2021年11月21日 · Welcome to the online home of the Vanderbilt Internal Medicine Residency Handbook (VIMBook.org). The Handbook is a peer-reviewed, yearly-updated, publicly-available resource, currently in its 6 th Edition (2024-25). Chief Editors for the 6 th Edition: Spencer Lessans, MD, Julie Giannini, MD, and Kristijan Bogdanovski, MD

Welcome to the online home of the Vanderbilt Internal Medicine Residency Handbook (VIMBook.org). The Handbook is a peer-reviewed, yearly-updated, publicly-available resource, currently in its 6thEdition (2024-25).

Background ACC / AHA Stages of HF Stage A: At risk but without structural heart disease, symptoms, or cardiac biomarkers Stage B: no symptoms/signs of HF; presence of structural heart disease, incr filling pressures, or incr cardiac biomarkers Stage C: + structural HD, + prior or current symptoms Stage D: marked HF, symptoms interfere with daily life and recurrent …

Background ¶ AF: 12-lead EKG with absence of p-waves and irregularly irregular QRS complexes Flutter: sawtooth atrial F waves (300 BPM) with regular or regularly irregular QRS complexes Ventricular rate ratio of F waves: V waves ~150 (2:1), ~100 (3:1), or ~75 (4:1) 3 classifications Paroxysmal (terminates within 7 days) Persistent (persisting beyond 7 days) Permanent …

Background Completely or partially occluding thrombus on a disrupted atherothrombotic coronary plaque leading to myocardial ischemia/infarction STEMI: Elevated troponin & elevation in ST segment or new LBBB with symptoms > 0.1 mV in at least 2 contiguous leads Exception, in V2-V3: > 0.2 mV in men older than 40 y/o > 0.25 in men younger than 40 y/o > 0.15 mV in women …

Many antiemetics prolong QTc, however in patients without underlying cardiac conduction abnormality, electrolyte abnormality, or organ failure the risk of QTc prolongation leading to significant arrhythmia is low. Obtain screening EKG in patients with underlying heart disease, electrolyte abnormalities, organ failure or on other QTc prolonging meds (antiarrhythmics, …

Evaluation ¶ Confirm hyperkalemia with repeat BMP Check EKG for hyperkalemic changes (sensitivity for EKG findings in hyper K is poor) K+ 5.5-6.5: peaked T waves, prolonged PR interval K+ 6.5-8: prolonged QRS, loss of P wave, ST elevation, ectopic beats K+ >8: sine wave pattern, asystole, PEA, VF K+ 5.5-6.5: peaked T waves, prolonged PR interval K+ 6.5-8: …

Most have order sets in Epic. Typically choose Titration Allowed” in ICU Vasopressors

Background ¶ A syndrome of diffuse systemic inflammation which damages the alveoli/capillary endothelium interface causing fluid and protein accumulation within the interstitium and alveoli leading to impaired gas exchange, decreased lung compliance, and pulmonary hypertension. ARDS new definition: Onset within 1 week of known insult with new/worsening respiratory …

Background ¶ Infection of ascitic fluid without evidence of a surgical intra-abdominal source Present in approximately ⅓ of patients with cirrhosis who are hospitalized Presentation: fever, abdominal pain, encephalopathy, renal failure, acidosis, and/or leukocytosis Pathophysiology: Combination of GI bacterial flora overgrowth, reduced liver protein production (low …