HouseStaff Handbook
This highlights key topics that all SAMC Family Medicine residents are recommended to acquire during their residency training. The topics included are routinely updated to reflect guideline changes and best practice recommendations. Other nuance topics that pertains to inpatient and outpatient rotations are included for guidance and expectations. Please utilize this handbook during your rotations.
General Information
Food
Free lunch at physician lounge West wing first floor (Code 135). Need to show ID Badge. Lunch ho...
Parking
Hospital Parking Park in the parking garage. Usually the gate open before 7AM but when it's clos...
Library
It is located on the 2nd floor near the Starbucks cafe, North Wing. Badge access is necessary. ...
Important Door Codes
Our Rounding room : 085# Sleeping Quarter: 4th floor 611# 6th floor doctors’ lounge 33115 From...
Sick, PTO, and Emergencies
If you need to take a sick day, PTO, and other emergencies, please contact our program coordinato...
How To
Inpatient Service
Signouts
Signouts occur at 7am and 7pm promptly on a daily basis. Do NOT be late. CORES on the EMR ...
Call Days
CALL days are designated as Monday’s and Fridays. Usually interns will do 24 hour shift on these ...
Admission Orders
Place admit order within 1 hour Go see the patient Do Medical reconciliation Place appropr...
Procedure Notes
Perform the procedure Find the appropriate procedure note in the EMR Complete the procedure ...
Death and Documentation
When called for a patient’s death, ascertain that the patient is unresponsive to verbal and tacti...
Common Calls From The Floor
Bradycardia
Evaluation Check if the patient is stable or unstable Get a complete set of vital signs and EKG...
Tachycardia
Narrow complex tachycardia Evaluation Obtain EKG and complete set of vital sign to check for he...
Hypotension
Evaluation Decreased SVR: Exam = warm extremities, sometimes flushing Sepsis: common cause. Obt...
Hypertension
Evaluation Physical examination Brain: headache, confusion, lethargy, stroke Eye: blurred visi...
Fever
Differential - Infection (lung, heart, brain, urine, sinuses, prostate, abdomen, skin, joints, l...
Low urine output
Normal urine output - typically at least 0.5 cc/kg/hr. - Oliguria: urine output < 400cc/day- Anu...
Dyspnea
DDx (5 major categories of disease to consider) Pulmonary Pneumonia = fever, purulent vs dry co...
Chest pain
I. DDx (Biggest killers) MI : Dull pressure pain associated with dyspnea, diaphoresis, radiatio...
Combative or Confused patients
Does the patient have altered mental status or is he/she upset over something? If there is any...
Falls
Evaluation/Management Assess patients at bedside. Look for any injury; any locality on exam must...
Insomnia
Trial non pharmacological measures first: sleep hygiene, noise reduction (ear plugs/muffs), reduc...
Acid/Base And Electrolytes
Hyponatremia
Definition Mild: Serum Na 130-134mmol/L Moderate: Serum Na 120-129mmol/L Severe: Serum Na <120...
Hypernatremia
Definition: Serum Na >135 mmol/L. Chronic means > 48 hours. Acute means < 48hrs. Etiology: R...
Hypokalemia
Definition: Serum <3.5mmol/L Etiology: Intracellular shifts: Hypothermia, Exogenous insulin/r...
Hyperkalemia
Definition Serum K+ >5.3-5.5 Etiology: Pseudohyperkalemia- K release from cells after blood dr...
Hypomagnesemia
Definition Serum Mg++ <1.8 mg/dL Etiology: Malnutrition (assc. with heavy chronic alcohol use ...
Hypermagnesemia
Definition Serum Mg++ >2.3 mg/dL Etiology: Insufficient excretion due to CKD Iatrogenic/exces...
Hypocalcemia
Evaluation: verify with repeat measurement that there is a true decrease in the serum calcium c...
Hypercalcemia
Evaluation: verify with repeat measurement that there is a true increase in the serum calcium c...
Hypophosphatemia
Evaluation: Serum phosphorus levels should be interpreted with concomitant evaluations of PTH, ...
