and replete PRN")
- IPASS (Illness Severity, Patient Summary, Action List, Situation Awareness, Synthe­sis): watcher vs stable status, summarize patient, to-dos, situat­ional awareness (ex. patient interm­itt­ently hypote­nsive overni­ght), ensure unders­tan­ding)