YL

[YL @yunnerz]

@PlayMapleM Y’all need better customer service. Weeks and no response.

[YL @yunnerz]

@VCUActingIntern @Dr_Mike_Stevens I would say S. aureus, enterococcus, gram neg rods, and candida. This is per the IDSA guidelines (but from 2009).

[YL @yunnerz]

@VCUActingIntern Not 100% sure, but I would consider an echocardiogram (TTE first) to look for endocarditis. As for indwelling line removal, I would remove if patient is floridly septic (hypotensive) and if organisms are high virulence (i.e. S. aureus or pseudomonas).

[YL @yunnerz]

Not 100% sure, but might consider an echocardiogram to rule out endocarditis. As for indwelling lines, I would remove if patient is hemodynamically unstable or if culture grows particularly virulent organisms such as S. aureus or pseudomonas.

[VCU IM Acting Intern Rounds @VCUActingIntern]

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?

[YL @yunnerz]

@VCUActingIntern I probably would start IV Vancomycin empirically until cultures return with species differentiation and susceptibilities. It would also be nice to know clusters vs. chains and possible sources of infection (i.e. skin, central line, GI, endocarditis, PNA).

[YL @yunnerz]

@VCUActingIntern In another study by Utter et al, it was found that anticoagulation reduced rates of proximal DVT and PEs w/in 180 days (OR 0.33), but also increased bleeding risk (OR 4.87). Therefore, benefits of anticoagulation needs to be weighed with bleeding risk. https://t.co/hphRujVfN1

[YL @yunnerz]

@VCUActingIntern In an article by Sule et al, the conclusion was "Distal DVT may not require treatment with anticoagulation. If leg symptoms worsen, or if there is an extension of distal DVT on the follow-up scan, treatment with anticoagulation is recommended." https://t.co/xwObOJSgFg

[YL @yunnerz]

@VCUActingIntern I believe studies have shown there isn't increased benefit with anticoagulation in isolated distal DVTs but higher risk of bleeding. Given patient's age and acute delirium on chronic dementia, she's a high fall risk, so I would stay away from anticoagulation.

[YL @yunnerz]

@tee_rav504 And lost up 3-1 in the finals

[YL @yunnerz]

@htownbyu @WorldWideWob Harden also missed...5 FTs :)

[YL @yunnerz]

@sharonmlisa @saradabney7 Tell me is what your daughter did right? Did you go home and go good job? If so, you're right, it's not your daughter's fault. It's yours.

[YL @yunnerz]

Aging is blessing not a curse. After all, I am a heck of a lot wiser that I was when I was younger. #VCUseniormentoring

[YL @yunnerz]

My doctor told me to stop drinking Pepsi, so I did. I lost only 1lb, so I told the doctor, "I'm having my Pepsi!" - S.M. #VCUseniormentoring

[YL @yunnerz]

Kind words & humble wisdom, lost thoughts & repetition, deep sorrows & endless worries, loving heart & joyful memories. #VCUseniormentoring