Hyperphosphatemia
Definition Serum Phosphate >4.5mg/dL. Etiology/Risk Factors Increased intake (external...
Algorithm For Acid Base Disorders
Before You Begin: Gather Data What lab tests do you need? ABG vs. VBG VBG can provide reliable...
Assessment Of RTAs
Definition Renal tubular acidosis refers to an impaired acid-base metabolism by the kidney in th...
Cardiology
Rule out MI
Admit to Telemetry Tele-nurse may reach out to you for > 6 PVCs/min, atrial fibrillation, vent...
CHF
Definition A condition in which the heart is not able to pump enough blood to meet the body’s me...
Endocarditis
Overview Diagnosis requires 2 major, 1 major with 3 minor, or 5 minor criteria from the modif...
EKG reading made easy
Rates Normal: 60-100 bpm Tachycardia: > 100 bpm Bradycardia: < 60 bpm Readings Count the n...
Syncope
Syncope Rapid onset of transient loss of consciousness Inability to maintain postural tone It ...
Endocrinology
DKA
Diagnosis DKA vs HHS: DKA sugar ranges from 250 to 500 mg/dL HHS typically has sugars > 60...
Inpatient Diabetes Guidelines
Definitions Type 1 DM: autoimmune. Patients require exogenous insulin to prevent DKA. Type ...
Hypothyroidism
Definition Primary Hypothyroidism: High TSH and Low T4 Secondary (central) Hypothyroidism: Low ...
Hyperthyroidism
Symptoms and signs Signs of hypermetabolic state: restlessness, tachycardia, diaphoresis, hyper-...
Gastroenterology
GI bleed
Etiology The site of bleeding is only suggested by the patient’s presentation and physical exami...
Ascites
Definition Accumulation of peritoneal fluid Symptoms Abdominal Distention and discomfort Anor...
SBP
Definition SBP is a bacterial infection of the ascitic fluid. Diagnosis: PMN count >= 250 cell...
Acute Pancreatitis
Definition indicates inflammation of the pancreas. Acute pancreatitis: results from the leakage...
Alcoholic Hepatitis
3 Histological Stages Simple steatosis (usually reversible w/ abstinence in 4-6 wks) Steatohep...
Nausea
Nausea Nausea is the unpleasant sensation of about to vomit. This can occur alone or with vomit...
Constipation
Check if patient has Bowel Obstruction before giving anything PO Stool Softeners - Colace 100-25...
Hematology
Anemia
Anemia can be caused by many things but first we should get some basic labs such as CBC that will...
Sickle Cell Pain Crisis
Sickled cells occlude arterioles and cause tissue infarction, resulting in recurrent painful epis...
Blood Component Therapy
Packed red blood cells (PRBC): - Consent: Always consent the patient or family member for transf...
Transfusion Reactions
For all reactions (except mild allergic/uricaria): STOP transfusion, send remaining blood product...
Infectious Disease
Neurology
Pulmonary
CAP
Common causes Streptococcus pneumoniae (pneumococcus) and respiratory viruses are the most frequ...
Asthma/COPD Flare
Initial pharmacologic therapy Beta adrenergic agonists Dose and administration – Albuterol 2.5 ...
Oxygen Therapy
●Venturi masks permit a precise upper limit for the FiO2, preferable for patients at risk of hype...
ARDS/Mechanical Ventilation
Pathophysiology: Scattered, nonhomogeneous alveolar damage that leads to oxygenation (V/Q mismat...
Stepwise approach to managing Asthma
Intermittent (Step 1) — Symptoms — <2 days a week, <2x nighttime awakenings/month, SABA use <2 da...
Nephrology
Acute Renal Failure
What is AKI? According to The Kidney Disease: Improving Global Outcomes (KDIGO), which it the mo...
Chronic Renal Failure
Definition GFR <60 for 3 months or more AND/OR presence of kidney damage (albuminuria, sedimen...
Indications for Dialysis
Acute Indications: Volume overload refractory to diuresis Severe hyperkalemia (K >6.5 mEq/L) or...
