General Hospital Medicine&nbsp;&nbsp;&nbsp;

How do you approach caring for patients admitted with decompensated CHF, but who also exhibit hypotension and do not have overt signs of hypervolemia on exam?

For example, do you consider "cautious" IV fluids or otherwise consider early vasopressors?

5 Answers available

Do you recommend that your patients with COPD avoid gabapentin or pregabalin entirely, given the increased rate of exacerbations noted in patients on these medications?

Rahman et al., PMID 38224592

How would you manage a patient with necrotizing pneumonia due to a susceptible Pseudomonas aeruginosa strain who continues to have significant purulent secretions and worsening imaging while receiving cefepime?

Do you recommend IV sodium bicarbonate for patients with rhabdomyolysis and AKI without metabolic alkalosis or hypocalcemia?

What is your approach when a patient has concomitant acute decompensated heart failure and rapid atrial fibrillation?

Does your approach change depending on whether and how long the patient has been anticoagulated?

How do you weigh the risk of urinary catheter or fecal management system placement with that of soiling sacral wounds?

If placed for this indication, how do you decide when to remove?

When do you recommend limited or targeted respiratory pathogen testing versus a full respiratory pathogen panel in a patient presenting with URI symptoms?

In other words, are there benefits to identifying URI pathogens that do not necessarily have targeted therapies (e.g., rhinovirus, non-COVID-19 Corona...

For patients with newly diagnosed VTE on IV heparin planned for transition to DOAC, would you start at the loading or maintenance DOAC dose?

If they have been on IV heparin for 3 days, for example, would you subtract those days from the recommended loading dose time?

5 Answers available

What are some practical tips for when a patient's consistently stated goals of care do not correlate with their actions?

For example, what do you do when someone requests aggressive, life-prolonging treatments but then is not receptive to elements of day-to-day care in t...

4 Answers available

How do you consider sending fungal studies in a patient with pneumonia?

When do you have consider sending them as part of your initial workup?

How do you decide which IV opioid to use for symptom relief at the end of life?

How do you decide between anticoagulation and observation for an incidentally detected subsegmental pulmonary embolism in elderly patients with a history of gastrointestinal bleeding?

7 Answers available

When can we consider deferring an insulin drip in patients with hypertriglyceridemia-induced pancreatitis?

If the patient does not have underlying diabetes, do the benefits of an insulin drip for this indication outweigh the risks?

How do you manage catheter-associated, upper extremity superficial venous thrombosis?

Do you prefer anticoagulation? Is there a role for aspirin? How strongly do you recommend line removal?

Do you use MRSA nares PCR to influence antibiotic selection for non-respiratory infections?

Do you recommend providing supplemental oxygen for patients with a pneumothorax in the absence of hypoxemia?

What are your thoughts on trending beta-hydroxybutyrate once a diagnosis of DKA is already established?

Do you find it helpful to monitor for treatment response, resolution, and/or recurrence?

How do you weigh the benefit of urinary catheter placement for strict I/O measurement with the risk of avoidable CAUTI?

How does your approach vary by indication (critical illness, acute renal failure, hyponatremia, diuresis, etc.)?

How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?

How do factors like the presence of varices, severity of coagulopathy, etc., play into your decision?

How do you recommend incorporating B-lines on lung POCUS as part of evaluating a patient's volume status?

In particular, how do you reconcile situations where lung POCUS findings contradict other components of volume assessment (e.g. JVD, peripheral edema,...

When giving albumin challenge, for acute kidney injury with suspected hepatorenal syndrome, do you administer a single dose daily or split the dose of albumin?

Do you routinely discontinue atypical coverage in community-acquired pneumonia when PCR testing (i.e., respiratory pathogen panel) is negative for atypical organisms?

Would you start octreotide in a patient with suspected sulfonyurea overdose but without frank hypoglycemia?

How do you decide on supportive care vs empiric antibiotics in a patient with suspected aspiration pneumonitis (i.e., witnessed macroaspiration event within the past 24 hours) but with features that could suggest pneumonia (e.g., acute respiratory distress, fever, leukocytosis, pulmonary infiltrates, etc.)?

Is it clinically necessary to provide supplemental oxygen to patients with mild, asymptomatic hypoxemia only during activity while they are recovering from an acute respiratory illness?

What is your preferred laboratory test to assess treatment response or infection resolution in patients with bacterial pneumonia?

For example, do you find trending WBC, procalcitonin, CRP, etc., more or less helpful?

Do you always stop dexamethasone at discharge for patients admitted with COVID requiring respiratory support (as done in the RECOVERY trial), or are there situations in which you will prescribe it to complete a 10-day course?

What situations prompt you to prescribe dexamethasone to complete a 10-day course at discharge?

Do you maintain a strict platelet threshold of >50k when performing a lumbar puncture, or are there situations in which you feel comfortable with a lower threshold?

While many US guidelines have supported a threshold of > 50k, there does not appear to be robust data to support it. Notably, the 2025 AABB and ICT...

Should long-acting subcutaneous insulin be started upfront in addition to regular insulin infusion for patients with diabetic ketoacidosis?

4 Answers available

What do you think about using conventional thoracic imaging methods (e.g., X-ray, CT, etc.) to determine if a pleural effusion is of adequate size to consider thoracentesis?

How do you rule out empyema in a small pleural effusion that is not amenable to thoracentesis?

How would you decide on the duration of antibiotics in this case?

Would you consider using steroids in patients with respiratory failure caused by aspiration pneumonitis?

Under what circumstances do you recommend POCUS guidance for lumbar puncture?

How do you decide the maximum amount of volume to remove during a therapeutic thoracentesis?

Do you use the traditional strict limit of 1.5 L, or do you consider removing more volume if a patient appears to tolerate it?

How do you decide whether to use lung POCUS versus CT as the next step when a chest X-ray is equivocal for pneumonia?

How do you use cardiac POCUS to potentially defer formal echocardiogram in patients presenting with an acute pulmonary embolism?