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Tales of Survival: Fury and Forgiveness in the ED

January 19, 2018
Tales of Survival: Fury and Forgiveness in the ED

By Katherine Otto

Peer Reviewed

“She refused the ultrasound!” my resident announced with exasperation, updating our attending on 17-year old, pregnant Mariana, who arrived four hours ago with abdominal pain and an unpleasant attitude that rubbed nearly everyone wrong way.

We could hear the crescendo of Mariana’s expletives from the hallway, as patient transport wheeled her back into our Emergency Department. “That bitch tried to stick a wand inside me!” she yelled out, to no one in particular, to everyone around her. “You all keep …

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A Critique of the ACGME Resident Work Hour Regulation Update

January 18, 2018
A Critique of the ACGME Resident Work Hour Regulation Update

By Simon Rodier

Peer Reviewed

On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME) announced a controversial decision. They decided that, effective July 1, 2017, the maximum work shift for medical interns would increase from 16 to 24 hours. Work hour restriction is a decades-old debate in medicine that raises many valid arguments on both sides of the fence. Was increasing the work hour limit from 16 to 24 the right decision?

Investigations into the effects of long work hours of resident …

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Core IM: 5 Pearls on Chronic Hepatitis B Part 1

January 17, 2018

By Amy Shen Tang MD, Marty Fried MD and Shreya P. Trivedi MD; Illustration by Mike Natter MD.  Quiz yourself on the following 5 Pearls on Chronic Hepatitis B (HBV)

Time Stamps

  1. What are the most common ways HBV is transmitted and how can we use this to prioritize screening? (3:37)
    1. Who is at risk for HBV reactivation?
  2. What tests do you order when screening for HBV?   (10:48)
    1. In which populations is HBV vaccination recommended?
  3. What are the four possible meanings of an isolated positive total anti-HBc? (13:55)
  4. In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01)
  5. What are the implications of seroconversion of HBeAg from positive to negative? (16:19)

Subscribe to CORE IM on any podcast app! Follow us on Facebook @Core IM || Twitter @COREIMpodcast || Instagram @core.im.podcast. Please give any feedback at COREIMpodcast@gmail.com.

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Game Changer? How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia?

January 16, 2018
Game Changer?  How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia?

By Calvin Ngai, MD

Peer Reviewed

A 71-year-old Caucasian woman with hypertension presented with a 2-day history of productive cough and fever. She was living alone and had no history of any recent hospitalizations. On examination, she was alert and oriented but slightly tachypneic; her lungs were clear to auscultation bilaterally. Laboratory tests were significant for a white blood cell count of 18,000 mL with 89% neutrophils. The chest x-ray showed a right lower lobe infiltrate. She was admitted and started on antibiotics for

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Tales of Survival: Do No Harm

January 12, 2018
Tales of Survival: Do No Harm

By Derek Moriyama, MD

He stared blankly at the ceiling. “Mr. K can you close your eyes?” my attending asked, speaking slowly and clearly, making sure that the patient could hear every word.

There was no response; his gaze remained unrelentingly fixed on the square panels above him, as if they were shooting stars through the night sky.
Trying once more, the senior doctor continued, “Can you squeeze my hand?”

Again, no response.

It was about one month into his hospital stay, half of that …

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From the Archives: The Complicated Story of Saturated Fat

January 11, 2018
From the Archives: The Complicated Story of Saturated Fat

Please enjoy this post from the archives dated November 8, 2013

By Gregory Katz, MD

Faculty Peer Reviewed

Everyday in clinic, we tell our patients to choose foods low in saturated fat. Because these foods raise plasma cholesterol, the thinking goes, they cause heart disease. Today, every major medical organization – from the American Heart Association to the Harvard School of Public Health to the USDA  – recommends a diet low in saturated fat to prevent and treat heart disease. The fat-cholesterol-heart disease connection …

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Primecuts-This Week in the Journals

January 8, 2018
Primecuts-This Week in the Journals

By: Justin Feit, MD

We were welcomed to 2018 with the coldest New Year’s in New York City in over 50 years with a cool 10°F recorded in Times Square . The onslaught of frigid weather continued as the northeastern United Status battled the ‘Bomb Cyclone’ this week . We turn our minds to warmer thoughts as we take a look at this week’s medical news.

Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices

Patients who have pacemakers or implantable cardioverter-defibrillators (ICDs) are …

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Tales of Survival: Red Sox Rivalry

January 5, 2018
Tales of Survival: Red Sox Rivalry

By Kate Otto, MD

Peer Reviewed

Mr. Williams came to us as so many patients do.

“I just fell down,” he repeated, grumpily, his snaggletooth resting on his cracked, pursed lips.

Our team of eight white coats had descended upon him with rapid fire CIWA questions during morning rounds—the Emergency Department’s workup suggested his fall was secondary to intoxication—but he wasn’t giving up a single hit.

“Have you been feeling sweaty at all today?”

“That’s no one’s business but my own.”

“Do you have a …

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