1. introduction

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

3. 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

4. Language Services

5. Language Services

6. 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 Workflow - Checklist system - Admissions/Discharges - Consults - Resources: CC, PT/OT, SW

7. 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

8. 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

9. 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

10. 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

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

12. intern year: All the feels