Good afternoon Doctors,
We hope you enjoyed the hot waffles at morning report this morning. Attendance to morning report has been slowing down but despite that, the senior talks have been wonderful! Please try to make it to morning report to support and learn from the seniors!
Sick Call Chief:
- We are planning a book club noon conference for Thursday, March 23rd. Details to come.
- Controlling a chaotic room is often the most important thing you can do as the code team and code leader, in addition to early defibrillation and good quality compressions.
- To improve organization and flow of information, we continue to suggest that one of the interns on the code team assume the crucial role of gathering patient information (primary team, admitting diagnosis, current issues, recent labs) while your senior is gaining control of the room.
- Residents and fellows are NOT to decline admissions to the medicine services without involving their attending in that decision. If you feel that a patient is not appropriate for the floor, this must be discussed with your attending prior to declining the patient.
- On PCS remember that a nurse should be informed of and present for all lines you’re placing in your patients.
- Have you seen an increase in sickle cell patients admitted to medicine? We want to provide these patients with the best medical care and pain control possible. Remember that even though a sickle cell patient may be profoundly anemic, the decision to transfuse is complicated (iron overload, several antibodies, high risk for transfusion reactions). A brief review of our inpatient sickle protocol follows:
- All sickle cell patients should have a reflexive heme consult, regardless of whether their hematologist is in our system.
- Pain control should be provided via PCA pumps or PO medications, not IV pushes.
- The heme fellow should primarily communicate with the PCA service.
- Please do not transfuse sickle cell patients without discussing with the heme consultant first.
- Patients still admitted on hospital day 7 should have a multidisciplinary meeting between the IM and heme attending, with other consult services and/or support staff as necessary
- We are working to have discharge summaries assigned to the correct intern- When you place your admit order “Admit to medicine” – the PROVIDER field should be updated with the name of the primary intern. Do not change the “medicine admission” order – this is the white card, placed by the ER.
- There will be a 30 minute VistA and CPRS outage this Saturday 3/4 from 4:30-5:00pm. Pagers and phones will work but overhead paging and vocera will not work.
- Remember to use the Admission Checklist and document smoking behavior (followed by ordering nicotine patches if appropriate) for every admission.
- Abdullah Alissa for a job well done on PCS! Please stop by to pick up your gift card.
Article of the week:
- A recent article published in JAMA by Anderson et al discussed “Intubation During Adult In- Hospital Cardiac Arrest and Survival”. It is important to remember that the study was observational (2000-2014) and was done using propensity score matching. Patients without an advanced airway at time of arrest who were then intubated between 0-15 minutes into a code were compared to propensity score- matched patients who were not intubated at the same moment of a code. The authors found that patients who were not intubated had a 4% survival compared to 16.3% in the intubated group- this was statistically significant. They also found significantly higher ROSC and functional status at discharge in the group not intubated. Of note, subgroup analysis of patients with respiratory insufficiency and trauma were the only groups to do better with early intubation during a code. This is food for thought – may not be enough to change practice at this time, but certainly focus on EARLY DEFIBRILLATION and QUALITY COMPRESSIONS during your codes.
Chief Contact info:
Ruth Adekunle p3379 c732-749-0069
Laura Ferguson p3369 c315-256-8803
Karan Kapoor p3396 c908-839-3636
Christina Koch p8740 c443-995-2068
Internal medicine resident website: https://imres.medicine.umaryland.edu/
Username: imres, Password: Woodward
RISE program: Available 24/7 for stressful clinically – related events. Pager #12602.
Employee Assistance Program: For anyone who would like to talk to a therapist for any reason. 410-328-5860 (anonymous)