VA Joint Chiefs

@BostonChiefs

We are chief medical residents from proudly serving New England Vets . Views do not represent VA

Boston, MA
Vrijeme pridruživanja: rujan 2014.

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  1. 4. velj

    Dr. Loriaux holds the second cost-effective patient-centered case tournament! Congrats to the winning team on diagnosing amiodarone-induced toxicity!

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  2. 3. velj

    What are we giving our patients when we order a ‘nectar thick’ diet? For , lets us find out! We taste test thickened liquids- water, apple juice, and cranberry juice! While this diet ⬇️aspirating food, it won’t ⬇️aspiration of saliva or reflux!

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  3. 30. sij

    B-ball Star Dr. Loriaux leads with can’t-miss EKG reads. Brugada syndrome is a diagnosis made by EKG, which can include coved ST elevations >0.2 followed by negative T waves in the precordial leads!

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  4. 29. sij

    Today’s led by covers AMS w/u! If a patient has sub-clinical hypothyroidism, it’s still prudent to treat if TSH>10! As a bonus, we also covered the Guinness World Record holder for most 3-pointers in 24-hours... our very own Dr.Loriaux!

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  5. 28. sij

    for more information, be sure to listen to this podcast by (Notes- )

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  6. 28. sij

    In today’s , tells a story of when she was called to an in-flight emergency when flying internationally. The most common cause of in-flight emergencies are from pre-syncope or syncope, and there is less in an airplane medical kit than we thought!

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  7. 27. sij

    When you order blood testing, do you know what color tubes are for which labs? primary care chief teaches us the difference. The purple and pink top tubes both have EDTA but they’re different colors so the pink one gets routed to the blood bank!

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  8. 23. sij

    Today’s by Chief covers that pesky influenza! - during the Spanish Flu epidemic, there was a spike in deaths the same year aspirin became generic, leading to ingestion of up to 10g a day, perhaps confounding data with aspirin toxicity-related deaths!

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  9. 22. sij

    Grand Rounds today by on the diagnosis of cellulitis. Remember to use the ALT-70 score to assist you in predicting cellulitis in someone presenting to the ED with a red leg! Teamwork is always helpful too!

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  10. 22. sij

    Welcome to w/ and ! We review early feeding in acute pancreatitis- a commonly seen practice but why might this help? In addition to ⬆️nutrition and hydration, the bowel has ⬆️ permeability so rest can lead to bacterial overgrowth!

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  11. 21. sij

    For today, Dr. Loriaux presents a case of thrombocytopenia... and ends up solving the case himself as a patient with ITP! While there is not great data to support holding antiplatelet or anticoagulation in thrombocytopenia, experts recommend holding when platelets<30K!

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  12. 16. sij

    What do new ATS/IDSA guidelines say about CAP? Chief leads with a review. Concerned for MRSA or pseudomonas? Look for past culture data or recent hospital stay with IV ABx to consider re-sending cultures, but DON’T treat based on MRSA + nares alone!

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  13. 15. sij

    Dr. Loriaux presents us with the ultimate challenge. Residents become the ultimate (frugal) sleuths to solve a case! For abdominal pain, remember to check for Carnett’s sign on physical exam- it has a +LR 6.5 for abdominal wall pathology!

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  14. 14. sij

    The nerve! leads and creates a helpful framework for polyneuropathy. Diabetic neuropathy is a common diagnosis but remember that this manifestation only presents after prolonged poor glycemic control, and should be symmetric on exam!

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  15. 9. sij

    It’s a reunion! Dr. Jon Li comes home to discuss population health! ACOs are making a dent in improving high-value care, but remember to use quality and cost metrics to assess for change! will join us soon, - we are waiting for you!

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  16. 9. sij

    Today we welcome future Chief to the team as she leads her first on posterior circulation strokes! A helpful framework for creating a differential for acute dizziness is TITRATE (TIming, TRiggers And Targeted Exam)!

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  17. 8. sij
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  18. 8. sij

    Have you ever looked at the mean platelet volume (MPV) in a CBC? We hadn’t either! BWH Chief Dan Loriaux presents a case of thrombocytopenia in a patient with a very high MPV. The MPV can be elevated if there are a large amount of immature platelets - as seen in ITP!

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  19. 7. sij

    In today’s by , BMC program director takes the place of (again) in an engaging discussion of hemolytic anemia. Warm hemolytic anemia needs immediate treatment with immunosuppressive medications (and splenectomy if anemia is refractory)

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  20. 6. sij

    For , Chief ⁦⁩ reviews how the physical exam can help us differentiate lower/upper motor neuron pathology from a myopathy! In addition to reflexes, remember to assess for tone and fasiculations!

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