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Home r/Residency • 4 yr. ago

supracondylar2
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tips for a new intern on cCU Residency
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TOPI C S About 3 weeks into residency I'll be thrown into 2 weeks of cardio nights followed by 3 weeks of CCU. Anyone have some tomorrow night. Welcome to the Residenc…
tips on how to survive / common conditions to review before starting? Thanks!
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r/Noctor

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COVID_DEEZ_NUTS • 4y ago
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STEMI, CHF, Diuretics, how to replenish K and Mg, A-fib w/ RVR management, how to read an EKG, and most r/Noctor

importantly, how to page you senior. Maybe look at ionotropes if you are covering a cardiac ICU How is this allowed?
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drpcv89 • 4y ago
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Your experience will depend a lot on what your program calls "CCU", some places is purely cardiac critical care,
Help others is a mix of tele floors with CCU, and a chest pain unit. Varies a LOT. In my (limited) experience the most Midwife fined $300,000 for
common things you'll see in a mixed setting are the following: falsifying the vaccine records o…
Blog
1.Chest pain w negative troponin and no STEMI: Know the diff between anginal chest pain, atypical cp, and non- 371 upvotes · 32 comments
cardiac chest pain. Unstable Angina is sometimes difficult to dx and have to have a very high clinical suspicion,
Careers
however most people wont have it. These people you will also end up "stressing". There are different modalities
TOP POSTS
but usually are two parts to a stress test: the "stress" part and an "imaging" part.
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Reddit
-Stress: Exercise or pharmacological (Ragadenosine or dobutamine)
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reReddit: Top posts of June 19, 2020
-Imaging: EKG only, Echo, or SPECT ("nuclear imaging")
POPU L A R POSTS
-Exercise is always preferred if possible, unfortunately most people cant even last 1 minute on a treadmill. Each Reddit
study has its drawbacks and each institution has a preference for each test.
English / Global reReddit: Top posts of June 2020
-Most people with "positive" or "high risk" stress tests will get cathed (aka left heart cath, coronary angio). Wether
Deutsch this is the right way to go is a point of contention in cardiology and will vary by attending, you will hear a lot Reddit
about the COURAGE and ISCHEMIA trials.
Español reReddit: Top posts of 2020
-CT heart is a separate modality and usually at my place we reserve it for young otherwise healthy people,
remember that this does not have a "stress" part so it is mostly an anatomical test to look for coronary calcium.
(For example this would be useless on people with ESRD).

2. NSTEMI: Ideally you could read the NSTEMI guidelines, this might be too much, so you can download the "ACC
guideline App" it has most conditions in there and the mangement.

Most NSTEMIs do not need immediate LHC, unless the CP does not go away nitro drip, shock, pulmonary edema,
or if the EKG starts looking like a STEMI. Your fellow should be informed in any of these cases.

Otherwise the tx is pretty standarized, anticoagulation (heparin or lovenox), DAPT (ASA, P2Y12, brillinta/ticagrelor
is preferred but keep cost in mind), BB (if not in shock), ACEi will depend on co-morbidities, disease, etc. See the
app I recommended.

3. STEMI: Most of them you will see after the cath lab (if they are comming from the street), know the post MI
complications.

4. Afib (with RVR): Try to find a reason why the patient is on RVR (infection, bleeding, thyroid, substance use,
volume overload). If patient is unstable, shock. If BP is stable you will usually start some rate controlling
medication. IV BB careful if in shock, careful with IV CCB if you dont know their LV ventricular function. Also
anticoagulate, at least with a drip, as most patients will require a cardioversion, wether they need long term AC
will depend on CHADSVASC scoring. Some people will need a rhytm control strategy.

5. HF: Varies a lot how sick they are, if you have a dedicated HF unit, etc. Overall, dont be afraid of diuretics, go
hard on them, make the patient's as dry as you can. Try to maximize GDMT (BB, ACE/ARB/ARNI, Spironolactone,
etc-HFrEF, for HFpEF there is limited benefit from those meds, maybe just Spiro).

Cardiology is a great field, there is so much data/trials out there and is easy to get overwhelmed but always ask
for help when in doubt! Try to learn (during your rotation), the basic echo views, these will help you throughout
your IM residency. If your program is heavy on POCUS this is also a great time to learn. And last, the worst thing
you can do is discharge a patient without meds, do not discharge a patient until they have their meds in their
hands, stents will thrombose without dapt.

Good Luck! Lmk if you have any questions

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stainedglass01 • 4y ago

COVID

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BigRodOfAsclepius • 4y ago

IABPs, LVAD, Swan Ganz, ECMO. Basically anything related to cardiogenic shock and advanced heart failure

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13Hackslasher • 4y ago

Lasix. If it bleeds or its blocked, call the surgeons. Dont mess this up.

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