James Lim, MD

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James Lim, MD

James Lim, MD

@JLimHospMD

Hospitalist 20+yr ➡️ both UCC & Hospital Med. Husband, dad of 3 🇭🇰🇷🇺🇦🇲 kids + 2 German Shepherds who like me have barks worse than their bite.

California, USA Katılım Ağustos 2015
2.8K Takip Edilen4.7K Takipçiler
James Lim, MD retweetledi
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊@PulmCrit·
my key advice on bupropion XR intoxication: if you intubate a patient for seizures, place a gastric tube & start whole bowel irrigation immediately don't debate, just do it irrigation reduces ongoing drug absorption, minimizing deterioration more emcrit.org/ibcc/bupropion/
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 tweet media
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Anil Makam
Anil Makam@AnilMakam·
Been ruminating on @PaulSaxMD piece on ID love-hates Here is my expanded list of Heroes to Zero (or stud to duds, stellar to cellar, ace to disgrace...) COVID mRNA vax Beta blockers for HTN and MI Aspirin Warfarin Revascularization for non-STEMI What else?
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James Lim, MD
James Lim, MD@JLimHospMD·
@Papa_Heme Blind adherence to Epic alerts based on guidelines w/o taking into account the pt in front of you often compounds this problem
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Papa Heme
Papa Heme@Papa_Heme·
Medical guidelines have destroyed critically thinking in medicine.
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James Lim, MD
James Lim, MD@JLimHospMD·
@AnilMakam On the glass half full side we have a “Patient does not have sepsis” box which prevents the alert from recurring every time we open the chart
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Anil Makam
Anil Makam@AnilMakam·
low grade fever, mildly tachycardic, weakness, nothing focal, no alarm signs/symptoms epic sepsis alert triggered vanc/pip-tazo given, lactate checked flu+ sepsis metric met care worse lather, rinse, repeat Metric based "QI" does net harm
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James Lim, MD
James Lim, MD@JLimHospMD·
@kristenmag Laura will organize a protest on behalf of the MMIWG2SLGBTQQIA+ 👍
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James Lim, MD
James Lim, MD@JLimHospMD·
@eye4msu @hugmeisterextra From what I understand (w/ caveat that I don't do peds), the nasal vaccine causes more systemic side effects vs injection form. It also has better efficacy in certain age groups so perhaps that's why pediatrician chose that route.
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jason IN flagstaff
jason IN flagstaff@eye4msu·
@hugmeisterextra @JLimHospMD It's odd for me. It's not recommended for me either, but my retired army insurance pays for it so wth? Might as well. That said,since yall are hcw,i tried the live/attenuated spray flu vaccine for my son this year,& it made him sick. Not nearly full flu,tbc,but def yucks x 2days
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James Lim, MD
James Lim, MD@JLimHospMD·
@ABsteward It matters when we speak w/ patients as it gives the perception of inferiority. Similar to when ppl say "I'm putting you on a strong abx".
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Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟
Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟@ABsteward·
Words matter! It’s very frustrating that I’m still encountering the term “oral step-down” in major ID journals. Let’s replace it with stewardship-aligned terms: IV to oral switch Oral transition Streamlining “Step-down” implies inferiority of oral antibiotics. Time to stop using this term in ID journals—authors, editors, reviewers. #IDXposts
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James Lim, MD
James Lim, MD@JLimHospMD·
My institution created an order set to guide abx treatment for outpatient cellulitis. While for non-purulent cellulitis duration default is 5d, when MRSA suspected default is set to 7d. Curious what ID folks think @BradSpellberg
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James Lim, MD
James Lim, MD@JLimHospMD·
@PulmCrit I actually write a nursing communication order stating “allow pt’s family to bring food from home”.
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𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊@PulmCrit·
Inadequate caloric & protein intake is common among hospitalized patients Acute illness isn't the time to start forcing patients to go on a diet Autonomy and self-determination are bedrock principles of medical ethics Hospitals should allow patients access to food they want
MAHA Action@MAHA_Action

Calley Means: “I was at Stanford Hospital with my mom… they served her Coca-Cola.” “She was a diabetic dying of a metabolic condition from cancer.”

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James Lim, MD
James Lim, MD@JLimHospMD·
@Zaydovudine @BradSpellberg No, likely b/c too much verbiage on the screen dissuades use. At least at my shop ppl don’t do the cephalexin / TMP-SMX I often see in the community b/c you can’t multi-select abx.
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Brad Spellberg
Brad Spellberg@BradSpellberg·
@zacroBID @JLimHospMD If only we were 3 toed sloths, 6 would work. But, alas, we’re 5 toed hominids, so 6 is a violation of the laws of nature (despite being studied in RCT!).
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James Lim, MD
James Lim, MD@JLimHospMD·
@VaniSubbarao @BradSpellberg I’m do adult urgent care & hospital med so can’t address kids but it’s my understanding that it can take up to 10d for redness to resolve. I tell pts key is improving tenderness, swelling, no advancing redness. I know it’s hard for pts & I’m sure parents to grasp sometimes…
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Vani Subbarao
Vani Subbarao@VaniSubbarao·
@BradSpellberg @JLimHospMD How do you guys define success in these patients regardless of the pathogen? My view is that the actual redness can take a long time to resolve sometimes, and the responsible clinician often does crp (I know, your favourite!) which invariably ends up being around 130 or so.
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James Lim, MD
James Lim, MD@JLimHospMD·
@DrDiGiorgio @mtick27 I’ve tried to address this in past for both in and outpt but not much luck. Maybe you might have more luck via your hospital’s health info committee but don’t cross your fingers as I was member of mine 😊
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James Lim, MD
James Lim, MD@JLimHospMD·
@DrDiGiorgio @mtick27 Yeah. 10pt ROS hasn’t been req’d for a while. Even things like PMH/PSH/H/FHx aren’t mandated. But hospital policy trumps CMS. Same thing for outpt end but most docs have in their clinic notes via archaic templates.
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Anthony DiGiorgio, DO, MHA
Anthony DiGiorgio, DO, MHA@DrDiGiorgio·
Did an emergency crani in the middle of the night for a young girl with an epidural hematoma and a blown pupil. Got scolded by an administrator the next day for failing to include a 10-point review of systems in my H&P.
Kevin Pho, M.D.@kevinmd

No surgeon. No anesthesiologist. One physician. Packed ED. @jessicasinghmd stabilized a critically ill patient with blood in their airway. Shift ends. The incoming physician, also an administrator, says in front of staff: "I need you to function." She reported it. Was told this person "was known for this." Had made other administrators cry. That was the culture. She left. Not because of the clinical work. Because the people who should have her back in life-or-death moments couldn't even acknowledge a successful resuscitation. Her advice now: don't accuse, observe. "I noticed this, and here's its impact." And if you don't feel safe saying it alone, bring a third party. Episode is in the comments. #PhysicianBurnout #PsychologicalSafety #EmergencyMedicine

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James Lim, MD
James Lim, MD@JLimHospMD·
@eye4msu @hugmeisterextra When I last did admitting shift, found my old PAPR device in Hospitalist offices gathering dust. Haven’t had COVID 💉 since primary series, I don’t see need. Boosters not mandated for HCP.
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Keşfet

@AnilMakam @PaulSaxMD @Kiradavis @spencerpratt @Papa_Heme @kristenmag @eye4msu @hugmeisterextra