MedChiefsCCHS

74 posts

MedChiefsCCHS

MedChiefsCCHS

@CchsMed

Chief Residents of the Christiana Care Internal Medicine residency at Christiana Care Health System, Newark, DE

Newark, DE Katılım Ekim 2018
57 Takip Edilen83 Takipçiler
MedChiefsCCHS
MedChiefsCCHS@CchsMed·
Happy Mother’s Day to our @christianacare EMIM PGY3 Erin Hansen, and all of our residency leadership moms (Jen Goldstein, Gretchen Rickards, Himani Divatia, Christy Edwards, Paula Barnes, Liz Cooley). Thank you for leading by example!
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ChristianaCare
ChristianaCare@christianacare·
Congratulations to Dr. Allen Friedland, Dr. David Cohen and Dr. James Piacentine for being honored with awards from the Delaware Chapter of the American College of Physicians! news.christianacare.org/2019/04/americ…
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
T-minus 2 months until we pass the torch! Where’d the time go?!
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
“Things We Do for No Reason” Ordering ammonia in patients with Chronic Liver Disease to diagnose Hepatic Encephalopathy. Not helpful! It does not exclude if normal, it does not diagnose if elevated! Rule out other causes of AMS! Ammonia may be helpful if NO prior dx of CLD.
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
“Things We Do for No Reason” Ordering prealbumin or albumin to assess malnutrition. No benefit! Pts with eating disorders had normal albumin. Malnourished Alzheimer’s pts who we’re refed and gained wait had no inc. in albumin. BMI levels need to be close to 10 to correlate.
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
“Things We Do for No Reason” Prophylactic PPI use in patients on Anticoagulation. No benefit! NNT to prevent GIB is over 700! NNH (c. Diff and HAP) is much less! #IM2019 @ACPinternists
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
“Things We Do for No Reason” Nebs in non-severe Asthma/COPD exacerbation (I.e not status asthmaticus, ICU patients). MDI is non-inferior. Improved technique with MDI use improves outcomes, so practice it in the hospital! Med-Peds plug: get your pts spacers! Use 4-6 puffs!
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
Dr. Feldman from Johns Hopkins on “Choosing Wisely: Things We Do for No Reason.” First: Inpatient antihypertensive management. Why do we treat it? Because we get paged! Short-term asymptomatic HTN urgency (even SBP > 220) does not cause poor outcomes. Address the etiology.
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
Most up to date C-diff treatment guidelines. Fidaxomicin decreases recurrence rates when compared with Vancomycin, however Fidaxomicin was not studied beyond 2nd recurrence. #ACP2019 @ACPinternists
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MedChiefsCCHS
MedChiefsCCHS@CchsMed·
This does NOT include severe drug reactions such as DRESS or SJS! Alternatives should be used in these cases.
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