reslounge

WELCOME NEW INTERNS!

2010-06-24T06:13:00.001-07:00

Welcome to your first day! Here's some pointers for you. :) For more humor, check out A Cartoon Guide to Becoming a Doctor

SCHEDULES FOR UPCOMING YEAR

2010-05-06T11:10:00.000-07:00

We are currently working on schedules for the upcoming year and trying to accomodate requests. We will be asking for elective and vacation preferences shortly, and then we will start scheduling clinics, conferences, etc. We appreciate your patience in this process.

Miten and Reena

ICU morning rounds template

2009-12-30T11:10:00.000-08:00

Template by Dr. Dhillon
CAM score to assess ICU delirium
Document available on the RESOURCES page under the INPATIENT folder

2009-12-17T15:29:00.000-08:00

As we're counting down the days for inpatient HealthConnect going live, here are some links you'll love. Links may be accessible only at work though

KP HealthConnect Ambulatory - What's New

KP HealthConnect Inpatient - What’s New

Announcements

2009-12-07T18:52:00.001-08:00

1) Please notify Dr. Lischner before your vacation so he can cover your clinic inbox while you are away
2) Holiday Party at Dr. Patton's house on Saturday, Dec 12, starting at 6:30pm. Check your Lotus Notes for her address.
3) Please continue to check CIPS regularly for your clinics
4) All research electives must be approved by Dr. Baudendistel or Dr. Brickner prior to the first date of the elective. There is also a research description form that you must fill out, the form is on Reslounge.com. (go to Resources then scroll all the way down to below the iPhone screen for "Joy's Forms")
5) Jason will start as chief starting Tuesday, Dec. 8th

Pressor dosing

2009-11-18T16:33:00.000-08:00

FYI for those in ICU: Weight Based dosing for Pressors won't be instituted yet until new pumps arrive. Please use Pressor dosing as indicated in our current ICU admit orders.

Weight Based dosing for Pressors

2009-11-02T06:02:00.001-08:00

Weight Based dosing for Vasopressors

See twitter link on right for quick link to table

Kaiser Oakland and Richmond hospitals will be implementing Baxter pumps programmed with a clinical library intended to provide additional safety features for medications delivered by continuous infusion.with weight based dosing to deliver medications. With the implementation of this clinical library, the dosing parameters for three vasopressor drugs will change. Three vasopressors in particular have significant importance and thus require attention. Significant changes are summarized below:

Medications affected: epinephrine (Adrenalin), phenylephrine (Neo-Synephrine), and norepinephrine (Levophed).
All three medications will need to be ordered as Dosing for all three medications will now be weight based in Mmicrogram/kg/min (mcg/kg/min). Previous dosing was mcg/min.
Orders should read according to the following guideline: “Start norepinephrine at 0.05 mcg/kg/min IV, titrate to maintain MAP greater than ____.”
Maximum infusion doses will now be weight specific, according to dosing charts which are readily available in ICU, PACU, ED and the Inpatient Pharmacy.
Shaded areas on the dosing chart are reserved for high doses and are considered unusual and atypical.
If a patient requires dosing of one of these pressors that is in the shaded area of the chart, a critical care physician should be consulted.

Specific Dosing charts are available in the ICU, PACU, ED. Please ask the nurse in charge.

Physicians who will order these medications are generally critical care specialists

Medication	Usual Starting Dose	Standard Concentration
Epinephrine (Adrenalin)	0.04 to 0.08 mcg/kg/min Titrate by 0.01 to 0.02 mcg/kg/min Max dose: See dosing chart	8 mcg/ml (2 mg/250 ml D5W)
Phenylephrine (Neo-Synephrine)	0.5 to 1 mcg/kg/min Titrate by 0.4 mcg/kg/min to SBP or MAP per MD order Max dose: See dosing chart	160 mcg/ml (40 mg/250 ml D5W or NS)
Norepinephrine (Levophed, Levarterenl)	0.2 mcg/kg/min Titrate by 0.05 mcg/kg/min increments to meet MAP or BP goals Max dose: See dosing chart	16 mcg/ml (4 mg/250ml D5W)

