Attending Rounds

AKI – part 2

June 15, 2011

A 60+ year old man was admitted for a 1 day history of abdominal pain, hematochezia, and a rash developing over his lower extremities bilaterally.  No significant PMH other than chronic pain. H&P revealed a history of nausea and vomiting the day previous to admission with 6 bright red bloody stools and diffuse abdominal pain. [...]

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The actual numbers

June 15, 2011

60-year-old man admitted for 3-5 days of nausea, vomiting (undigested food), watery diarrhea (volume not specified) and alcohol on his breath. Patient has significant orthostasis with pulse increase (just raising head of bed).  PMH of hypertension – only prescribed metoprolol. Predict the electrolyte disorders and acid base disorders. There are no surprises here – we [...]

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Acute kidney injury

June 14, 2011

  A 60+ year old man was admitted for a 1 day history of abdominal pain, hematochezia, and a rash developing over his lower extremities bilaterally.  No significant PMH other than chronic pain. H&P revealed a history of nausea and vomiting the day previous to admission with 6 bright red bloody stools and diffuse abdominal [...]

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Has resident education become compromised?

June 6, 2011

This past weekend I attended an internal medicine meeting during which several internists expressed strong concerns about medical education with the new work hour restrictions.  Readers know that I make rounds often (probably > 150 days each year) and in two disparate sites – a large community hospital with family medicine residents and a VA [...]

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Predict the numbers (electrolyte panel)

June 2, 2011

60-year-old man admitted for 3-5 days of nausea, vomiting (undigested food), watery diarrhea (volume not specified) and alcohol on his breath. Patient has significant orthostasis with pulse increase (just raising head of bed).  PMH of hypertension – only prescribed metoprolol. Predict the electrolyte disorders and acid base disorders. There are no surprises here – we [...]

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#sgim2011 Friday’s activities – Better ward attending rounds

May 7, 2011

In the afternoon, we held a workshop based upon research we are doing on the factors that differentiate the perceived quality of ward attending rounds. We presented several posters on this topic during the meeting.  The workshop allows participants to discuss the many techniques one can use to improve attending rounds. I can't blog too [...]

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On doctoring

April 14, 2011

Over the past few weeks I have considered doctoring philosophically.  My thoughts started to coalesce after Rich Baron's outstanding keynote address at IM 2011.  His remarks struck a chord and enhanced some ideas that I have considered the last few years. Many academicians, many wonks, most congressmen, and most "suits" believe that we can define [...]

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How important is the ward attending?

April 4, 2011

At a delightful dinner last night in San Diego – here for the IM 2011 meeting – the conversation turned to a discussion of medical students training outside the traditional academic medical center.  Many academicians have the opinion that students cannot learn as well outside the "hallowed" halls. Some readers know that I work as [...]

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Centor’s rules for attending rounds

March 31, 2011

Attending rounds in internal medicine in many ways define the internal medicine rotation.  We who love making attending rounds each develop our own implicit rules.  In this post I am working to make those rules explicit.  I do not pretend that my list is comprehensive or complete.  I would appreciate additions and suggestions. Be timely [...]

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The acidotic patient – my teaching points on management

February 21, 2011

50-something year-old woman is admitted for weakness.  She has a history of chronic diarrhea.  She has had type II DM for over 15 years.  Her labs are remarkable: Fluid Balance Panel 137 113 48 163 5.6 14 1.5   Arterial Blood Gas pH 7.24 pCO2 36 pO2 79 c HCO3 16 What do you think [...]

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