CONSULT PRO TIPS PULM:

1. ABNORMAL IMAGING:
FOR ALL CONSULTS: DO YOUR OWN WORK UP!!!
1. Know the patient’s MRN, name, age, gender, and room number.
2. Have a question.
3. Know the patient’s VS (AKA are they stable or not?).
4. Check the last clinic note! (notes>filters>specialty)
CARDS:
1. ISCHEMIA:
a. Recent and old EKGs.
b. Full set CEs (and serials pending).
c. Old cath and non-invasive study results.
d. Last TTE.
2. ARRYTHMIAS:
a. Have recent and old EKGs and any event strips if on tele.
b. Have recent chemistry and TFTs.
c. Caths and TTEs as above.
d. ?Any exam findings c/f valve dz or cardiomyopathy?
e. If the pt has new heart block, EP can place PM.
ID:
1. GENERAL CONSULT:
a. Know the results of the previous cx and imaging results.
b. Know the abx the patient are on/has been on and the
duration.
2. FUO:
a. Know results of previous cx, imaging, bx, ESR, CRP, and
connective tissue dz studies.
b. Know results of, or perform, fluid taps on all tap-able
sources prior to consult.
c. Consider consulting rheum (instead/as well depending on
above results).
GI:
1. GI BLEED:
a. Know the pt’s H/H on initial presentation (and know their
baseline).
b. Know the pt’s H/H after transfusion and how many units
they’ve received.
c. Know the pt’s coags and plts.
d. Know the results of the pt’s NG lavage (if you did one).
e. Know the trends of the patient’s VS. Persistently tachy or
hypotensive?
f. Know the results of the previous EGD/colonoscopy!!!
i. Variceal re-bleeds are VERY BAD vs just simple PUD.
a. Please obtain CT chest PRIOR to consulting!!!
b. Know meds current, recent, and past.
c. Know THOROUGH social history.
d. Know smoking history especially!
e. Any autoimmune/CTD labs done and their results.
f. ABG results if available.
g. Has the pt ever required oxygen at home, in hospital, or
been ventilated?
2. BRONCH:
a. Know what you’re looking for, but they’ll decide if IR bx
would be better.
b. Know if they’re on anticoagulation.
c. Know last hgb, plts, INR.
d. Effusion to tap? Tap first!
e. Bronch or lung bx in past? Results?
f. Do they have TB? (airborne precautions)
3. ILD:
a. Results of prior CXRs and CTs.
b. Recent PFTs.
c. PMH (autoimm dz), medication hx (pneumotox!), occupation
hx, infectious w/u?
d. Make sure volume status optimal, then obtain HRCT.
4. “PH”: Do they really have it?
a. PLEASE KNOW THE RHC RESULTS AND INTERPRET THEM
APPROPRIATELY!!!
b. Know last TTE.
c. Make sure PH w/u is done – look up types I-IV.
i. HRCT and/or CTA or VQ scan, TTE, PFTs, PSG, HIV,
Heps, autoimmune w/u
RHEUM: (Always know baseline values of below labs if known!)
1. SLE/RA/Sjogrens/Scleroderma/MCTD:
a. UA, CBC, CMP, ANA, dsDNA, RF, CCP, C3/C4, CRP, CK, LDH
b. ENA panel
2. Wegeners (GPA), MPA, Churg Strauss, and other vasculitides:
a. UA, ANCAs, MPO & PR3 abs, C3/C4, hx asthma?
3. Myositis:
a. CK, aldolase, CRP, TSH, free T4, ANA, anti-Jo, myositis panel
b. Neuro exam!
4. Crystal Induced Arthritis:
a. CBC, BUN, Cr, LFTs, CRP, uric acid
5. Arthralgias/Myalgias NOS:
a. TSH, free T4, HIV, hepatitis panel, ANA, RF, CCP
 2. LIVER CONSULT: ONC:
a. If it’s cirrhosis (do they really have it?) know the cause – if 1. GENERAL CONSULT:
it’s EtOH when was their last drink? a. Patients actively undergoing chemotx.
i. Know their volume status (meds), pertinent labs b. Patients admitted for complications of their chemo (ie
(albumin, INR, TBili, Cr, Plts), ?EV/GV (last scope), neutropenic fever).
?HCC (last RUQ or CT), are they on tx list/have they c. Patients enrolled in clinical trials.
been seen in liver clinic? d. Patients suspected of having malignancy while “tissue is the
b. If it’s transaminitis: issue”, onc is happy to help w/ further w/u and
i. Know if they have hepatic or cholestatic pattern. recommendations.
ii. Meds. RENAL:
iii. Recent social history. 1. AKI:
iv. Any hx or current autoimmune labs + a. Know admission Cr, bl Cr, current Cr.
v. Any hx or current infections + b. Also know lytes w/ Ca, Phos, acid/base, volume status.
3. PEG TUBE: c. Know all meds/toxins (NSAIDs, ACEI, diuretics, abx,
a. What are the indications? contrast?)
b. Are they on any AC (ASA or Plavix)? d. Know urinalysis and urine electrolytes (calculate FeNa and
c. When is the goal for discharge? FeUrea).
d. Are they consented? e. Know UOP over past 24 hours and if this is stable or
e. Recent coags and plts. trending down or up.
HEME: f. Rule out obstruction, ?renal US.
1. ANEMIA: g. Know hx of DM2, Heps, HIV, SLE, renal stones, MM, and
a. Know the H/H trends (and know their baseline!). other malignancies.
b. Know the WBCs and plts. 2. DIALYSIS:
c. Know the meds the pt is on or has recently taken. a. ?Is pt already on HD?
d. Know the MCV, the retic count, and the results of the Fe i. Type?
studies/B12/folate, etc. ii. Access?
e. Know the results of the peripheral smear!!! iii. Last dialysis?
f. Know the results of any previous BMBx. b. Nope?
g. Know any other pertinent PMH (hx malignancy, weight loss, i. Know admission Cr, bl Cr, current Cr (how rapidly is
renal failure?). it rising)?
2. THROMBOCYTOPENIA: ii. Know potassium and trend.
a. Know the plt trends (and know their baseline!). iii. Have a recent EKG (that day preferably).
b. Know the H/H and WBCs. iv. pH + full chem 7 (particularly for K as mentioned
c. Know the meds the pt is on or has recently taken. above and then bicarb and BUN)
d. Know the results of any previous liver w/u. v. Volume status?
e. Know the results of any previous BMBx. vi. Encephalopathy?
f. Know the results of the peripheral smear!!! 3. NA PROBLEMS: Basically, know serum osm, serum Na (and bl and
g. Know the retic count if the pt also has anemia. trend), and urine Na. (Do your own w/u)
h. Know any other pertinent PMH (alcoholic, liver dz, a. Hypertonic vs isotonic vs hypotonic (based on serum osms)
autoimmune dz?). b. If hypotonic, what’s the volume status? Create your ddx
from here.
c. Steal my .phrase (.mghypoNa)