MedChiefsCCHS

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

[MedChiefsCCHS @CchsMed]

Just some of the MANY posters at the Mid-Atlantic SGIM! What a fantastic showing @christianacare @SocietyGIM #christianaproud #IMproud #proudtobeGIM #midatlanticSGIM #UPMC

[MedChiefsCCHS @CchsMed]

Absolutely honored to have spent most of the morning learning from Dr. Centor today! @medrants @christianacare #medicine #RBTlecture #healthdetectives

[MedChiefsCCHS @CchsMed]

If you’re anything like us, you frequently need help remembering tropical infectious diseases. Morning report focused on an interesting Malaria case! #malaria #dengue #infectiousdisease #CCHS #tropicaldisease #yellowfever #typhoid https://t.co/c5XJssXwYI

[MedChiefsCCHS @CchsMed]

Lookout! New chiefs in town! Welcome to our new interns!!!

[Dan Hess @jdanielhess]

New chiefs and new interns getting orientation started this week! @CchsMed @CCHSIMResidency

[MedChiefsCCHS @CchsMed]

So incredibly proud to bring in the new intern class!!! @christianacare @DonJohnelly #cchs #christiana #whitecoat #interns #sofresh

[MedChiefsCCHS @CchsMed]

Shout out to our amazing @christianacare residents! Three oral presentations and seven poster presentations at national SGIM this year!

[ChristianaCare @christianacare]

We’re jazzed for our internal medicine residency after their strong showing at @SocietyGIM. With three oral and seven poster presentations, our IM residents brought their A-game to the meeting! #NiceWork

[VA Boston Joint Chiefs @BostonChiefs]

What’s your differential for ST elevation? And do you group them in buckets? Great schema by @DPipilasMD in #AMreport #MedEd

[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!

[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! https://t.co/cjyBxR9gJ2

[MedChiefsCCHS @CchsMed]

T-minus 2 months until we pass the torch! Where’d the time go?!

[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.

[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.

[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

[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!

[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.

[MedChiefsCCHS @CchsMed]

Day 2 of #chiefsatACP! First up, Drs. Bobby DeGrazia and Vali Kondos presenting their posters this morning! #IM2019 @ACPinternists

[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

[MedChiefsCCHS @CchsMed]

This does NOT include severe drug reactions such as DRESS or SJS! Alternatives should be used in these cases.

[MedChiefsCCHS @CchsMed]

Have a patient with a true IgE mediated allergy to PCN? (Yes, EVEN anaphylaxis) You don’t have to avoid the majority of Cephalosporins! #chiefsatACP #ACP2019 @ACPinternists