VCU IM Acting Intern Rounds

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

[VCU IM Acting Intern Rounds @VCUActingIntern]

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 @VCUActingIntern]

@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 https://t.co/nZDKfKkNxh

[VCU IM Acting Intern Rounds @VCUActingIntern]

@yunnerz Can anyone find the guidelines and name the pathogens where a CVC or port needs to be removed in blood-stream infections? There are a few specific ones where this is a must! I'm sure @Dr_Mike_Stevens can weigh in. Let's give the AIs another chance first! You can do it!

[VCU IM Acting Intern Rounds @VCUActingIntern]

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 @VCUActingIntern]

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?

[VCU IM Acting Intern Rounds @VCUActingIntern]

@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 https://t.co/nZDKfKkNxh

[VCU IM Acting Intern Rounds @VCUActingIntern]

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.

[VCU IM Acting Intern Rounds @VCUActingIntern]

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

[VCU IM Acting Intern Rounds @VCUActingIntern]

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

[VCU IM Acting Intern Rounds @VCUActingIntern]

Calling all Acting Interns, this is a great resource of Tweetorials! #MedEd

[Tony Breu @tony_breu]

https://t.co/9t9lWZPP9C

[VCU IM Acting Intern Rounds @VCUActingIntern]

Lets see if we can drum up some tweets (and learning!). Please post/tweet what you found https://t.co/0sG79lFJR7

[VCU IM Acting Intern Rounds @VCUActingIntern]

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

[VCU IM Acting Intern Rounds @VCUActingIntern]

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

[VCU IM Acting Intern Rounds @VCUActingIntern]

Alright block 2 AIs, this tweet was left unanswered from the last cohort. What are your thoughts? https://t.co/HTn7IAMaMD

[VCU IM Acting Intern Rounds @VCUActingIntern]

Any thoughts? https://t.co/L8quJED0dQ

[VCU IM Acting Intern Rounds @VCUActingIntern]

Any thoughts? https://t.co/L8quJED0dQ

[VCU IM Acting Intern Rounds @VCUActingIntern]

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?

[VCU IM Acting Intern Rounds @VCUActingIntern]

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?

[VCU IM Acting Intern Rounds @VCUActingIntern]

@kevkimhak And arboviruses and tick-borne bacterial infections start now (early spring) - last through summer (affects our pretest probability). So how do we establish the diagnosis? Is CSF analysis the gold standard for distinguishing each of these encephalitides?

[VCU IM Acting Intern Rounds @VCUActingIntern]

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.

[VCU IM Acting Intern Rounds @VCUActingIntern]

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?