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polymorphic vtach. uh-oh! the glasses are from the "succubus" episode. three-fitty.

Click on one of the calculators below to make it appear, and click again to hide it. Note that calculations are done in "real time" - that is, the answer field will constantly update as you put in data.

A-a Gradient

Calculated Osmolality

Child's Class

Bilirubin
Albumin
INR
Ascites
Encephalopathy
Child-Pugh score
Scoring:			A: 5-6 B: 7-9 C: 10-15

Cockroft-Gault eGFR

Corrected Calcium

Corrected Sodium

FENa / FEUrea

Framingham Risk

FRAX Score

Free Water Deficit

Heparin Dosing

For ischemic CVA the heparin dosing is as follows: no bolus, and 600-1000 units/hr drip (not weight-based). For other indications, use the calculator below.
Heparin indication
(For ACS, strongly consider LMWH instead of unfractionated heparin. Also, if using a IIb/IIIa inhibitor with unfractionated heparin, dose the unfractionated heparin as though the patient has a STEMI.)
Patient sex
Weight
Height
Heparin dosing weight (kg)
Bolus dose	^*
Initial drip rate	^*
*Maximum doses: VTE 9000 bolus, 2000/hr gtt NSTEMI 5000 bolus, 1000/hr gtt STEMI 5000 bolus, 1000/hr gtt

Ideal Body Weight / BMI

MDRD eGFR

MELD Score

Bilirubin

INR

Creatinine^*

^*If the patient has been dialyzed at least twice within the last week, enter "4.0" for the serum creatinine.

MELD Score

Three-month mortality risk based on MELD Score:
Score	Mortality
‹10	4%
10-19	27%
20-29	76%
30-39	83%
40+	~100%

Narcotic Converter

First drug
First drug dose (mg)
Second drug
Second drug dose (mg)
Note #1: Opioid analgesics have widely variable half lives, and when you switch from one form to another, you should adjust the scheduling accordingly. Note #2: Methadone should be dosed by someone with experience using the drug. Consult palliative care or pain management.

QTc

Steroid Converter

TIMI Risk

Age over 65

3 or more CAD risk factors

Prior coronary stenosis (50% or more)

ST segment deviation on initial ECG

2 or more anginal events in previous 24 hours

ASA use in last 7 days

Cardiac enzyme elevation

TIMI Score

TIMI Risk for cardiac event (mortality, new MI, or need for emergent revascularization) in the next 14 days:
Score	0-1	4.7%
	2	8.3%
	3	13.2%
	4	19.9%
	5	26.2%
	6-7	40.9%

TTKG

If you're discharging a patient from Parkland who doesn't currently have a primary care provider, and would like to send them to one of the satellite clinics instead of PCIM, you can use the tool below to determine their assigned clinic based on zip code. Please note that this tool is for elligibility only; obviously, you should use your own judgement when referring patients.

Amion	McKesson	Resident Program Website
New Innovations	Parkland Remote	PCIM
Parkland lab	vCDR: PMH - UTSW	PRIME
ARUP - Mayo labs	EPIC: PMH - UTSW	Book of Knowledge
Hopkins Antibiotic Guide	Directory: PMH - UTSW	CQI Online (login)
UpToDate	iSite: PMH - UTSW

