Ward Calls

The intern suppository


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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)

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Ward CallsBy Sam Holford