Author Archives: ovmcwp

TCA Induced Cardiotoxicity

Thank you Dr. Daniel Jimenez for an excellent presentation on TCA induced cardiotoxicity

Teaching Points

  • Clinical presentation: anticholinergic sx (urinary retention, constipation), CNS (seizures, coma), acidosis, arrythmias
  • ECG: prolonged QRS/PR/QT –> predisposes for ventricular arrhythmias)
  • Management: supportive care, benzos for seizures, activated charcoal if 2 hours of ingestion, sodium bicarb if QRS>100msec (goal ph 7.5-7.55), aggressive IVF/pressor support if hypotensive

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NEW Collaborative Care Round

Howdy, residents! We are rolling out our new Collaborative Care Round (CCR)! See roll out date and schedule below:

 

Teams Location Rounding Time Roll out Date
C & D 4D127 Team D: 10:00am

Team C: 10:15am

 March 7th,2017
A & B 4D107 Team B: 10:00am

Team A: 10:15am

 March 13th, 2017
E & F 5C106 Team F: 10:30am

 

Team E: 10:45am

 March 20th, 2017
G & H 5D107 Team H: 10:30am

 

Team G: 10:45 am

 March 27th, 2017

 

 

BRIDGE TRIAL

Thank you Thomas Vu for your excellent overview of the BRIDGE trial (Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation)

Conclusions of the study:

  • In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low molecular weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding.

Main Points: BRIDGE PowerPoint

Read Full Article: BRIDGE Trial

 

STOPAH TRIAL

Thank you Quynh Vu for your excellent overview of the STOPAH trial (Prednisolone or Pentoxifylline for Alcoholic Hepatitis)

Conclusions of the study:

  • Pentoxifylline did not improve survival in patients with alcoholic hepatitis
  • Prednisolone was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year

Main points: STOPAH PowerPoint

Read Full Article: STOPAH Trial

Block 8 Ambulatory Week: Academic Half Day

All Intern Didactics have been rescheduled to Wednesday on Ambulatory week to pilot Academic Half Day. SBP is still on Friday.

 

Fri 
Location: Clinic A
7:30-8:00am: SBP (Dr. Soleymani)

Wed
Location: 6D103
7:30-8:00am: COPD (Dr. Gold)
8:00-8:30am: URI (Dr. Rotblatt)
8:30-8:45am: Break
8:45-9:15am: Asthma (Dr. Suthar/Dr. Barot)
9:15-9:45am: Wellness 101 (Dr. Nafisi/Chiefs)
9:45-10:00am: Break
10:00-12:00pm: Profession of Medicine (POM) – Geriatrics (Drs. Kim/Schickedanz)

Disseminated Histoplasmosis

histo-microscopy

Thank you Dr. Brendan Cerk for an excellent presentation on neurocysticercosis presenting with new onset seizure

Teaching Points

  • Histoplasmosis is a common endemic mycosis, usually asymptomatic but occasionally results in severe illness
  • Hematogenous dissemination occurs during the acute infection before cellular immunity develops
  • Diagnosis: serum and urine antigen
  • Treatment: itraconazole for 12 months, if CNS then liposomal amphotericin B for 4-6 weeks then itrazonazole for an additional 12 months

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Neurocysticercosis

Thank you Dr. Rajat Suri for an excellent presentation on neurocysticercosis presenting with new onset seizure

Teaching Points

  • Initial treatment for seizure: IV lorazepam 0.1mg/kg –> IV fosphenytoin –> sedation/intubation
  • Neurocysticercosis  is caused by Taenia Solium
  • Spreads hematogenously to the brain, liver, muscle
  • Diagnosis: presentation+imaging.  serum testing not reliable
  • Treatment: dexamethasone, albendazole, anti-epileptic

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Acute Esophageal Variceal Bleed

esophageal_varices_by_ink95-d9f81u1

Thank you Dr. Kirollos Zaki for an excellent presentation on UGIB from esophageal varices

Teaching Points

  • Management of GI bleed
    • fluids, goal hg>7, plt >50, INR<1.5.
    • protonix drip if UGIB, add octreotide drip if concern for variceal bleed
  • Endoscopy
    • variceal ligation: using banding, goal is within 12 hours
    • sclerotherapy: usueally epi is used, similar results as ligation but high rebleeding risk
  • TIPS
    • Indications: active hemorrhage despite endoscopic treatment or recurrent bleed

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Pulmonary Squamous Cell Carcinoma

1

Thank you Dr. Annie Belzowski for an excellent presentation of pulmonary squamous cell carcinoma complicated by pulmonary abscess

Teaching Points

  • Common causes of pulmonary abscess:
    • Bacterial: Anaerobic bacteria, Pseudomonas aeruginosa, Mycobacteria
    • Fungal: Aspergillus, Coccidioides, Histoplasma, Blastomyces, Cryptococcus
    • Non-infectious: malignancy, embolism, vasculitis, scarcoidosis
  • Clindamycin preferred agent, time course dependent on follow up imaging
  • Common forms of lung cancer: adenocarcinoma (40%), small cell (15%), squamous cell (30%)

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