Phone numbers

Parkland Memorial Hospital

214.590.xxxx or 2.xxxx
Lucinda Nichols 214.590.8953
	STAT	7890	8E - Rehab	8139	ER - West	8824
	2E	7240	8N - Psych	6133	GI Lab	8839
	2N - SICU A	6100	8W - Neuro	7840	Immunology	8571
	2N - SICU B	6216	8W - Stroke	7879	Interpreter	8945
	2N - SICU C	6212	8SS - EMU	8834	Lab main	5227
	2N - SICU D	6201	9E	7900	Med recs	6540
	2W	7285	9N - MICU	6142	Microbiology	5426
	2S - OR Sched	8257	9N - MICU RR	6973	Nuc cards	8395
	2S - PACU	8549	9W	7910	Page oper	8630
	2SS - Day Sur	8746	9S	7905	Path	8686
	3N	7340	9SS	7915	PCIM - Cheryl	0050
	3E	7345	10E	7000	PCIM - DM	5696
	3W	7348	10W	7010	PCIM - Meds	8209
	3S - New Nurs	4050	10S (CCU)	7040	PCIM - Sched	8753
	3S - L&D E	7381	ACC	5512	PFTs	8167
	3S - L&D W	8376	ADT	8920	Pharmacy	8711
	3SS - NNICU	6500	Amelia Court	5647	Phlebotomy	6687
	4E	7434	Blood Bank	8211	Police	8104
	4N	7400	Card rehab	8236	Rad - Main	8596
	4W	7496	Cath lab	8617	Rad - Body CT	6669
	5E - NSG	7585	Chaplain	8512	Rad - Chest	8720
	5N	7580	Computers	5999	Rad - CT scan	8413
	5W - Ortho	7593	CV lab	8395	Rad - CT sch	0062
	5S	7590	Cytology	8743	Rad - ER	0909
	6E	7650	Dialysis	5793	Rad - MRI	4525
	6N - BICU	7635	DM Foot Nurse	5449	Rad - Nuclear	7176
	6W	7678	Drug/Alc	8770	Rad - Outpt	8582
	6S	7690	Echo/Holter	7169	Rad - IR	6798
	6SS - GI Lab	8839	EEG	8334	Rad - U/S	8474
	7E	7735	EP	5055	Rad-Onc	645.8525
	7N	7700	ER - East	8108	Res Lib fax	6994
	7S	7775	ER - OB	8145	Tele monitor	7017
	7SS	7798	ER - Psych	8761	Toxicology 800.222.1222
Suggest a Number for this List

St. Paul University Hospital

214.645.xxxx or 5.xxxx
Maria Santos-Garcia 214.645.1825
	3N	1390	7S	1792	ECG	1781
	3S	1392	7W	1798	ER	5582
	5W	1596	MICU	1794	Interpreter	1270
	6N	1690	CVICU	1661	Med recs	5260
	6S	1692	Admissions	5375	Radiology	5081
	7N	1790	ECHO	1961	Social	4838
Suggest a Number for this List

VA Medical Center

214.857.xxxx or 7.xxxx
Lillian Britain 214.857.1517
	4C	1628	Admissions	1449	Lab	0666
	5ATele	1654	Bed control	1454	Med recs	0055
	5B	1636	Cards office	1556	Mental health	0806
	6C	2240	Cath lab	1642	MRI	6089
	7A	1646	CT	6052	Nuc Rad	0130
	7B	1650	Drug/Alc	0950	Pharmacy	0556
	MICU	1660	ECHO	1531	PFTs	1601
	CCU	2182	ER	1975	Rad - main	0170
	SICU	1620	GI lab	1590	Security	0411
	TICU	1625	Holter	0407	Ultrasound	6055
Suggest a Number for this List

Area Hospitals


	Arlington Memorial Hospital	817.548.6100
	Baylor University Medical Center - Dallas	214.820.0111
	Baylor University Medical Center - Frisco	214.618.2000
	Baylor University Medical Center - Garland	972.487.5000
	Baylor University Medical Center - Grapevine	817.481.1588
	Baylor University Medical Center - Irving	972.579.8100
	Baylor University Medical Center - Plano	469.814.2000
	Centennial Medical Center	972.963.3333
	Charlton Methodist Hospital	214.947.7777
	Children's Medical Center	214.456.7000
	Dallas VA Medical Center	214.742.8387
	Denton Regional Medical Center	940.384.3535
	Doctors Hospital	214.324.6100
	Harris Methodist Hospital	817.882.2760
	Irving Coppell Surgical Hospital	972.785.5500
	John Peter Smith - Arlington	817.852.8500
	John Peter Smith - Main (Ft. Worth)	817.921.3431
	Kindred Hospital Ft. Worth	817.332.4812
	Lake Pointe Medical Center	972.412.2273
	Las Colinas Medical Center	972.969.2000
	Leland Medical Plaza	972.276.7116
	LifeCare - Dallas	214.525.6300
	LifeCare - Plano	214.473.8822
	LifeCare - Ft. Worth	817.370.6078
	Mary Shiels Hospital	214.443.3000
	Medical Center of Arlington	817.465.3241
	Medical Center of Lewisville	972.420.1000
	Medical Center of McKinney	972.547.8000
	Medical Center of Plano	972.596.6800
	Medical City Dallas	972.566.7000
	Methodist Medical Center	214.947.8181
	North Texas Hospital	940.220.0600
	Parkland Memorial Hospital	214.590.8000
	Presbyterian Hospital - Allen	972.747.1000
	Presbyterian Hospital - Dallas	214.345.6789
	Presbyterian Hospital - Denton	940.898.7000
	Presbyterian Hospital - Plano	972.608.8000
	Presbyterian Hospital - Rockwall	469.698.1000
	Renaissance Hospital Dallas	214.623.4400
	RHD Memorial Medical Center	972.247.1000
	Richardson Regional Medical Center	972.498.4000
	St. Paul University Medical Center	214.645.5555
	Trinity Medical Center Carrollton	972.492.1010
	USMD Hospital at Arlington	817.472.3400
	Vibra Specialty Hospital	214.638.1500
	Zale Lipshy University Hospital	214.645.5555