10/28/2009

Inpatient Pharmacy

KM/AH

Chief's Annoucenements and more

2009-10-27T19:48:00.000-07:00

Hi everyone,

A few announcements:

1) R2 retreat is this Thursday, 10/29. All R2s meet at Blackberry Bistro at 8:30am, then to the Oakland Zoo afterwards. Restaurant address is 4240 Park Blvd, Oakland. Web: http://theblackberrybistro.com/
2) Please check the retreat coverage info posted above the water dispenser in the lounge. On-call R2s, please return to relieve the R3's covering for you immediately after the retreat because the R3's have a recruitment event that same evening.
3) Please help keep the lounge clean because interviews begin next Monday
4) Please check the interview tank/tour schedules to be posted later this week (on the schedule board above the water dispenser)
5) I am doing a 2-3 hour hiking at Redwoods Regional Park in Oakland Hills this Sunday afternoon. We will meet at East Entrance at 1pm and carpool there. If interested, please let me know.

Thanks,
Anthony

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Sungchan is organizing an outing to "Nightlife" @ the California Academy of Sciences. Check your email
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This slideshow of inpatient tools will eventually be expanded and find a permanent home on the website. In the meantime, enjoy this digoxin nomogram and a collection of dot phrases from Ben.

Communication Mtg Announcements

2009-10-21T21:27:00.000-07:00

Tasks, Dates and Deadlines

R2 retreat: 10/29/09 (R3s please check out coverage schedule)

Identify QI project by 11/1/09

Get vaccinated: H1N1 flu shot and nasal vaccine at 3rd floor of Fabiola. Drop-ins also welcome from 8-10 AM at Employee Health in Broadway MOB, 5th floor. There's also a roving cart rounding each day in the hospital.

Morning to-do tasks: check lotus notes and CIPS schedule

Complete your duty hours sheets

Complete Survey for Clinic (see Dr. Brickner's email)

Look out for Lotus Notes email regarding your mid-year eval meetings

We need to be doing a better job using Hospital Problems in our notes

ACP presenters: send Jason your poster text/pictures this week

R1s: Please do Step 3 by 15th month of residency

Whew! As if we didn't have enough to do...

Housekeeping:
Three more computers to come to resident lounge
OK to put DC summaries into bins on floors for medical records pickup
Get ready for interview season!

reslounge.com
Scroll down to the 9/17/09 blog post on the HOMEPAGE - ED Consults and Admissions. You can enlarge the slideshow by clicking on the control on the bottom next to the slide number. This is a great tutorial on how we can incorporate the Hospital Problem list into our notes.

Check out the tabs at the top. There's more than the front page!

Deadlines and conference schedules is under the SCHEDULES tab on this site as well as on the wall of the res lounge.

LECTURES page still needs some TLC so thanks for your patience while it's being fixed

Check out the NEWS page for news feed from NEJM, ACP, medical blogs, and more

There's a mini-album under the THRIVE page. Please send in your pictures. The interns are dominating the album.

Twitter feed on the right includes important announcements and the clinic topic for the week.

ACP Doctor's Dilemma™ is on bottom right hand corner. It works even on your phone while you're waiting for the elevator.

--Photo courtesy of DL. Thanks to our Chief for this wonderful chart.

If you would like to see pictures of people in these blog posts instead, please send them to reslounge at gmail dot com.

Dr. Baxter's Flu update

2009-10-20T21:12:00.000-07:00

There is major H1N1 Influenza activity in NCAL at this time. Last week 1084 (45%)of 2390 specimens were positive for Flu A. Both the percent positive and total have increased to greater volumes than the Regional Lab can sustain. Please stop sending outpatient specimens, except under unusual circumstances. All flu-like illness can be assumed to be H1 influenza at this time. There were only 5 specimens positive for RSV, and 4 for Flu B, both under 0.5% positive.

