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Summary Ferri's Practical Guide Fast Facts for Patient Care Ninth Edition

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A. CHARTING 0 ADMISSION ORDERS A, Admit to: Indicate ward where pt is being admitted and attending physician (e.g. , coronary care unit, Dr. Smith 's service) . B, Because: I ndicate admitting dx (e.g. , chest pain). C, Condition: Specify pt's general condition (stable, fair, poor, critical). ...

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,Ferri's Practical
Guide
Fast Facts for Patient
Care

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,This page intentionally left blank

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,Ferri's Practical
Guide
Fast Facts for Patient
Care
Ninth Edition

FRED F. FERRI, MD, FACP
�
� BROWN
� Alpert Medical School
Clinical Professor
Alpert Medical School at Brown University
Providence, Rhode Island

Author contact for comments about the book:
fred_ferri@brown. edu

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,ELSEVIER
MOSBY

1 600 John F. Kennedy Blvd.
Ste 1 800
Philadelphia, PA 1 9 1 03-2899

FERR I ' S PRACTICAL GUI DE: FAST FACTS FOR PATIENT CARE ISBN:978- 1 -4557-4459-6

Copyright© 2014 by Mosby, an imprint of Elsevier Inc.
Copyright© 2011, 2007, 2004, 2001, 1998, 1995, 1991, 1987 by Mosby, Inc.,
an affiliate of Elsevier Inc.

All rights reserved. No part of this publi cation may be reprod uced or transm itted in any form or by any
means, electronic or mechan ical, including photocopyi ng, record ing, or any information storage and
retrieval system , without perm ission in writi ng from the publisher. Details on how to seek perm ission,
further information about the Publ isher's perm issions policies and our arrangem ents with organiza
tions such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our
website : www.elsevier.com/permissions.

This book and the individual contributions contai ned in it are protected under copyright by the Pub
lisher [other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experi
ence broaden our understanding, cha nges in research methods, professional practices, or medi
cal treatment may become necessary. Practitioners and researchers must always rely on their
own experience and knowl edge in eval uating and using any information , methods, compounds,
or experiments described herein. In using such information or methods they should be mi ndful
of their own safety and the safety of others, including parties for whom they have a professional
respon sibil ity.
With respect to any drug or pharmaceutical prod ucts identified , readers are advised to check
the most current information provided [i) on proced ures featured or [ii) by the manufacturer of
each product to be ad ministered, to verify the recom mended dose or formula, the method and
duration of administration, and contraindicati ons. It is the respon sibil ity of practitioners, rely
ing on their own experience and knowledge of their patients, to make diagnoses , to determine
dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fu llest extent of the law, neither the Publ isher nor the authors, contributors,
or editors , assume any liabil ity for any inj ury and/or damage to persons or property as a mat
ter of products liabil ity, negl igence or otherwise, or from any use or operation of any methods,
prod ucts, instructi ons, or ideas contai ned in the material here in.

library of Congress Cataloging-in-Publication Data

Ferri, Fred F., author.
[Practical guide to the care of the medical patient]
Ferri's practical guide : fast facts for patient care I Fred F. Ferri. -- Ninth edition.
p. ; em.
Practical guide
Preceded by Practical guide to the care of the medical patient I Fred F. Ferri. 8th ed. c20 1 1 .
Incl udes bibl iographical references and index.
ISBN 978- 1 -4557-4459-6 [pbk.)
I. Title. I I . Title: Practical guide .
[DNLM: 1 . Clin ical Medici ne--Handbooks. 2. Clin ical Laboratory Tech niq ues--Handbooks.
3. Diagnos is, Differential-Ha ndbooks. WB 39]
RC55
6 1 6--dc23 20 1 3042887

Senior Content Strategist: James Merritt
Content Development Specialist: Maria Holman
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Saravanan Thavamani
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Last digit is the print number: 9
8 7 6 5 4 3 2 1
•

,T h e a ut h o r w i s h es to a c k n ow l e dge t h e fol l ow i n g physi c i a n s w h o h ave c ontri b uted
to this book and to several editions of Ferri 's Clinical Advisor.