Dictation Instructions

Parkland Memorial Hospital

1.877.481.2545

1. Enter physician ID.

2. Enter work type.*

3. Enter MR number.

*Work types:

2: Discharge summary

3: Death summary

8: Admit H/P

24: PCIM Clinic note

1
Rewind to start

2
Record

3
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4
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5
End transcription

6
Pause

#9
Priority

St. Paul University Hospital

214.645.8888

1. Enter attending ID.

2. Enter work type.*

3. Enter FIN.

*Work types:

2: Admit H/P

4: Discharge summary

21: Addendum

22: Death note

1
Pause

2
Record

3
Rewind a few secs

4
Forward a few secs

5
End transcription

6
Priority

7
Continuous rewind

8
Next job

	New England Journal of Medicine

	Annals of Internal Medicine

	Journal of the American Medical Association

	The Lancet

	British Medical Journal

Cardiology			MD Consult
	Cardiology Site		Access Medicine
	ECG Learning Ctr		Warfarin Dosing
	Harvard ECG Cases	Heme/Onc
	ECG Wave Maven		Cancer Treatment Guide
	Alan E. Lindsay ECG Learning Center		Cancer Management
	Echocardiogram Review Article		Cancer Medicine
	Blaufuss Medical Multimedia Labs	ID
	Dartmouth Cardiac Auscultation		Johns Hopkins Antibiotic Guide
	Univ. of Washington Cardiac Auscultation		Johns Hopkins HIV Guide
Dermatology			Microbiology and Immunology
	Hopkins Derm Atlas		ID Society of America
	DermAtlas	Pulmonary
	Dermnet New Zealand		Pneumotox
	Dermatology Information System		American Thoracic Society
Endocrine			Univ. of Kentucky Chest Radiology
	An Integrated Approach		Univ. of Virginia Chest Radiology
	Endotext		Medpix Medical Image Database (CXR and more)
General			University of Washington PFTs
	Preventive Medicine		Cleveland Clinic PFTs
	National Guidelines	Renal
	Atlas of Histology		Nephromatic
	ARUP Consult
	$4 drugs (Target, Walmart, Kroger)

A 32 y/o Hispanic man with history of metastatic mediastinal germ cell tumor was admitted from the oncology clinic complaining of cough and shortness of breath. He had fevers for two days prior to admission. He denied chest pain and hemoptysis, although he did have significant sputum production, which was thick and yellow, "like pudding." Click on the image to the left to enlarge for a better view.

What do YOU think?! What's the diagnosis? Any comments?

Previous cases (click to see images): Bullous pemphigoid || IVC leiomyosarcoma || Necrotizing fasciitis || Pneumocephalus || Tattoo dermatitis (Image 1, Image 2) || Crusted scabies || Left atrial myxoma || Rapid growing mycobacteria || Central pontine myelinolysis || "Cupping" || Right axillary Burkitt's lymphoma (Image 1, Image 2)

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