Newborn Service
Toxicology
ETOH Intoxication
Management: Ensure airway, adequate respiratory drive, and management of secretions/emesis Thia...
Acetaminophen Overdose
Check Acetaminophen levels and urine toxicology for co-ingestions Call poison control NGT, lava...
Salicylate Overdose
Check salicylate level and check urine toxicology for co-ingestions. Try to determine whether sal...
TCA Overdose
Call poison control. Check urine toxicology for co-ingestions esp. salicylates , acetaminophen....
Cocaine Overdose
Call Poison control ABCs, vital signs, Tele monitor Diagnosis EKG, CXR, head CT if suspect c...
Opiate Overdose
Effects CNS - sedation and respiratory depression, seizures w/ meperidine, propoxyphene and dext...
Carbon Monoxide Inhalation
Symptoms depend on CO level (carboxyhemoglobin) CO: 20-40%: Dizziness, headache, weakness, distu...
OB/GYN
Rotation expectations
Call group (only cover patients of the following): Dr. Vishwanath Dr. Dickinson Dr. Marquez D...
Routine Visit Schedule
The first visit of prenatal care typically occurs in the first trimester. The frequency of follow...
Routine Testing Intervals/Schedules
Initial Visit or First trimester visit: Prenatal Panel: CBC, GC/Chlamydia, HIV, Rubella, RPR, HB...
Pregnancy Dating
Step 1: Document First day of the last normal menstrual period then use Nigel's rule or use uptod...
Fetal Well-Being
These are ways used to establish fetal well being: Fetal movement count Non-stress test Contra...
Intrauterine Growth Restriction
Definition Sonographic EFW <10th percentile Etiology Maternal factor: Behavioral (smoking, sub...
Nonstress Testing
Contraindications: Gestational age <24 weeks Interpretation: >32 weeksReactive NST: two fetal ...
Contraction Stress Test
The contraction stress test is interpreted by the presence or absence of late fetal heart rate de...
Biophysical Profile
Scoring: The non stress test (2), fetal breathing movement (2), Fetal tone (2), Fetal movement (2...
Fetal Heart Rate Monitoring
BASELINE FHR The normal FHR range is between 120 and 160 beats per minute (bpm). The baseline ra...
Laboratory Values in Pregnancy
Lab values in Pregnancy
Bishop Score
The Bishop score may be used to rate the readiness of the cervix for labor. Scores ≤ 5 suggest ...
Recurrent Pregnancy Loss
Definition 3 or more consecutive preg losses before 20wk gest or after 2 consecutive losses, esp...
Hyperemesis Gravidarum
Definition Nausea and vomiting in pregnancy that significant enough to cause dehydration, metabo...
Hypertension in Pregnancy
Definition Chronic HTN: SBP greater equal to 140 or DBP greater equal to 90 prior to 20 weeks or...
Vaginal birth after Cesarean
Appropriate candidates Hx 1-2 C-section via low transverse hysterotomy. Inappropriate candidat...
Post Dates Management
Review gestational dating AFI/BPP and NST at 41 weeks and repeat once to twice a week Consider ...
Gestational Diabetes
Universal screening start at 24-248 weeks. Consider screening earlier in all women with BMI >25 ...
Twins
At risk for hyperemesis, GDM, HTN, hemorrhage, cesaeran, postpartum depression, preeclampsia, pre...
ER precautions in Term Pregnancy
Regular painful contraction every 5 minutes (nulliparous) or every 10 minutes (multiparous), or s...
Medication in Obstetrics
Minimize all medication use during pregnancy (especially in 1st TM), unless clearly indicated! F...
PAP Smear Referral Guideline
Algorithm 2013 Univ Washington
PEDS
Immunization Schedule
ACLS Protocols
Outpatient Service
Expectations
Outpatient Preceptorship Precept all patients with attending All Residents should: ...
Morning Report
Mon and Tue from 8-8:30AM Location: NW Clinic Back Conference Room MonBoard Review Questions ...
Stanford Diabetes ECHO
GME SAMC IM and FP have signed a collaborative agreement with Stanford University's Diabetes ECHO...