Tanya Ali, MD Mark J. Fagan, MD
Clinical Assistant Professor of Director
Medicine Medical Primary Care Unit
Department of Medicine Rhode Island Hospital
Alpert Medical School Professor of Medicine
Brown University Alpert Medical School
Providence, Rhode Island Brown University
Providence, Rhode Island
Mel L. Anderson, MD, FACP
Assistant Professor of Medicine Timothy W. Farrell, MD
University of Colorado School of Clinical Assistant Professor
Medicine Department of Family Medicine
Denver Veterans Affairs Medical Center Alpert Medical School
Denver, Colorado Brown University
Providence, Rhode Island
Michelle Stozek Anvar, MD
Assistant Professor (Clinical) Glenn G. Fort, MD, MPH, FACP, FIDSA
Alpert Medical School Clinical Associate Professor of Medicine
Brown University Alpert Medical School
Providence, Rhode Island Brown University
Chief
Sudeep Kaur Aulakh, MD, CM, FRCPC
Infectious Diseases
Assistant Professor of Medicine
Our Lady of Fatima Hospital
Tufts University School of Medicine
North Providence, Rhode Island
Baystate Medical Center
Springfield, Massachusetts Paul F. George, MD
Assistant Professor
Lynn Bowlby, MD, FACP
Department of Family Medicine
Medical Director
Alpert Medical School
Duke Outpatient Clinic
Brown University
Duke Internal Medicine Residency
Providence, Rhode Island
Program
Durham, North Carolina Sajeev H anda, MD
Director
Gaurav Choudhary, MD
Division of Hospitalist Medicine
Assistant Professor of Medicine
Rhode Island Hospital
Alpert Medical School
Clinical Assistant Professor
Brown University
of Medicine
Providence, Rhode Island
Alpert Medical School
Alexandra Degenhardt, MD Brown University
Director Providence, Rhode Island
Multiple Sclerosis Center
Taylor Harrison, MD
New York Methodist Hospital
Assistant Professor of Neurology
Brooklyn, New York
Department of Neurology
Joseph A. Diaz, MD Emory University
Associate Professor of Medicine Atlanta, Georgia
Division of General Internal Medicine
Jennifer Jeremiah, MD
Memorial Hospital of Rhode Island
Clinical Associate Professor of Medicine
Alpert Medical School
Alpert Medical School
Brown University
Providence, Rhode Island
Brown University
v
Providence, Rhode Island

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,vi Contributors

Powel H. Kazanjian, MD Joanne M. Silvia, MD
Professor and Chief Clinical Assistant Professor
Division of Infectious Disease Department of Family Medicine
Director of H IV Program Alpert Medical School
University of Michigan Medical Center Brown University
Professor of Internal Medicine Providence, Rhode Island
University of Michigan Medical School
Dominick Tammaro, MD
Ann Arbor, Michigan
Associate Director
Kelly A. McGarry, MD Categorical Internal Medicine Residency
Program Director Co-Director
General Internal Medicine Residency Medicine-Pediatrics Residency
Program Division of General Internal Medicine
Rhode Island Hospital Rhode Island Hospital
Associate Professor of Medicine Associate Professor of Medicine
Alpert Medical School Alpert Medical School
Brown University Brown University
Providence, Rhode Island Providence, Rhode Island

Lynn McNicol!, MD Iris Tong, MD
Assistant Professor of Medicine Assistant Professor
Alpert Medical School Department of Medicine
Brown University Alpert Medical School
Geriatrician Brown University Women and Infants
Division of Geriatrics Hospital
Rhode Island Hospital Providence, Rhode Island
Providence, Rhode Island
Margaret Tryforos, MD
Melissa Nothnagle, MD Clinical Assistant Professor
Assistant Professor of Family Medicine Department of Family Medicine
Alpert Medical School Alpert Medical School
Brown University Brown University
Providence, Rhode Island Providence, Rhode Island

Carolyn J. O'Connor, MD Marc S. Weinberg, MD, FACP
Assistant Clinical Professor Clinical Professor of Medicine
Yale University School of Medicine Boston University School of Medicine
Department of Medicine Clinical Associate Professor of Medicine
St. Mary's Hospital Alpert Medical School
Waterbury, Connecticut Chief of Nephrology
Roger Williams Medical Center
Steven M. Opal, MD
Providence, Rhode Island
Professor of Medicine
Infectious Disease Division Wen-Chih Wu, MD
Alpert Medical School Associate Professor of Medicine
Brown University Alpert Medical School
Providence, Rhode Island Brown University
Cardiologist
Paul A. Pirraglia, MD, MPH
Providence VA Medical Center
Assistant Professor of Medicine
Providence, Rhode Island
Alpert Medical School
Brown University
Rhode Island Hospital
Providence, Rhode Island

