Acidemia is a serious condition that leads to hemodynamic repercussions if unattended. Acidemia decreases cardiac output by affecting myocardial contractility and reducing afterload, also causes a relative tachycardia, which decreases the filling time of the ventricle. However, the evidence to give bicarbonate is not that robust. For example, should we give bicarbonate during cardiac arrest? … Read more
The CMS 1995 Documentation Guidelines for E&M Services begins with a list of general principles of medical record documentation. Number two on the list behind “the medical record should be complete and legible” is “the documentation of each patient encounter should include a reason for the encounter” (chief complaint). The Guidelines later go on to … Read more
Patients present inconveniently. Not only do they come in to the hospital at all hours of the day and night, but they may come in with symptoms that don’t suggest an immediate diagnosis. Clinicians (and nurses) have variable degrees of comfort with uncertainty, and let’s face it, when our health is at stake, we all … Read more
Diagnosing, treating, monitoring, and transitioning our patients are core skills for hospitalists. We work in a high risk, high reward environment. The risk is taken by the patient. For us, the risk is medico-legal. The reward of recovery from illness goes to the patient. For us, the reward is professional and personal satisfaction. In order … Read more
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