Weekly Announcements

VA Transfusions - Don’t forget to get consent before transfusing blood products through I-Med when you are at the VA. If you are having issues, you can do a paper consent. If done on paper make sure to place it in patient chart and document it in CPRS!

Wash your hands yall!! There is a new viral illness in town (AND covid) that is making its way through the residency. Please wash your hands frequently and clean your work spaces!!

Registering to Vote - If anyone would like to register to vote or request an absentee ballot, all required paperwork and envelopes are available in Chris & Sarah’s office. Stop by anytime. Deadline to register to vote is October 11, 2022.

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

Academic Half Day - Seniors - when your schedule allows, we would LOVE to have your leadership and wisdom as preceptors at AHD. Click here to sign up!

VA Access - The VA is working hard to fix some of our access issues. Please remember to remotely log on to CPRS once per month. This resets the clock, keeping your CPRS access active! There are instructions on the silver fridge and if you need a card reader, we can get you one!

Education Corner: A Case

I had an interesting case recently. A 64 yo M presented to the ED with horrible chest pain. For the 24 hours, every time he swallows he has excruciating pain. One week prior to presentation, he had an EGD for GERD + weight loss. My initial thought was, “What in God’s green earth happened during that EGD?” But when you ask him, he says his throat hurt for a few hours after the EGD, but then felt fine. Could that be connected to his acute presentation for the last 24 hours? The timeline doesn’t really fit. Later in conversation, he says he has been taking an antibiotic for the last two days prescribed by his Urologist for a penile implant infection. Immediately, alarm bells ring. What antibiotic could be connected to such severe odynophagia?

Try your best to answer the question above without looking anything up. If you’re having trouble, see the answer at the bottom of the scoop.

Upcoming Education

Monday: Acute Care Pathway with Dr. Clark in 5051

Tuesday: A Case with Sarah in E701

Wednesday: MGR

Thursday: Weesner/Academic Half Day!

Friday: MedEd Pathway with Dr. Frost and Dr. Kelleher in 5051

Resident Photos

Shout Outs!

To Matthew Harden - you are so funny, kind, and talented at talking with patients! Thank you so much for being an awesome senior and great role model. Your next intern will be lucky to have you!

Approbation to Aram Derbedrossian (ADB) for just making me hoot and holler and guffaw every day on these VA wards!! Always so fun to be around!

To Mati and Salima for leading an important discussion this week during MM&I.

To Dr. Cook and Drew for last weeks AHD! Great Pearls!

To Dr. Samuels for always being a superb patient advocate and top doctor!! Thanks for being awesome.

To Dr. Frost for being a beam of light and good vibes in clinic. You are an amazing doctor! Thanks for always helping me out!

To the Chiefs for doing great work. We appreciate the hard work qday.

To George! For being curious, not judgemental.#goodguy

Laudation to Julia Raleigh for always being so cheery and lifting spirits!

Salutes to Sierra Hadju (EM) who got wham-bam-slammed doing a bunch of call-outs her first MICU shift and handling it like a champ!

Werd to Christian Adams-Carey for leading a really tough goals-of-care conversation and doing such a great job on it! I learned so much!

To Sarah for always being a great listener and a shoulder to lean on.

To Jackson Walker for running many many rapids on his first few aod shifts, and for nerding out during this one in particular =) (see below)

Education Corner: Discussion

Back to the case. This patient’s Urologist started him on doxycycline 2 days prior to presentation. In light of our recent Antibiotics AHD this week, remember that tetracyclines are the most common antibiotic class to cause pill esophagitis, though PCNs, Bactrim, and clindamycin can as well. Other medications can be implicated such as bisphosphonates, NSAIDs, KCl, and iron. Risk factors include the medication size, administration (ie supine position, small sips of water, etc) and anatomic abnormalities in the esophagus.

But why do some medications cause esophagitis, but not others?Prolonged contact of some medications with the mucosa causes a direct irritant effect and disrupts the cytoprotective barriers. This is supported by the typical endoscopic findings of a small, punched out ulcer right where the medication was in contact as it dissolved. The pathophysiology is less understood, but thought to be caused by the low pH and hyperosmolar properties of the medication itself. 

We internist often think of po antibiotics as pretty benign medications, but just remember that even the “simple” medications can have substantial side effects. Just food for thought…no pun intended.

Lunch Calendar

Official Resident’s Guide to Cincy Food and Drink is here!