introduction

Overview Topics Covered Informed Consent Language Services Difficult Patient EMR/Inpatient Tips IPASS/Handoff Antibiotic Stewardship Sleep & Fatigue Introduction to US

Patient Care Informed Consent, Difficult Patient Informed Consent - Patient must demonstrate capacity (competence and comprehension) to make informed decisions about medical treatment - Print document via iMedConsent - Consent ONLY for therapies/procedures YOU are providing Difficult Patient - Remember: It’s not you, it’s me (the patient) - Identify interests/positions of respective parties - Communication strategies for conflict resolution

Language Services

Language Services

EMR +INPT Hints+ Wards 101 EMR - Tips on managing care team lists, printing, updating sign-out, documentation views (filters, notes, and admission/discharge order sets - Call 9800 for access issues Wards 101 - Workflow - Checklist system - Admissions/Discharges - Consults - Resources: CC, PT/OT, SW

Antibiotic stewardship SSTI - Purulent (cover MSRA/Strep) vs. Non-purulent (cover Strep) - Potential NSTI: Stat ACS consult, labs/imaging, and empiric, broad-spectrum antibiotics CAP - B-lactam + macrolide (or doxycycline) for most patients - Pseudomonal/MRSA coverage usually not warranted HAP - Risk factors: SNF, recent hospitalization, recent antibiotics - Cover for Pseudomonas +/- anaerobes UTI - Treat symptomatic UTIs only (exceptions: patients w/neurogenic bladder or foley-dependence, who cannot report symptoms) IAI: - Community acquired: Cover for GNs and anaerobes (eg ceftriaxone + metronidazole) - Health care associated: Cover for Pseudomonas and anaerobes (eg cefepime + metronidazole) - Risks for ESBL or shock: Cover for ESBL (Eg meropenem) Meningitis - LP prior to initiation of antibiotics - Community acquired: Vancomycin (to cover resistant S. pneumoniae) + Ceftriaxone (to cover S. pneumoniae, Neisseria) - Indications for Ampicillin: age>50yo, immunocompromised, pregnancy, alcohol abuse

Antibiotic stewardship Restricted Antibiotics at LAC+USC AmBisome Itraconazole Aztreonam Linezolid (IV or PO) Cefepime* Meropenem Ceftazidime Micafungin Colistin (IV and inhaled) Moxifloxacin Daptomycin Piperacillin-tazobactam (Zosyn) Ertapenem Posaconazole (PO or IV) Ganciclovir Tigecycline Isavuconazole (PO or IV) Voriconazole* (IV or PO) If you haven’t heard of it, it’s probably restricted: Avycaz, Zerbaxa, Vabomere, Synercid… M-F (8am-5pm): ID pharmacy M-F (5pm-8am): ID fellow Weekend (8am-5pm): ID resident Weekend (5pm-8am): Keck ID fellow

INTRO to us Understand purpose of diagnostic US - Volume status - Bedside cardiac: wall motion abnormalities - Procedures (central line, paracentesis, thoracentesis) Probes - Linear: vascular - Phased: thoracic (and often, intraabdominal) structures Basic Positions Standard views - Cardiac: parasternal long, parasternal short, apical, subcostal, IVC

Overview Pending Topics Primary Care Pearls Top Nursing Calls Outpatient Medicine Radiology Family Meeting/GOC Surgical skills > Paracentesis > Thoracentesis > Lumbar Puncture > Central Lines Pain & Poop Insulin Management Crashing Patient

Surgical Skills Session: 2 hours, 30minutes/station Brief lecture, demonstration, practice on models 4 skill areas Central Lines Thoracentesis Paracentesis Lumbar Puncture

intern year: All the feels