“Beep, beep, beep” – the one sound you dread to hear at 3 AM. As you get up from what you thought might be a few “clutch hours” of precious sleep, you see the numbers “6666” on your beeper – and your heart sinks… It’s the ER with your 7
th
admission of the night. Sleep deprived and bleary eyed, you drag yourself down to meet your 86 year old female patient from the nursing home with presumed urosepsis. But there’s something different about this case. You notice that her electrolytes are off – and not what you’d expect from a uroseptic patient. You note that instead of being acidotic as you might expect, she’s alkyotic. And it’s 3 AM…
Fast forward to 4:30 AM and you see that same “6666” appear on your beeper. You are summoned down to the ER once again, this time to admit a street person who is in diabetic ketoacidosis (DKA). You remember reading about DKA and rehydration when you were studying for your boards, part II, but you can’t remember if you should use a bicarb drip or not… and is 4:30 AM.
Now it’s approaching 7:30 and morning report looms large on the horizon. You need to present a case to your chief from last night’s admissions. You want to use the DKA case and you know you are going to be questioned about all the things you were supposed to do for the patient in the wee hours of the night. And you want to look good – and you need a quick review so you can look smart at rounds…
Now it’s 10AM and you are in clinic and you have a sickle cell patient come in and ask you about whether she can or should get pregnant or not… What do you tell her?
What do all these things have in common? They all require that you take a moment at the point-of-care to refresh yourself on the latest information about how to care for your patient at a challenging (if not critical) time. And your brain is just so big. One of the biggest challenges that you have as a new medical student, intern or resident is being able to get to the information you need to attend to your patients in the middle of the night. For over 40 years, young clinicians like yourself have relied on not only their wits to get them through the night, but on top quality information at the point of care. These days, all you need is your smartphone. The question is, do you have the right resources for your clinical clerkships and rotations?
Being prepared for your nights on call or night float, the ICU or CCU, tough clinic cases, and morning report all call for having information at your fingertips – and more precisely, quick access to accurate and trusted information. Over the past 10 years, developments in pocket smartphone apps presents a solution to this challenge. Companies like Skyscape, UpToDate and ePocrates provide an array of clinical decision support references, calculators, nomograms and other tools at the point-of-care. In fact, there are top-tier, trusted medical information now available for nearly every specialty and subspecialty. Some of these resources have been around in one form or another for over 40 years. But the best, most trusted, and up-to-date content is curated for your smart phone.
Here’s a guide to the most needed apps for your smartphone.
When you embark on the wards or for your rotations, you really want to have the right constellation of apps readily available. This would include the following:
- Drug guide
- Antibiotic guide
- Domain-specific information (eg: Internal Medicine, Ob/Gyn, Pediatrics)
- Medical Calculators
- Local phone numbers and look-ups
- Evidence-based Medicine guides
Let’s dive deep into just one of these go-to resources:
The Drug Guide:
Clearly, one of the most important applications you can have on your phone is a drug guide. With the rapidly growing number of both branded and generic medicines, it is simply not possible to keep the entire pharmacopeia in your head. Keeping track of all the drug-drug interactions and black box warnings is a herculean task that is really only suited for a computer. There are a variety of drug databases from a core set of companies for your smartphone including:
- Dr. Drugs – Authors: Judith Hopfer Deglin, PharmD, April Hazard Vallerand, PhD, RN, FAAN and Cynthia A. Sanoski, Publisher: F.A. Davis Company
This guide provides over 1000 easy-to-read monographs that get you to the needed information in just a few clicks. The content is updated on a regular basis as well. The Skyscape app is well worth the price as this application also works in concert with other Skyscape apps to provide quick links from one reference to the other. It also provides built in calculators and dosing nomograms for the most accurate dosing. Monographs are easy to read and navigate.
