Q: How to Dial in JMC ?
A:
From outside – Dial 718-918-Extension (Ex:  for extension 6910, Dial# 718-918-6910)
From Inside – Dial 3-Extension (Ex: for extension 6910, Dial# 3-6910)
Rare cases: Some extensions are preceded by 4.
For NCB dial 5 then extension

**see http://www.nbhn.net/phonebook/    menu on left for more numbers and faxes.

Floors:

3B/Onc:  6910
4A:  5693/5694  | 4B MICU:  7160
5A:  7018  |  5B CCU:  7150  |  5D:  5256
6A:  6926
Dialysis: 6931

Consult Services:

Renal:  4282;  5722
Onc fellows room: 5663
Psych ER: 4850, 4989, 4089
Psychiatric consult: 6790;  Stat Consult:  917-577-8129
Detox: 4492, 4795, 4478 (Mr. Caldwell)
GI consult pager: 917-956-7333
GI room (callback): 3-5020
ID approval: (917) 218-5755 from 9am to 5pm, Monday through Friday. 3-7635
ID consult: 917-956-2877
Cardiology Fellow Room 3-5906
Ortho *8-0890
Ortho nextel: 646-601-1066
Ortho office: 3-4922
Plastic office: 3-8272
Gen surg office: 4-1535
Trauma office: 3-4147; 3-4148

MISC.:

Cardiology Cath room: 7150
Cardiology Echo: 5911
Cardiology clinic appointment:  5900 (looking for Carmen)
Patient Escort:  5763
Kitchen: 7634
HHC Transfer center:  844 – 442 – 2337

SMR Pager *8-0636/SMR Room 6915
CCM Nextel:  917-557-9962
Bed board: 3364
Rehab consults: 8469/8470/5535
Telemetry room: 7157

ED Social Worker: 3-5834

Labs:

General: 5995
Hematology: 5925/5926
Chemistry:  5980
Serology: 5952
Microbiology: 5949
Blood bank: 5227
Hematology lab 3-5925, 3-5926

Conference Rooms

4A small (Pulmonary/Sign-Out) 8163/8132
4A big (ICU) 46210
5A White Team:  8129/8126
6A Blue Team: 8133
5E15 Purple Team: 7598/6063
5D Green Team: 6831
Resident Lounge 4E12  6246/6247
4E4 Fish Bowl (Orange Team) 6944/8439
Medicine Clinic 4A: 8662, 4B: 8662, 4C:  8634, 4D: 8052  DT 8622/8620

Day float room: 7944
Medicine consult phone in day float room: 7929

Radiology:

CT:  4950  |  ER CT: 35335
CT supervisor: 3166
MRI: 4795
MRI Fax: 7988
Pharmacy: 34646
Vascular lab/echo: 35575

Hospitals:

Jacobi 718-918-5000
Montefiore (Moses) 718-920-4321
Montefiore (Weiler) 718-904-2000
NCB 718-519-5000
Lincoln 718-579-5000
Monte North 718-920-9000
St. Barnabas 718-960-9000
Bronx Lebanon 718-590-1800
AECOM 718-430-2000
Westchester Sq Hosp 718-430-7300

Q1: I am not sure about my team distribution, what should I do ?

Q2: When should I call chiefs for potential back-up residents ?

Q3: What is the cutoff time to assign/inform teams about day float admissions ?

Q4: Which kind of admission I should give to Neurology Team ?

Q5: What about the Med-Onc team (yellow) ?

Q6: What should I do if I receive a call from NCB SMR to transfer patient to JMC ?

Q7: What should I do if all the teams have very high census ? When should I give patient to Pulm/ACS team ?

Q8: Who should I board to 3B ?

Q9: Neuro team weekend coverage

Q1:   I am not sure about my team distribution, what should I do ?

In the beginning of the year, don’t place the assignment/distribution sheets in the conference room until the chief doing intake has seen it; sometimes we have to redistribute patients and it becomes chaotic if the residents have started signing out patients already.

Q2:  When should I call chiefs for potential back-up residents ?

If by 10 PM  you have 10 admission for the night team. Go down to the ED, check to see how many pending admissions both sides of the ED have and then call the administrative pager/chief to see if backup has to be called in.

Q3:  What is the cutoff time to assign/inform teams about day float admissions ?

Monday to Friday

• 3 PM for non-call teams
• From 3 to 5 PM the Day Float can continue to admit and the admission will be assigned to one of the on call interns. This will count towards their admission cap for the day.

Saturday – Sunday

• 1 PM for non-call teams
• From 1 to 3 PM the Day Float can continue to admit and the admission will be assigned to one of the on call interns. This will count towards their admission cap for the day.

Q4: Which kind of admission I should give to Neurology Team ?

