jacobi – Page 3 – Jacobi IM Residency

jacobi August 3, 2017August 3, 2017ImageTidbits, Weekend CoverageID, sepsis, toxoplasmosis, weekly image

weekly image 0803

39M from DR, h/o AIDS (CD4 = 40, VL 250k) not on HAART, p/w AMS, also have decreased ambulation/appetite/speaking/ambulation for 2 wks Vitals: 98.3/55/18 BP: 100/60 What is the differential diagnosis ? What to do for this patient ? From NEJM Teaching Topics | February 23, 2012 Q. What neoplastic processes are part of the differential diagnosis of a peripherally enhancing brain lesion? The differential diagnosis of a peripherally … Continue reading “weekly image 0803”

jacobi August 3, 2017August 12, 2017ImageEducation, Tidbitspulmonary, tuberculosis, weekend coverage, weekly image

Jacobi Weekly Image 0805-0806

24M from Albania no PMH, move to US * 2 years, present with cough * 2 months, right post upper back pain, night sweats, poor appetite for months Found to have RLL cavity 6.5 x 5 x 6 cm with scattered nodular, tree and bud capacities What is the differential diagnosis ?

jacobi August 3, 2017Tidbitscardiology, Education, neuro, syncope

Syncope

1: Reflex syncope Neuro-cardiogenic (vaso-vagal), carotid sinus syndrome, situational (micturition) 2: Cardiogenic Arrhythmias – Tachyarrhythmia: WPW (especially with Afib), Brugada, Long QT syndrome, – Bradyarrhythmia: Second degree AV Block Mobitz II, Third degree AV block, Sick sinus syndrome – Structural heart disease (HOCM, LVOT obstruction, Aortic stenosis, Intracardiac tumor: Myxoma 3: Orthostatic

jacobi August 3, 2017August 11, 2017Asideannouncement, Weekend Coverageweekend coverage

Weekend Coverage 8/5-6

Important Announcements Qmed downtime 8/4 – 5 Please note that there will be a Qmed upgrade overnight from 8/4 @ 11:45 PM to 8/5 @ 07:45 AM (hopefully will be done by 06:15 AM) . During the Qmed downtime house staff will be UNABLE to review charts or place orders in Qmed. For chart/lab review: Please use the Qmed downtime system (review these instructions) For ordering labs/medications: Unfortunately, all orders will need to be WRITTEN (order sheets are available at nursing stations on all the … Continue reading “Weekend Coverage 8/5-6”

jacobi August 1, 2017August 1, 2017Asideannouncementsick call

Sick Call Rules

jacobi July 31, 2017July 31, 2017QuoteResident of the Monthresident of the month

7-2017

I would like to nominate Dr. Kavisha Patel for resident of the month. Last week she accomplished a nearly insurmountable task with her patient. She gained his trust. Sounds silly, but this particular patient has a long standing history of mistrusting anything at all to do with the medical community. Kavisha took the time to learn about this patient and actively listen to what he had to say. He has been in this hospital since June 6th and asked if he can go … Continue reading “7-2017”

jacobi July 30, 2017July 30, 2017announcementweekend coverage

Weekend Coverage 7/29-30

1. Floor Reminder: Next Wednesday will be intern switch day, residents please supervise interns to start drafting off service note over the weekend. Residents starting floor next Monday MUST receive signout from current residents Orange: Claudia <> Wondim Yellow: Daniel <> Avantee Green: Jorge <> Sriram White: Shenduo <> Qingying Purple: Sandy <> Chioma ACS: Emma <> Max Pulm: Leslie <> An Neuro: Hector <> Neva Residents please supervise intern’s sign-out, and make sure to sign-out all the sick patients, upcoming important procedure, daily major events and renew all the necessary orders if necessary(especially restrain, 1:1, fluid) … Continue reading “Weekend Coverage 7/29-30”

jacobi July 24, 2017July 24, 2017AsideTidbitsAfib, anticoagulation, cardiology, DVT, Education, Pulm/CCM

NOACs

Antidote: Dabigatran = Idarucizumab (Praxabind) Idarucizumab for Dabigatran Reversal N Engl J Med 2015; 373:511-520 Factor Xa (Apixaban, Rivaroxaban) are POTENTIALLY reversible by Andexanet alfa (study was done in healthy human subjects, Andexanet reverses effect while infusion is running but rebounds on completion, further data will be available later) ANNEXA-4 trial N Engl J Med 2016;375:1131-41. Aripazine (PER977) is a medication currently on trial and can potentially reverse Factor Xa, dabigatran AND heparin, LMWH Use of PER977 to Reverse the Anticoagulant Effect of Edoxaban N Engl J … Continue reading “NOACs”

jacobi July 20, 2017AsideTidbitsbrugada, cardiology, sudden death

Brugada syndrome

Brugada Syndrome is an ECG abnormality with a high incidence of sudden death in patients with structurally normal hearts. It is due to a mutation in the cardiac sodium channel gene. This is often referred to as a sodium channelopathy. The 3 common types: TYPE I VERY SCARY – refer to arrhythmia team for ICD!

jacobi July 20, 2017AsideTidbitsEducation, Pulm/CCM, sepsis, shock

Pressors

Highlights from Sepsis surviving Campaign 2016: Base on ProCESS, ProMISe and ARISE trials, all 3 trials confirmed that there was no survival benefit of EGDT compared to usual resuscitation. However, in all three studies patients had early antibiotics, >30ml/kg of IVF prior to randomization. We need therefore to keep in mind that the practice has changed. Source control: empiric broad-spectrum therapy Abx to cover all likely pathogens within 1hr Initial resuscitation: 30ml/kg of IV crystalloid fluid in first 3 hours … Continue reading “Pressors”