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Common Inpatient Problems


  1. Notify your senior.
  2. Get vitals first. If unstable, manage patient via ACLS guidelines. Call a Rapid Response or potentially a code if you need help.
  3. Go see the patient. Is this new? Are they symptomatic? Order stat EKG.
  4. Compare EKG to old. See cardiology section for algorithm on how to diagnose rhythm and when to use adenosine and vagal maneuvers.


  1. Notify your senior.
  2. Get vitals first. Go see the patient.
  3. If they are symptomatic (dizzy, chest pain, syncope) or hemodynamically unstable, follow ACLS guidelines. Put patient in Trendenlenberg. Call a Rapid Response or potentially a Code if you need help.
  4. If stable, order atropine to the bedside and consider placing the patient on telemetry.
  5. Place pacer pads on the patient (can always take them off).
  6. If ECG shows either Type II second degree or 3rd degree AV block, consider transcutaneous pacing and possibly a transvenous pacer. Call Cardiology ASAP, and transfer to ICU.
  7. If patient is stable and not symptomatic, take a quick look at the chart to try and determine why this might be happening.
  8. DDX:
  9. Meds: β-blockers, Calcium-channel blockers, digoxin, amiodarone, clonidine.
  10. Cardiac: sick sinus syndrome, inferior MI, vasovagal (usually transient), 2nd or 3rd degree AV block, junctional rhythm.
  11. Autonomic N.S: neurocardiogenic syncope, carotid-sinus hypersensitivity, cough/micturition/emesis/defecation induced.
  12. Management (if stable):
  13. Take a focused H&P and look at the medication administration record.
  14. If you think this is medication induced, consider holding a dose of the med if stable. Consider calcium or glucagon administration if you believe it to be secondary to the calcium channel or beta blocker the patient is taking.
  15. Put patient on telemetry to track trends. Consider sending electrolyte panel.



  1. Notify your senior.
  2. Start with your ABC’s. Is this person symptomatic (dizzy, chest pain, unconscious...)?
  3. See the patient immediately. If unstable, call a Rapid Response or potentially a Code.
  4. Get the rest of the vitals. Is there evidence of shock (distributive, cardiogenic, hypovolemic)?
  5. Make sure the blood pressure is real (if the patient is stable). Measure it yourself with a manual cuff. Make sure all vitals are current.
  6. Is this patient’s blood pressure always 80/40 and they feel fine (you will probably see this on the cardiology service)?
  7. Calculate the MAP: MAP <60 is associated with decreased perfusion to vital organs.
  8. Determine what your IV access is: Make sure there are two large bore IV’s and start Normal Saline wide open while you are thinking, unless the patient is in cardiogenic shock.