Neurology Team cannot get admissions that are overflow medicine cases.  Admissions to their team are stroke patients and some neurology cases that the Neurology Consult will discuss with the stroke attending.  If in doubt SMR can contact the Neurology Consult to confirm the disposition for a patient.

Q5: What about the Med-Onc team (yellow) ?

Yellow team has a soft cap of 18 patients: If all other teams are at 19 or 20 then cap can be increased to 19. There is a hard cap of 19 for the team unless the patient is an inpatient chemotherapy patient then the team can go to 20 patients.

(New 8.2017) Oncology patients should be distributed to all the primary inpatient medicine teams evenly (NOT ACS, PULM OR NEURO) as Yellow team will no longer be the only team accepting oncology patients.  They will, however, continue to take the direct admissions from oncology and/or active chemo patients.

Q6: What should I do if I receive a call from NCB SMR to transfer patient to JMC ?

Please make sure:

• The transfer is coming to medicine (occasionally you get contacted for transfers to surgery).
• From 8a-5p the Medicine consult resident is the one handling all the transfers.  After 5p it’ll be the SMR.
• If the transfer is from ED, then the patient should be transfer to ED.  Please ask them to contact ED attending.
• You should not give your name as the accepting physician.
• Ask the transfer center to connect you to the person asking for the transfer. You can get some of the information but they should speak to the critical care attending after 5p and they are the accepting physician.  Floor patients get transferred directly to the floor which is why everything should be clarified before the patient is transported here. Same rules apply for ICU to ICU transfers.
• If a patient is being transferred from JMC to NCB (most will be patients who need to go to Moses for radiotherapy).  The floor team should contact the NCB SMR/Dr. Ramasamy. The SMR can help facilitate the process but it is not his/her responsibility to make the arrangements it is the primary team’s responsibility.

Q7: What should I do if all the teams have very high census ? When should I give patient to Pulm/ACS team ?

Please refer to escalation policy.

Q8: Who should I board to 3B ?

(New 8.2017) Patients with ANY onc-related diagnosis should go to 3B WHENEVER possible. “Onc-related diagnosis” means any patient with active malignancy AS WELL AS any patient with onc-related complications, patients with prior onc-related diagnoses, as well as clear malignancy workups

Q9: Neuro team weekend coverage

(New 8.2017) Neurology inpatient team will not be taking Friday DF admissions or Saturday AM pickups.  Any patients that would normally be admitted to them will go to another inpatient floor team (to be presented Saturday morning), and remain on that team until Saturday night at which point they will be signed out to the Neurology team night intern.

Click here to download

if you see hydrocephalus in a patient with consistent severe headaches, this could be a sign of impending herniation. Patient will need emergent relief of intracranial pressure.

Botulism:

Rapidly progressive paralysis with blurry vision, sluggish pupils and diplopia. This condition is caused by an irreversible toxin and the antitoxin should be given as soon as possible, so needs high clinical suspicion. The diagnosis is by injecting patient’s serum in mice to see if it causes paralysis (takes a few days).

The antitoxin is at LaGuardia Airport !!!

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 enhancing brain lesion should always include the following neoplastic processes: metastatic tumors, primary glial tumors, and primary lymphoma of the central nervous system. Although tumor metastases may cause a solitary peripherally enhancing lesion, such lesions are more commonly multifocal. High-grade glioma may cause a solitary, rim-enhancing lesion as the relatively rapid tumor growth outstrips the blood supply, leading to central necrosis. However, both anaplastic astrocytoma and glioblastoma are more typically heterogeneously enhancing and often cross the midline. Primary lymphoma of the central nervous system, usually diffuse large B-cell lymphoma, may occur in otherwise healthy persons. Alternatively, it may occur as part of advanced infection with human immunodeficiency virus (HIV), in which case it is characteristically associated with detectable Epstein–Barr virus (EBV) DNA in the cerebrospinal fluid. It is usually homogeneously enhancing, although cases involving patients who are HIV positive may be heterogeneous or peripherally enhancing.

Q. What is the typical presentation of CNS toxoplasmosis?

A. Toxoplasma is a protozoon that rarely causes serious illness in normal hosts. In patients with advanced HIV infection, however, it is the most common cause of focal brain mass lesions. Patients with toxoplasma infection typically present subacutely with headache, fever, changes in mental status, and focal neurologic deficits. Imaging studies of the brain reveal characteristic rim-enhancing lesions that are usually multifocal but may be solitary in up to 30% of cases. Lesions are typically less than 4 cm in diameter. Serologic testing for toxoplasma IgG would be helpful, since this test has high sensitivity for toxoplasma exposure. However, antibodies may be lost in patients with profound immunosuppression, and seroprevalence is higher in Europe than in the United States. These lesions characteristically improve rapidly with appropriate treatment. Therefore, if the clinical scenario allows observation, a trial of specific antimicrobial agents may be both therapeutic and diagnostic.