Manufacturers: Skyscape –
www.Skyscape.com
$49.95
- SKYSCAPE RX™
This free resource has a subset of drug monographs that were curated from top-tier content. Providing both monographs and dosing calculators for hundreds of the most used drugs in the pharmacopeia today.
Manufacturer:
www.Skyscape.com
– FREE
- ePocrates Drug Guide
Providing a suite of information about drugs, ePocrates has been one of the most used drug handbooks on a handheld device. In addition, you can use ePocrates content inside of some EHR (eg: AthenaHealth). In addition the ePocrates tool has links to other resources including formulary guides, lab look-ups and calculators. ePocrates does provide the service for free by showing ads and collecting data and aggregate information to life science companies.
Author: ePocrates, Manufacturer: ePocrates.
www.ePocrates.com
Free or Paid subscription
- The Sanford Guide to Antimicrobial Therapy, HIV/AIDS Therapy, and Hepatitis Therapy (Author: The Sanford Guide)
For over 4 decades, the go-to resource for everyone from medical students to attendings for selecting the very best antibiotics for their patients. Filled with tables and various means to navigate to the right choice for your patient, the guide is the single best source of antibiotic information – full stop. The Sanford Guide is available on multiple platforms – including smartphones.
Manufacturer: The Sanford Collection –
www.Sanfordguide.com
–$59.95
- Drugs for Pregnant and Lactating Women (Author: Carl P. Weiner, MD, MBA, FACOG and Catalin Buhimschi, MD, Publisher: Saunders | Elsevier, Inc.,
One of the most vexing questions in medicine is about what drugs are appropriate in pregnancy. “Drugs for Pregnant and Lactating Women” answers that question in great detail. Providing the most comprehensive overviews on the topic in the industry.
Manufacturer: Skyscape –
www.Skyscape.com
– $99.95
- MOSBY’S HANDBOOK OF HERBS & NATURAL SUPPLEMENTS (Author: Linda Skidmore-Roth, RN, MSN, NP, Publisher: Mosby | Elsevier, Inc.,
One of the more challenging issues faced by clinicians these days is the growth in the use of herbal and natural supplements. Most drug handbooks do not list these compounds. This reference provides a quick and easy way to get not only the information about the compounds, but how they interact with pharmaceuticals.
Manufacturer: Skyscape:
www.Skyscape.com
) – $42.95
In addition to these titles, there are literally dozens of other titles designed to help everyone from 3
rd
years students to interns, residents, and attendings “get it right, in the middle of the night”. Domain-specific titles for every clerkship are available – for just about every domain in medicine. Picking the titles that are right for you can be tricky. One of the best ways to help with that decision is to ask your upperclassman peer, class advisor, medical director or residency director. Just some of the titles are listed below (and there are literally hundreds of others out there), with Skyscape having the broadest portfolio of resources
- The Washington Manual of Medical Therapeutics
- UpToDate
- The 5-Minute Clinical Consult
- The 5-Minute Pediatric Consult
- The Harriet Lane Handbook: A Manual for Pediatric House Officers
- The Cardiac Care Unit
- The ICU Book
- Braunwald’s Heart Disease Practice Guidelines
- E-Z ECG Rhythm Interpretation
- Handbook of Fractures
- Harrison’s Manual of Medicine
- Pediatrics on Call
- Spanish-English English-Spanish Medical Dictionary
- Taber’s Cyclopedic Medical Dictionary
One thing’s for sure, when you need a guiding light in the middle-of-the-night (or in clinic), having ready access to the right information is clearly in your patient’s best interest. Ensuring that you can provide the best and most up-to-date information when and where you need it most is now ante-stakes in medicine. Make sure you have a guiding light in the middle of the night – and not just the flashlight app on your smartphone! Now, should or should you not use a bicarb drip?
For more information about the titles mentioned in this article, please see:
Skyscape Medical References :
www.Skyscape.com
ePocrates:
www.ePocrates.com
The Sanford Guide:
www.SanfordGuide.com