Thank you to Dr. Farah and Dr. Nagra who presented Tumor Lysis Syndrome in morning report. Dr. Nagra highlighted many clinical pearls about risk factors, diagnosis, differential diagnosis and management. Dr. Farah discussed evidence grading system and the evidence supporting the use of single dose Rasburicase vs multiple doses vs Allopurinol for TLS treatment. Some clinical pearls from these presentations:
 Full presentation is available on our resident shared google drive: https://drive.google.com/file/d/1DTNVb02PmSh95Fbzr9Wt73dKVIvWSINS/view?usp=sharing https://drive.google.com/file/d/1q9JzFJo-YopF_84PhIbWIDFmx405qRMM/view?usp=sharing New interns; Welcome! We are so excited to have you join St Joes family! Here is some useful information and tools to survive your first month on the floors! This file include information about MTS, AIM clinic, electives, didactics and much more. Please reach to your chiefs if you have any questions. We will always be happy to help. https://drive.google.com/file/d/1nSfCjzJz-vuX9Igg8vYHR61PHauEka6i/view?usp=sharing
On Friday 6/14/2019, we celebrated the graduation of of the internal medicine residents at St Joseph Mercy Hospital Ann Arbor, class of 2019. Congratulations to the Achievers class:Dr. Haritsa Asuri: going to Addiction Medicine Fellowship at St Joesph Mercy Hospital Ann Arbor Dr. Aparna Bhat: going to Sleep Medicine Fellowship at Cleveland Clinic. Dr. Nauman A. Chaudhry : going to work as a hospitalist and starting his software business. Dr. Shraddha Desai: staying as a chief medical resident at St Joseph Mercy Hospital Ann Arbor. Dr. Sarah Finlay: will be working as a hospitalist at Chatham Kent Health Alliance in Canada. Dr. Elissa S. Gaies: going to be a primary care physician in Ann Arbor Dr. Linsey Gilbert: staying as chief medical resident at St Joseph Mercy Hospital Ann Arbor. Dr. Eghosa Idumwonyi :who will be working as a nocturnist in Buston Dr. Reddappa Venkata Sai Rakesh Kanipakam: who will be joining Nephrology Fellowship at Browns University. Dr. Noura Nachawi: who is staying as chief medical resident at St Joseph Mercy Hospital Ann Arbor. Dr. Rachana Ramesh Amberker: going to work as a hospitalist in Iowa Dr. Dmitriy Petrov: going to Geriatric Fellowship at University of Toronto. Dr. Shrenika G. Reddy going to Endocrine Fellowship at UTMB, Texas Zeyad Sako: going to Hematology & Oncology Fellowship at St John Hospital , Michigan Dr. John Wei: going to be primary care physician in Oregon. A big thank you to our chief residents who are leaving us to their next adventure:Dr. Brian Gallagher: going to work as a hospitalist in Nebraska Dr. Sohaib Gilani : going to Pulmonary & Critical Care Fellowship at Henry Ford Hospital, Michigan Dr. Stephanie Norris: will be working as a hospitalist at St Joesph Mercy Hospital Ann Arbor.
Continued Shortages Dobutamine: On shortage for long term most likely. We have approximately 2 weeks left at normal use. If our supply is depleted the recommendation is milrinone for ICU use. Magnesium: Injection is now difficult to order. At this time the only restriction is for TPN use: No adult, only pediatric and neonate. The following adjustments will be made to all Inpatient and ED IV Zofran orders:
Potassium 20-80 meq/ 1L of NS, LR, etc. The potassium vials used to add KCL to large volume parenterals is also short. Please avoid ordering this for potassium supplementation.
Iron Dextran IV—Will need to change to sodium ferric gluconate if supply is depleted Diltiazem injection: The 5 mg vials for bolus are depleted and we have one week remaining of the supply for continuous infusions. Alternatives include:
After our recent dermatology jeopardy session, some of our dermatology TYs, Zac and Adam, wanted to pass on an excellent overview of dermatology: Lookingbill and Marks’ Principles of Dermatology, Sixth Edition. We actually have electronic access to this resource on our hospital intranet (or at home if you make a free account to Clinical Key while on the hospital computers). The link is: https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20150008814 To browse our e-book collections please follow this link: http://stjoesannarbor.libguides.com/c.php?g=571449 As always, our medical librarian, Jillah Biza, is a fantastic resource for any other questions.
Continued Shortages The ondansetron (Zofran) IV situation continues to be a large concern. Pharmacy continues to implement the AUTOMATIC SUBSTITUTION: – All IV PRN and Scheduled orders will be changed to the Ondansetron 4 mg ODT (oral dissolving tablet) keeping same schedule as IV. – Only 1x order for IV will be allowed for patients who are ACTIVELY vomiting. Potassium 20-80 meq/ 1L of NS, LR, etc. The potassium vials used to add KCL to large volume parenterals is also short. Please avoid ordering this for potassium supplementation. First choice are the KCL 10meq/100ml and 20 meq/50ml IVPB—this supply is recovering. Iron Dextran IV—Will need to change to sodium ferric gluconate if supply is depleted Diltiazem injection: The 5 mg vials for bolus are depleted and we have one week remaining of the supply for continuous infusions Alternatives: – Oral diltiazem whenever possible – Intermittent IV Push metoprolol – Esmolol infusions reserved for situations where intermittent Given the recent Code Red (Fire) that occurred, we wanted to remind the general expectations of all staff, including residents: There may be a change in the naming convention of various codes that is upcoming. We will keep you informed. Certain synthetic cannabinoids might be contaminated with the long-acting anti-coagulant brodifacoum which is found in rat poisons. Patients ingesting this substance can present with coagulopathy akin to toxicity from Vitamin K-dependent antagonism. For more information on presentation, treatment, and overall costs, please refer to the CDC COCA alert article here
Potassium 20-80 meq added to 1L of NS, LR, etc. The potassium vials used to add KCL to large volume parenterals are on critical shortage. Please avoid ordering this for potassium supplementation-pharmacy will contact prescribers to change orders. First choice are the KCL 10meq/100ml and 20 meq/50ml IVPB. Thank you. Still remain a concern: The ondansetron (Zofran) IV situation continues to be a large concern. We have less than 1 week left of supply with normal use. Pharmacy continues to implement the AUTOMATIC SUBSTITUTION: All IV PRN and Scheduled orders will be changed to the Ondansetron 4 mg ODT (oral dissolving tablet) keeping same schedule as IV. Only 1x order for IV will be allowed for patients who are ACTIVELY vomiting. If we run out of IV ondansetron, the plan is to change to IV granisetron (Kytril)—non-formulary. But that product is on shortage. Please be aware of this temporary substitution while the shortage is critical and share this information with all of your colleagues, please. Iron Dextran IV—May need to change to sodium ferric gluconate if supply is depleted Lidocaine 1% 20ml MDV—will find 5mg and 30 ml substituted in pxyis. Aminophylline injection Primary use is reversal of symptoms related to Dipyridamole (Persantine®)in Nuclear Medicine Stress Lab. Regadenoson (Lexiscan®) is a more expensive option which is currently restricted. Diltiazem injection: The 5 mg vials for bolus are depleted and we have one week remaining of the supply for continuous infusions Alternatives: -Oral diltiazem whenever possible – Intermittent IV Push metoprolol -Esmolol infusions reserved for situations where intermittent For a comprehensive list, click here |
St joseph mercy ann arbor program internal medicine residency
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