Fever of Unknown Origin and Giant Cell Arteritis

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Teaching Points

  • Definition of Fever of Unknown Origin (FUO):
    • Fever for >3 weeks
    • Documented T>38.3
    • At least 1 week of inpatient investigation or 3 clinic visits
  • FUO Differential: infection (24.5%), malignancy (14.5%), inflammatory (23.5%), micellaneous  (7.5%)
  • FUO labs: CBC, ESR/CRP, LFTs, Blood cultures, UA, CXR, PPD/quant gold, HIV, hepatitis serologies, ANA, RF

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Updated Remote ORCHID Access… MAC Users Included

If you are as yet unable to connect to ORCHID remotely, this update is for you.

You can now connect to ORCHID through VDI (virtual desktop infrastructure), and this will work for PC and MAC users alike.  Simply follow the attached instructions: DHS VDI for External Users.  They will guide you to download and install VMWare for your operating system, and then you can log-in via the new link: https://myremotepc.dhs.lacounty.gov

Some notes:

  • If you previously installed another version of VMWare, you may need to uninstall the old version and install the new one.
  • The Virtual Desktop includes access to workstation applications like Synapse.
  • Protect all health information! You should not allow others to access health information or leave your workstation or mobile device unattended or insecure.

Hemophagocytic Lymphohistiocytosis

Teaching Points

  • Definition: severe hyperinflammation caused by uncontrolled proliferation of activated lymphocytes and macrophages
  • Presentation: fever, hepatosplenomegaly, lymphadenopathy, jaundice and a rash.
  • Diagnosis: Fulfillment of five out of the eight criteria below: fever (>100.4 °F, >38 °C), splenomegaly, cytopenias affecting at least two of three lineages, hypertriglyceridemia, ferritin ≥ 500 ng/ml, haemophagocytosis in the bone marrow, spleen or lymph nodes, low or absent natural killer cell activity, soluble CD25
  • Treatment:  high dose corticosteroids, etoposide and cyclosporin

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Dressler’s Syndrome

Thank you Dr. McCutcheon for an excellent case and presentation on Dressler’s Syndrome

Teaching Points

  • Post MI complications: electrical, mechanical, ischemic, shock, pericaditis, post infarction angina
  • Electrical: accelerated idioventricular rhythm, ventricular arrhythmias, bradycardia, heart blocks, intraventricular blocks
  • Mechanical: papillary muscle dysfunction/rupture, ventricular septal rupture, free wall rupture
  • Dressler’s syndrome:  immune mediated pericarditis in response to the damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury

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FALL RETREAT !!!!!!!!!

fall-retreat-image

 

When: Friday, Sept 9th; arrive by 9:30am at Memorial Park Levitt Pavillion.

The theme for our retreat is “ the Amazing Race through Residency”

Wear comfortable clothes and shoes.  bring a bottle of water and sunscreen

Address:  85 East Holly Street, Pasadena, CA 91103

The team list is attached below

Parking :  Please the attachment below .

Lunch:  After our race, we will have a wrap up session,lunch, meeting and feedback session at Cafe Santorini from 12:30-4pm.

Happy Hour with The Chiefs after 4 pm in Pasadena

Goals:

The goals for the  Fall retreat are to promote teamwork and for all of us to get to know each other better while giving you an opportunity to get important updates and give feedback !!!!We are looking forward to a great bonding experience while we discover more about our neighboring city and each other.

2016-fall-retreat_parking-options

ovmc-fall-retreat-2016-team-list

 

Tolosa Hunt Syndrome

Cavernous-sinus

Teaching Points:

Definition: Episodic orbital pain associated with paralysis of one or more of the CN III, IV, VI due to granulomatous inflammation of the cavernous sinus

Presents with episodic painful ophthalmoplegia, CNIII, IV, VI Palsy leading to diplopia, usually unilateral, headache often precedes paresis

Etiology – inflammation unknown etiology

Treatment – glucocorticoids

Morning Report 8.23.16 – Tolosa Hunt

Drug reaction with eosinophilia and systemic symptoms (DRESS)

OLYMPUS DIGITAL CAMERA

Teaching Points

  • Potentially life-threatening, drug-induced hypersensitivity reaction
  • Presents with fever, malaise, skin eruption, hematologic abnormalities (eosinophilia, atypical lymphocytosis), lymphadenopathy, and internal organ involvement (liver, kidney, lung)
  • Management is withdrawal of offending drug, topical or oral/IV glucocorticoids (if severe disease)

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Inpatient Reminders This Past Week

Admission Orders: Level of care must agree

  • The level of care must agree between the Request for Admit (placed by ED) and Admit to Inpatient (placed by admitting team) orders while the patient is boarding in the ED.  If one of these is not correct, re-order it. Don’t cancel the prior order.
  • If changing the level of care while still boarding in the ED, place a new Request for Admit and Admit to Inpatient order with the new level of care. Don’t cancel the prior orders. Let the nurse and bed control know.

Admit order

Inpatient Lab Orders: Time it right

  • Routine Lab Collection times: 0000, 0400, 1000, 1300, 1700, 2100
    Labs with an order time set after one of these times will be rolled over to the next collection time.  So if you need “PM Labs”, set a Routine priority at 1700 or 2100.
  • Avoid using the Timed Routine lab priority.
  • Do not use the Label comment field or Order Comments to communicate to the Lab/Phlebotomy. They cannot see this information when drawing labs.  Instead, call Phlebotomy to let them know if special instructions, e.g. “Please use pediatric tubes”

Remember the Required Provider Note Details

  • Remember to fill out the Required Provider Note Information for every patient, every day in the hospital before you write your progress or procedure note

Procedure Note - Required Details

Choose the right Note Type, Correct it before you sign

  • Remember to choose the correct Note Type when creating your note.
  • If you initially selected the wrong Note Type, you can change it by clicking the blue hyperlink at the bottom of the note before you sign it.

Update Change Note Type

Write the right information on the Discharge Summary

  • Discharge Medication List: The auto-populated “Home” Medications should be the same as the Discharge Medications.
    Make sure to do the Med Rec prior to creating the note, or clicking the little refresh button in the Mediation section to update the list.
  • Hospital Course: Summarize the hospital course by problem.  A summary is a synthesis of the findings, assessment and course, including rationale to explain events or course of action
  • Discharge Plan/Follow-up: Be succinct! This includes the plan for the patient and follow-up.  Deleting the problem list in this section is okay. A bulleted list of plans is okay.