Workroom
What to say on rounds
A guide for medical students and interns on a hospital medicine team. Choose the patient’s problem. Each topic gives you four lines: the problem, the main danger, what you are doing, and one question for your senior.
Emergencies
Start here if the patient may be unstable. Read the four lines, and call your senior if you are not sure.
Admissions
Common problems you will present on a hospital medicine service.
Treatments
The antibiotic for the infection, intravenous fluid, and the laboratory values that need treatment now.
Assessment and plan
How to turn the history, the exam, and the data into a note you can present. Follow the steps in order.
Cheat sheet
A short list of the first action for common problems. Open the full topic above if you need the reasoning.
Act now
The first action for this problem.
Sepsis
Antibiotics within the hour
Low blood pressure
Norepinephrine. MAP 65
Chest pain
ECG within 10 minutes
Confused
Check the glucose first
High potassium
ECG. Calcium if it changed
No pulse
Compress. Do not stop
Thresholds
Past this number, the treatment changes.
pH under 7.35
Start BiPAP
Potassium under 3.5
Hold the insulin
Unstable atrial fibrillation
Cardiovert
Low ejection fraction, fast AF
No diltiazem
Volume overloaded, creatinine up
Keep the diuretic
Glucose under 54
Treat it now
Standard orders
The usual choice when nothing above applies.
Ward pneumonia
Ceftriaxone + azithromycin
Sepsis, source unknown
Piperacillin-tazobactam or cefepime, plus vancomycin
COPD flare
Prednisone 40 mg for 5 days
Oxygen in COPD
Keep it 88–92%
Needs volume
Lactated Ringer’s
Meningitis, over 50
Add ampicillin
Study notes
Short notes for reading before a shift. Use the topics above when you are about to present.
The team and the day
Who does what, how the day is organized, admission orders, and how to sign out.
Illnesses to review
The same problems as the lists above, written for review before a shift.
Drugs and emergencies
The antibiotic for each infection, intravenous fluid, a code, and potassium, sodium, and glucose.
The longer version is Rounds.