Thread by @POPCoRNetwork

Are you a peds provider caring for adult pts in a COVID-19 world? Last admitted an adult as a 3rd year med student? In this #POPCoRNtweetorial, we will lay the groundwork for how to get this admission started off on the right foot. #POPCoRNet #COVIDPOPCoRN 1/

You can’t ask EVERYTHING in your Hx, but definitely ask this:
Substance use: frequency, duration, last use (esp. EtOH & Benzos)
Functional status: who lives at home, help with ADLs or meds?
Code status, advanced directives, healthcare proxy or POA
#POPCoRNtweetorial 2/

What can your pt order on Door Dash?
DM: diabetic diet
CAD: low chol & sat fats
(pre)HTN: Na <2g/day
CHF: Na <2g/day + <2L fluids
ESRD: low phos, 60mEQ K
ESLD: low protein, Na <2g/day +/- <2L fluids
EtOH: multivit, folate, B12, aspiration risk?
#POPCoRNtweetorial 3/

Telemetry or not to tele? Yes, if…
Acute MI, MI r/o
Coronary path pre-intervention or post-PCI
Tachy/bradyarrhythmia
Pacemaker, AICD, s/p ablation
Risk/recent cardiac arrest
Syncope
Poison vs. OD w/ pro-arrhythmic drugs
Acute EtOH WDL
Acute myo/pericarditis 4/

DVT - Do we REALLY need SCD boots?
Bed-ridden: wt dosed Enoxaparin SC (30-40 mg QD vs. BID). If unsure, talk with pharm
If CrCl<30 or AKI give 5000U SC Hep TID
Low plts or bleed risk SCDs/compression socks
H/o HIT? Fondaparinaux 2.5 mg SC QD #POPCoRNtweetorial 5/

Diabetes?
1) No home non-insulin; order sliding scale insulin w/ meals and hold all oral agents
2) Start ½ basal insulin & order prandial insulin day 2-3
3) NPO? ½ basal insulin, hold prandial dose, continue SSI with q6 finger sticks
4) PO? finger sticks @ night & w/meals 6/

You get a bowel reg! Start: Docusate 100mg PO BID, PRN Senna/Miralax
Stimulants: Senna 2 tabs PO BID, Bisacodyl PR 10mg qHS
Osmotics: MiraLax 17mg PO qd, Lactulose 30mL PO qd, MgOH 30mL PO qd
Enema: Phosphate fleet 1 bottle PR qd
#POPCoRNtweetorial 7/

Does your patient need a foley?
Well, do they have UT obstruction or neurogenic bladder & retention? → Yes.
Do you need accurate UOP measurements → Yes.
Are you concerned about infxn? Daily address utility of foley and consider external catheter.
#POPCoRNtweetorial 8/

Day2Day
Pulse Ox: concern for hypoxemia such as PNA, COVID, pulm edema? Consider for COPD & asthma exacerbations; if stable, spot checks
Daily Labs: BMP-CBC-Mg, stop after 3d if stable
GI prophy: for cont outpatient PPI, high dose NSAID or steroid, Upper GIB 9/

Before you go: 1) PT/OT for pts with limited mobility 2) Speech if AMS, stroke, or worsening neuro issues. Assess reg diet with bedside RN 3) ongoing discussion about goals of care
FInd the one-pager here--> popcornetwork.org/admissiondisch… Find the rest on popcornetwork.org 10/x

Thanks to @robertdaulton for his work on this one-pager!