H1N1 Vaccine is available now, in both the spray and injectable forms, for the following people:

Pregnant women
Health care and emergency medical services personnel
People who live with or provide care for infants aged <6>
Children 6 months to 24 years old
Young adults 19 to 24 years old
Adults 25 to 64 years with medical conditions putting them at increased risk of complications from from influenza.

The state has made an exemption to the thimerosal law, so children and pregnant women may be given vaccine with thimerosal. Although many are worried about thimerosal, it has never been shown to have any toxic or long term ill effects, including autism. There has never been a connection established between thimerosal and autism, and multiple studies has shown no relationship.

Seasonal Vaccine is also available, for all who want it.

Flu Protection

Encourage face mask wearing: Physicians and nurses: every patient should be asked if they have a fever or are coughing, when they present. Coughing or febrile patients should be asked to wear a face mask to help prevent spread in the clinics. Let's all work to protect each other.
Do not come to work if you have a fever!

Managers should ask staff about fever and cough, and send ill staff home. Health care workers with flu are not infectious 7 days after onset of symptoms.

Infection Control Practices for Healthcare Workers:
- Use surgical masks for patients with suspected or confirmed influenza unless performing high risk procedures.
- Use N-95 respirators in the setting of high risk procedures intubation, CPR, bronchoscopy, sputum induction, open circuit suctioning, and nebulizer treatments.

Testing: Flu is circulating widely, so a diagnosis should be made on the basis of symptoms and does not need testing.

Test hospitalized patients only.
In general, do not test outpatients. Please do not test because of your or your patient's desire to just know.
If the test is positive for Flu A, at this time it should be considered diagnositic of the new H1N1 strain.

Treatment (expandable section)
Consider treatment in patients at high risk for complications of flu

You must call ID if you prescribe more than one course at the same time, or self-prescribe.
Most healthy people with flu do not need to be treated.
Treat pregnant women, children under age 5 (especially under 2) , and patients with underlying chronic medical illness. An interim Regional Guideline for treatment and prophylaxis is attached.
Obese patients (BMI over 35) are also at increased risk for complications, and should be treated.
Treat only if the patient can get the medication within 48 hours of symptoms.

Flu Rx Guide

KPHC inbox management

2009-09-25T07:38:00.000-07:00

Click on image for full view

Napa, Summer 2009

ED Consults & Admissions

2009-09-17T22:10:00.000-07:00

Coding for Sepsis

2009-09-15T18:10:00.000-07:00

- Evaluate ED patients for SIRS criteria and possible sepsis
- Make dot phrase screening tools in HealthConnect for Sepsis, Severe
Sepsis, and Septic Shock (feel free to use the ones listed below)
- Do not use UROSEPSIS as a diagnosis. Examples of proper diagnostic coding
are: SEPSIS due to UTI, or SEVERE SEPSIS from pyelonephritis with lactic
acidosis , or SEPTIC SHOCK from pyelonephritis with lactic acidosis.

Sepsis screen– An infection with systemic inflammatory response (SIRS):
Defined as any 2 of the following:
T > 38 or < 36:***
HR > 90:***
RR > 20:***
Altered level of consciousness:***
WBC > 12K or < 4K:***
Bandemia > 10%:***

Severe Sepsis Screen:
complicated by organ dysfunction:
Altered mental status:***
Acute renal insufficiency:***
Hypoxia:***
Hypercapnea:***
lactate level of > 2/lactic acidosis:***

Septic Shock Screen: Complicated by Refractory hypotension: ***

hello

2009-09-14T08:50:00.000-07:00

Hi, the website got a makeover for your viewing pleasure.

Oh BTW, did you check your CIPS and Health Connect inbox today?

Barrel tasting, Russian River, Fall 2008