The intern suppository

Dr Ivor Popovich presents examples of evidence-based decision making during ward calls. We also highlight some recommendations from Choosing Wisely and give an update on death certification.

• The Intern Suppository – Ivor’s EBM blog
• The Rational Clinical Examination – JAMA
• Plain film in small bowel obstruction
  • The gas-less abdomen
  • Paucity of gas
  • Non-specific bowel gas pattern
  • Read more in the blog post here
• Plasmalyte in renal failure
  • Not contra-indicated
  • Actually alkalinises plasma, driving potassium into cells
  • The chloride in NaCl acidifies plasma, drawing potassium into the extracellular space
  • Read more in the blog post here
• Asthma admission
  • Tachycardia is not explained by salbutamol administration alone
  • A large diurnal variation in peak flow (e.g. >50%) is a major risk factor for in-hospital cardiac arrest (not severity of asthma exacerbation at admission).
  • Severity of wheeze does not correlate with severity of exacerbation
  • Read more in the blog post here
• Choosing wisely
• New Death Documents website
• MOH Completing the Medical Certificate Cause of Death form (March 2018)
• MOH Examples of incorrect and correct cause of death certification (March 2018)