• Document: Intern Night Float Survival Guide. SUNY Upstate Medical University
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Page 1 Intern Night Float Survival Guide ‘Your guide through the dark’ SUNY Upstate Medical University List of Topics: Page Number Leaving Against Medical Advice (AMA) 4 Constipation 4 Pain Control 5 Acute Anemia 6 Low Urine Output 7 Hypoglycemia 8 Chest Pain 9 Arrhythmias/ACLS 10 Atrial Fibrillation 11 Hypertension 12 Acute GI bleed 13 Shortness of Breath 14 Oxygen Delivery system 15 Electrolyte Replacement 16 Hyponatremia 17 Hyperkalemia 18 Abdominal pain 19 Hypernatremia 19 Insomnia 19 Hyperglycemia 19 Agitation/Confusion 20 Fever 21 Sepsis 22 Phone Numbers 23 Page 3 INTRODUCTION Welcome to world of ‘night float’. Night float is a unique rotation which gives you the autonomy of making many clinical decisions. Remember, ‘with great power there must also come - great responsibility! (Ref: Ben Parker, Spiderman), after all, you are ‘cross covering’ for other physicians’ patients. This book has been assembled by senior / chief residents as well as faculty members to help you with important tips and tricks to guide you through your night float rotation. It includes topics which the night float is most commonly contacted about by nursing staff. Each topic includes the information you need to obtain from nursing staff /chart and possible differential diagnosis and management based on etiology. Although this book has several helpful hints and references, please remember to use your clinical judgment in each individual case. Remember: you always have your senior with you! We look forward to working with you and we know it will be a great year! We also look forward to hearing any suggestion / tips from you to make this manual better. Sincerely, SUNY Upstate Medical University. Department of Internal Medicine. RESIDENT AUTHORS FACULTY MENTOR Rushikesh Shah. M.B.,B.S. Amit Dhamoon. MD, PhD. Viren Kaul. M.B.,B.S. CONTRIBUTING AUTHORS Omair Chaudhary. MD. Syed Wajihuddin. M.B.,B.S. Harvir Singh Gambhir. M.B.,B.S., M.D. Priyanka Pitroda. MD. Arpan Patel. MD. Aditya Kalakonda. MD. Subhash Sitaula. M.B.,B.S. Aakriti Pandita. M.B.,B.S. Sumendra Joshi. M.B.,B.S. Pallawi Kopparty. M.B.,B.S. Shalin Kothari. M.B.,B.S. Page 4 PATIENT LEAVING AGAINST MEDICAL ADVICE CONSTIPATION • Discharge against medical advice (AMA) is a situation in which a patient chooses to leave the • Defined as decrease in frequency ( < 3 BMs / week) or hospital before the treating team recommends change in consistency to hard / lumpy stool or difficulty discharge. in evacuation with feeling of incomplete evacuation. • Prior to prescribing medications, ensure patient is not • Review patient’s chart and ensure that patient does obstructed. Is the patient passing flatus ? Any vomiting not have a condition that impairs his / her capacity to ? Abdominal pain ? If concerned, examine for signs of make decisions. e.g psychiatric problems, mental surgical abdomen. retardation, encephalopathy, delirium. • Review the chart to for medications which can cause • Suicidal patient, or patients admitted after attempting constipation: opioids, anticholinergics, 1st degree to commit suicide are not allowed to leave unless antihistaminics. specifically recommended by psychiatry. • Evaluate patient’s bowel medications. (All patients • Review sign out for instructions from primary team. with opioids should be on bowel regimen) • Once dynamic obs

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