Internal Medicine Residency

“Residency” is a training period that follows medical school. Every licensed, practicing physician in the U.S. must successfully complete three or more years of residency training. This section includes posts authored during or about my time training as an internal medicine resident physician.

ACLS Protocols

As a senior internal medicine resident on night float and overnight call, I’m responsible for running to codes and rapid responses.  Rapid responses at my institution are critical patient situations that require urgent bedside attention for things like symptomatic supraventricular tachycardia, new typical chest pain, hemodynamic instability, etc.  Today after work, I wanted to brush up …

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HFpEF Treatment

These patients tend to be very VOLUME SENSITIVE. Daily weight checks – get an accurate bathroom scale. No medications have proven mortality benefit. Treat causes Hypertension – lower the patient’s blood pressure Tachycardia – AV nodal blockade depending on etiology.   Bibliography ACP MKSAP 17:  Cardiovascular Medicine, pp. 32-34 Image credit (follow link)

HFrEF Medical Treatment

Heart Failure with Reduced Ejection Fraction (also known as systolic heart failure) is broken up into two phases of treatment:  the acute (on presentation to the hospital) and chronic (long-term to prevent re-hospitalization). Acute Exacerbation Treatment DIURETIC (urinate off all the excess fluid in a volume-overloaded patient) ACE inhibitor or Angiotensin Receptor Blocker (ARB) contraindicated if …

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Heart Failure Pathophysiology and Diagnosis

Pathophysiology In an average healthy person, normal LV ejection fraction (LVEF):  >50% Roughly 50% of those with heart failure have reduced left ventricular (LV) function (HFrEF) Heart cannot squeeze/contract properly, and then progressively dilates. The other 50% have preserved (normal contraction) LV function (HFpEF) Cannot relax properly, leading to high diastolic (filling) pressures. New heart failure …

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