Program Announcements

Hodgkin’s International Long-Term Survivorship Symposium: UC will be co-hosting this conference October 16-17. Learn more about the event here and sign-up here if you are interested in attending!

Voting Registration

It’s that time of year! Election Day is November 3rd. The deadline to register to vote in Ohio and Kentucky is October 5th.

• OH: https://olvr.ohiosos.gov/

• KY: https://vrsws.sos.ky.gov/ovrweb/

VA Updates

Board Question

A 72-year-old man is brought to the emergency department 90 minutes after his wife noted the sudden onset of right-sided weakness and inability to speak. His medical history is notable for hypertension and a prior peptic ulcer. Two weeks ago he underwent a craniotomy for resection of a meningioma.

On examination, blood pressure is 158/88 mm Hg, heart rate is 82/min. He has a left gaze preference, global aphasia, right homonymous hemianopia, right facial droop, and dense right hemiplegia. NIH Stroke Scale score is 20.

Fingerstick glucose is 112 mg/dL. Noncontrast head CT shows no hemorrhage and an ASPECTS of 9. CT angiography demonstrates occlusion of the left middle cerebral artery (M1 segment). Coagulation studies, platelet count, and renal function are normal.

Which of the following is the most appropriate next step in management?

• A. Administer IV thrombolysis, then proceed to mechanical thrombectomy

• B. Administer IV thrombolysis alone

• C. Proceed directly to mechanical thrombectomy without IV thrombolysis

• D. Administer high-dose aspirin and admit for observation

• E. Lower blood pressure to <140/90 mm Hg and reassess in 1 hour

Upcoming Education

UC

Monday: Labor Day - No Conference

Tuesday: Mystery Case

Wednesday: LGBTQ Pathway

Thursday: AHD // Senior Education

Friday: Mystery Case with Dr. Nicole Damari

VA

Monday: Labor Day - No Conference

Tuesday: VA Orientation

Wednesday: Whiteboard Case

Thursday: AHD

Friday: Hyponatremia & Hypernatremia

Photos

Board Answer

Correct Answer: C) Proceed directly to mechanical thrombectomy without IV thrombolysis

Teaching Points:

• Recent intracranial surgery or trauma (within 2 months), active intracranial hemorrhage, bleeding diathesis, and severe uncontrolled hypertension are among the absolute contraindications to IV thrombolysis.

• When IV thrombolysis is contraindicated, guidelines and consensus statements recommend proceeding directly to thrombectomy in otherwise eligible large-vessel-occlusion patients, since these patients still derive substantial benefit from endovascular reperfusion.

Shout Outs!

To Anna Cauley and David Warner for their abstracts that were accepted for poster presentation at OH ACP this fall!

To Mike Brooks - For being the best senior, taking the time to always teach on a super busy VA wards service, and for staying late with me many nights to help share the intern workload. 

To Anna for learning a new EMR very quickly with a great attitude!

To Denny for an awesome noon report on a very difficult topic of biostats. The likelihood ratio for this lecture being useful is >10 - strong evidence that I'm actually learning biostats!

To Azl for being such a patient and gracious senior! Wards wouldn’t be the same without you <3

Ongoing Reminders

AHD Preceptor Sign-Up: We would love for senior residents and attendings to join us for AHD. Sign-up to precept here.

GME Peer Support Program: It helps to talk to someone who’s been there. Call (513)- 585-6100 and ask for the Peer Support Program or email GMEPeerSupport@uchealth.com

VA Night Algorithm Tools: Check it out here!

In-Person Interpreter Services: Call (513) 476-5682 or email interpreter@uchealth.com

Ultrasounds: 8E (8161) and 6NW (6419) - sign it out w/ HUC

Procedures/Paracentesis: Check your certification on SilverFridge (Education > Procedure), don’t forget you can consult IM Procedure Team!

Duty Hours: Weekly reminder! Have you done your duty hours this week? If not - stop and do them now! Just click here.

Mail: Please stop by Liz’s office in MSB once per month to pick up your mail!

Mental Health Resources: Employee assistance program offers short-term therapy options, will see residents <72hr - call at 513-585-6100. Psychiatric services - 513-585-7754; Physician Support Line - 1-888-409-0141; Suicide and Crisis Lifeline - 988