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Prophylaxis for deep vein thrombosis (DVT) and pulmonary embolism (PE), together referred to as venous thromboembolism (VTE), must be addressed for every patient going to the operating room. Multiple guidelines are available to assist choosing the correct prophylactic agent for each patient and type of surgery. The American College of Physicians (ACCP) guidelines have been one of the standards for hospitalist for decades but was last updated in 2012 (1) and recommendations and suggestions are based on the type of surgery. The American Society of Hematology (ASH), which put forth their first guideline in this field in 2019 (2), took a broader and slightly more universal approach to prevention strategies. The authors of this module bring forth a blended approach of these two guidelines with an emphasis on the newer guideline.
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$95.00
Perioperative fever has multiple possible etiologies, including infections such as pneumonia, fungal infections, central-line associated infections, and urinary infections. By understanding the typical time frame and common risk factors for each etiology, hospitalists and other perioperative consultants can develop a differential diagnosis for perioperative fever. The following module will provide a general approach for determining the differential diagnosis in patients with a perioperative fever, as well as an outline of the diagnostic and treatment modalities.
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$95.00
Acute kidney injury (AKI) is an important complication following cardiac and noncardiac surgery. Up to 18% of hospitalized patients develop AKI, and those who are critically ill have an even higher risk. Comparatively, the incidence of AKI in the perioperative period is 18-47%(1). Patients with even modest increases in their serum creatinine have increases in their mortality, morbidity, length of stay, and hospital costs. Perioperative AKI is associated with an increased risk of sepsis, anemia, coagulopathy, and mechanical ventilation. Notably, mortality is higher in patients with perioperative AKI even after complete renal recovery(1). Perioperative AKI correlates with type of surgical procedure, patient characteristics, volume status, hemodynamics, and exposure to nephrotoxins. Presurgical risk stratification and early risk mitigation is extremely important to avoid injury and need for renal replacement therapy (RRT). The following module defines perioperative AKI, identifies specific risk factors and tools for risk stratification, provides an overview of the workup of perioperative AKI, and evaluates various renal protective strategies that can be implemented during this high-risk period.
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$95.00
Medical consultation is an important clinical responsibility for most hospitalists. Traditionally, consultants evaluated patients at the request of the referring physician (RP) and provided an assessment and recommendations. Today, hospitalists are also asked to provide both informal “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The following module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communication and RP satisfaction.
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$95.00
Pain is probably the most common presenting or associated symptom in patients in the hospital, and patients are often more concerned about being in pain than they are about the primary reason for admission. Pain is a completely subjective experience that is the consequence of the filtering, modulating, and distorting of the afferent nerve activity (i.e., nociceptive input) through the affective (i.e., limbic system) and cognitive processes unique to each individual. The following educational module discusses why postoperative pain requires treatment, outlines methods for performing a proper assessment of pain, provides strategies for utilizing patient-controlled analgesia safely and effectively, and summarizes the use of opioid and non-opioid analgesics in the postoperative setting to help hospitalists improve patients’ quality of recovery and life.
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- 2.00 ABIM ...See more
$95.00
Atrial fibrillation is the most common arrhythmia in the postoperative period. It is important that hospitalists understand the current management of postoperative atrial fibrillation (AF) because it is a frequent reason for consultation. Postoperative AF after noncardiac surgery has been associated with risk of thromboembolism, myocardial infarction, and mortality. The following module addresses the incidence, natural history, risk factors, prevention, clinical significance, evaluation, and management of newly diagnosed postoperative AF after non-cardiothoracic surgery.
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- 2.00 ABIM ...See more
$95.00
Although obstetricians play the most critical role in the health of a pregnant woman and her fetus, the internist’s skills are also often needed to assure their health. From caring for chronic medical illnesses during pregnancy to diagnosing and managing acute medical complications of pregnancy, the internist must comfortably practice obstetric medicine. The following module discusses these important topics and explains how to provide a cost-effective and evidence-based preoperative evaluation of a pregnant patient. In addition, a discussion of the use of appropriate intraoperative and postoperative interventions and methods for employing an evidence-based approach to prescribing medications in pregnant patients is included.
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