Harlan G. Rich, MD
Director of Endoscopy
Rhode Island Hospital
Associate Professor of Medicine
Alpert Medical School
Brown University
Providence, Rhode Island

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,Th i s m a n u a l i s a c o n c i s e refe r e n c e for t h e b u sy c l i n i c i a n i n n e e d of i m m e d i ate
m e d i c a l i n fo rmatio n . Its p u rpose is to p rovi d e a fast a n d effi c i e n t way to i d e ntify
i m p o rtant c l i n i c a l , l a b o ratory, a n d d iagnostic i m a g i n g i n formati o n .
T o l i m it its s i z e t o a pocket refe re n c e , l e s s e m p h a s i s h a s b e e n p l a c e d o n
patho p h y s i o l ogy a n d e p i d e m i ol ogy, with m o re e m p ha s i s o n p racti c a l c l i n i c a l i n
format i o n . C l i n ic a l a l gorith m s a n d t a b l e s have b e e n u s e d extensively t h ro u g h o u t
t h e m a n u a l to s i m p l ify d iffi c u lt t o p i c s a n d to e n h a n c e rec o l l ecti o n of p r i n c i p a l
p o i n t s . I t i s h o p e d t h at i t s c o n c i s e sty l e w i l l h e l p t h e read e r , p a rti c u l a rl y d u r i n g
a n a ctive c l i n i c a l s e rvic e , w h e n t i m e to r e a d i s extre m e l y l i m ited .
T h e c o m b i nati o n of p ractic a l c l i n ic a l i nformatio n with d rug therapeutics, p ro
ced u re s , d i ag n o st i c i magi ng, a n d l a b o ratory m e d i c i n e m a ke s t h i s m a n u a l u n i q u e
a n d u sefu l , n ot o n l y to m e d i c a l res i d ents a n d stu d ents b u t a l s o to p ractic i ng
p h ys i c i a n s a n d a l l ie d h e a lt h p rofe s s i o n a l s . I w i s h to t h a n k t h e m a n y t h o u s a n d s
of physi c i a n s w h o h ave m a d e t h e p r i o r e d i t i o n s a bestse l l e r i n m e d i c a l p u b l i sh
ing and hope that futu re u s e rs w i l l fi n d this e d i t i o n the m o st u sefu l m e d i c a l
h a n d b o o k that t h e y w i l l eve r p u rc h a s e d u ri ng t h e i r tra i n i ng .
Fred F . Ferri, MD, FACP

Pearls of Wisdom in Medicine
1 . C o m m o n t h i ngs o c c u r c o m m o n l y .
2 . W h e n y o u h e a r h oofbeats, th i n k of h o rses, n ot zebras.
3. Place y o u r bets o n u n c o m m o n m a n ifestat i o n s of common c o n d it i o n s , rathe r
t h a n c o m m o n m a n i festat i o n s of u n c o m m o n c o n d i t i o n s .
4 . I f what y o u a re d o i n g i s worki n g , kee p o n d o i n g it.
5 . I f what y o u a re doing i s n ot worki ng, stop d o i ng it.
6 . I f y o u don't know w h at to d o , d o n 't d o a n yt h i ng .
7. Above a l l , n ever l et a s u rgeon g e t y o u r pat i e n t .
From Matz R : Principles o f medicine.
NV State J Med 77:99-101, 1977.

vii

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, I also extend a special thanks to my sons, Dr. Vito F. Ferri and Dr. Ch ristopher A. Ferri
for their help in the preparation and review of the man uscript and to the a uthors
and contributors of the following texts who have served as a val uable resource in the
development of the n i nth edition of this manual:
Goldman L, Schafer AI (eds) : Goldman 's Cecil Medicine, 24th ed. Philadelphia,
Saunders, 20 1 2 .
Vincent JL, Abraham E, Moore FA, et al (eds) : Textbook of Critical Care, 6th ed.
Phi ladelphia, Saunders, 20 1 1 .
Medical Knowledge Self-Assessment Program (M KSAP) 16. Phi ladel phia, American
College of Physicians, 20 1 2 .
Gilbert D N , Moelleri ng RC , El iopoulos G M , et a l : The Sanford Guide to Anti m icrobial
Therapy 20 1 3 , 43rd ed. Anti microbial Therapy, I nc, 20 1 2 .
Users of our book are encouraged to use the above noted reference texts for ad
d itional information on the topics discussed i n this manual .
Fred Ferri, MD

viii

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