Monthly Archives: June 2016

Interns Q&A

We do I park?
You will get your official parking pass from the medicine admin (Gus) by Block 1 (next Thurs 6/30/16). In the meantime, we recommend you not to park at the patient’s area since you may be ticketed. The designed parking for you now is located in “Bowl Parking” and “Parking Lot J” (See Map below)Map

How do I change my password for orchid?
Go to the hyperlink below, then click on “change my password” on the right hand navigator. It should be self-explanatory from there. (hyperlink can only be accessed on intranet or when on VPN)

http://mylacounty.gov/wps/portal/mylac

Consult start time?
Usually 8am, but residents like to be at the hospital earlier to preround as necessary. Page your consult fellow for specifics.

How to use medconsent?
Log on to iMedConsent on Intranet homepage. Select the specific consent of interest. Fill out consent as instructed on screen (fairly self-explanatory). Print then instruct patient about consent and obtain signatures. Make a copy of consent and place it in the patient chart (located at nursing station).

How do we access synapse?
Synapse is connected to orchid, so once you log on orchid, you should be able to access synapse. Otherwise, log on with your regular username/passoword when you open up the synapse application.

Whats the code for the resident lounge?
Ask us when you walk by chief offices

Social service for patients and how to coordinate for efficient turnover?
Great question. We (or your respective team/attending) will go into more details with you about specifics during each of your various rotations. For now, know that social work office is located on 1st floor (x4236)

What apps do you recommend to help us on wards and outpatient?
The very basic you should have: epocrates, medscape, uptodate, U World, MKSAP 16 and 17, Board Basics. MKSAP 16/17 and Board Basics are all free for our residents. Let us know if you have any questions about how to access these resouces

How do we get access to uptodate on our phone?
Come by our office, we will show you based on your particular phone.

Do we input billing code?
Yes, when you are on outpatient rotation.  Usually is 99213 (office visit, expanded, established)

Translation for patients?
Addressed during bootcamp, come to our office if anymore questions.

How do we know when we are on jeopardy?
Check Amion

Can we get food in the middle of night?
Hospital cafeteria opens from 6am-8pm (sharp) on weekdays, and 6:30am-8pm (sharp) on weekends. Breakfast ends at 11am, Lunch ends at 5pm. You can so always order delivery, there are some chief’s fav, come by our office, we will let you know based on your food preferences.

Re: cafeteria hours – is it open overnight? When does breakfast end?
See above

Where do we put our bags? Store food?
If you are in the clinic, place them inside the physcian work room for safety. If you are on the wards/ICU, we recommend you to store them inside the intern call room (there is a code to every intern call room). That said, we do not recommend bringing valuable items to the hospital as storage of personal items are under your own discretion. Unfortunately, there is no locker in the hospital for us at this time… (PI project?)
There is a frig inside the 4th floor central resident work room, where you may store your food.

Where do we see how much money we have on our meal cards?
You have $64 of meal credit to use per week, limited to $6 for breakfast, $8 for lunch, and $7 for dinner. Ask the cafeteria cashiers before or after you purchase your food (they will swipe your card) if you are ever curious to see how much credit you have left on your meal card.

Where are the equipment closets?
Patient’s supplies are locked and assessed per nursing staff personnel. Ask them for supplies if you ever need them (i.e. central line kit, ABG kit, guaze, etc)

General Consents Show Patient Empanelment +/- Provider

Trying to figure out your patient’s primary care physician?

When your patient is admitted, under the Documentation section, look for a note type labeled Consents General. This may include a scanned document with identification of 1) if the patient is a DHS or non-DHS empanelled patient and 2) who that empanelment provider might be.

Use this information for discharge planning.  Remember, empanelled patients should follow-up with their empanelment provider, not in CCC-Post-Discharge Clinic (Clinic A).  CCC-PDC should be reserved for un-empanelled patients (call Clinic A for an appointment).

The “empanelment” provider listed in the patient’s banner bar is not reliable at this time.

Ischemic Stroke From Infective Endocarditis

stroke

Thank you Dr. Tu for an excellent presentation of ischemic stroke due to septic emboli from infective endocarditis

Teaching Points:

  • CNS complications of infective endocarditis can occur in 20-40% patients
  • Etiology: occlusion of cerebral arteries by septic emboli, cerebral hemorrhage, meningitis, encephalitis, brain abscess, mycotic aneurysm
  • Diagnosis using Duke Endocarditis Diagnostic Criteria
  • Treatment tailored antibiotics for 4-6 weeks

Further Reading:
Management of neurological complications of infective endocarditis in ICU patients

Evidence Based Medicine:
Analysis of the Impact of Early Surgery on In-hospital Mortality of Native Valve Endocarditis

Progression of Myocardial Infarction

MIThank you Dr. Janoian for a great presentation on the progression of myocardial infarction.

Teaching Points:

  • pathologic outcomes of MI: arrhythmia, ischemic cardiomyopathy with or without cardiogenic shock, mechanical dysfunction/complications, pericarditis
  • mechanical complications: papillary muscle rupture, ventricular free wall rupture, ventricular aneurysm

Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

ARVD

Thank you Dr. Layoun for an excellent presentation on arrhythmogenic right ventricular cardiomyopathy/dysplasia

Teaching Points:

  • ARVD is a genetic cardiomyopathy with mutations in desmoglein-2, desmoplakin, desmocollin-2, plakophilin, etc
  • Characterized by life-threatening ventricular arrhythmias (monomorphic VT)
  • ECG: QRS prolongation (in right precordial leads), RBBB morphology, Epsilon Wave (distinct wave between QRS and T waves, seen in precordial leads, V1 is the best spot)
  • Treatment: refrain from high intensity exercise, low dose beta-blocker, ICD for secondary prophylaxis in patients with history of VT or VF

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