@VCUActingIntern

A Twittersphere of teaching points, clinical questions, challenging diagnoses, and all things Internal Medicine M4 Acting Intern

 Richmond, VA
Joined April 2018
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  • Following3
  • Followers54
So our last block of AIs talked about gram + bacteremia (great MRSA resource below). What about patients with gram neg bacteremia? - duration of treatment? - what modality of antibiotics (IV/PO)? - do indwelling lines need to be removed? - do we need surveillance cultures?
VCU IM Acting Intern Rounds@VCUActingIntern27 Jun 2019
Replying to @yunnerz
Yes! TTE should be performed +/- TEE. See this great review of Staph bacteremia specifically also with treatment recs. No linezolid, yes Dapto or Vanc. Management of Staphylococcus aureus Bacteremia ja.ma/2J5EHcY
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An old post but a good one that no one responeded to previously. Let's see what you all think!
VCU IM Acting Intern Rounds@VCUActingIntern1 May 2018
You are the intern who admits a patient with sepsis found to have gram-positive cocci bacteremia - what are the next steps in management that all pts with GPC bacteremia need? Also what antibiotic, duration & route to treat with?
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Good job! IV Vanc to start is perfect if we don't know the speciation. I can think of something else to order, especially if there are more than one set of positive cultures. Any thoughts? Since it was brought up, what bloodstream infections require indwelling line removal?
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Alright, let's resurrect this thing! You are the AI for an 80 yo female with dementia admitted with delirium from a UTI. On hospital day 2, you notice left calf swelling and ultrasound (US) confirms peroneal vein DVT. What do you do next? Select an answer and post your rationale
43%Anticoagulate for 3 mos.
0%Don't treat/defer to PCP
43%Don't treat/order 1 wk US
14%Anticoagulate for 6 mos.
7 votes • Final results
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Great studies @komal_safdar & @yunnerz! As you can see the evidence isn't convincing. CHEST guidelines give grade C evidence to support 2 week ultrasound surveillance of low-risk distal DVTs. It is a risk-benefit discussion with the patient and risk assessment of clot extension
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I am excited that not treating with anticoagulation is an option. This patient received a week of anticoagulation inpatient before I assumed care of her. Repeat US showed resolution of the thrombus & we stopped anticoagulation.
Calling all Acting Interns, this is a great resource of Tweetorials! #MedEd
Tony Breu@tony_breu10 Feb 2019
xitter.cf/i/moments/109439565001…
Lets see if we can drum up some tweets (and learning!). Please post/tweet what you found xitter.cf/VCUActingIntern/status…
VCU IM Acting Intern Rounds@VCUActingIntern24 May 2018
2 tweets today: What criteria supports the clinical diagnosis of acute diverticulitis? Who should be admitted vs managed as outpt? Do all these patients need antibiotics? What are some options for antibiotic regimens, including duration (PO and IV)? Share your resources
2 tweets today: What criteria supports the clinical diagnosis of acute diverticulitis? Who should be admitted vs managed as outpt? Do all these patients need antibiotics? What are some options for antibiotic regimens, including duration (PO and IV)? Share your resources
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Alright block 2 AIs, this tweet was left unanswered from the last cohort. What are your thoughts? xitter.cf/VCUActingIntern/status…
VCU IM Acting Intern Rounds@VCUActingIntern11 May 2018
Any thoughts? xitter.cf/VCUActingIntern/status…
Any thoughts? xitter.cf/VCUActingIntern/status…
VCU IM Acting Intern Rounds@VCUActingIntern1 May 2018
You are the intern who admits a patient with sepsis found to have gram-positive cocci bacteremia - what are the next steps in management that all pts with GPC bacteremia need? Also what antibiotic, duration & route to treat with?
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You are the intern who admits a patient with sepsis found to have gram-positive cocci bacteremia - what are the next steps in management that all pts with GPC bacteremia need? Also what antibiotic, duration & route to treat with?
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Alright Acting Interns, here's your first question to ponder. A common problem we face are patients admitted to the hospital with altered mental status. How do we differentiate between meningitis and encephalitis? Let's list some differentials of each too.
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Good. So this patient likely has encephalitis. What's our differential? In addition, how does our differential vary by the time of the year?
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Here's another question hot off the wards -- My pt c/o dysuria. This is her UA: UA -- Prot Neg, Leu Lar, Nit Pos, Ket Neg, Glu Neg, RBC 7, WBC 25, pH 8.0, triple phosphate crystals seen. What is likely organism? Should I treat? With what?
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