Weekly Update - December 31, 2012

By admin3

From the Director

Happy New Year to everyone! It's the last Updates of 2012.  I hope everyone has enjoyed their holiday.  Your hard work is appreciated.  Lots of fun was had for Christmas eve dinner here (thanks again to The Klotmans) and with the never-ending Chinese food buffet on Christmas day, Christmas night and leftovers (thanks to Larry Greenblatt, Saumil Chudgar and Dan Kaplan's contributions to our efforts on this one!). Very impressive results from the holiday gift drive….thanks Joel Boggan and Armando Bedoya for championing this.  Official results are that there are 5 very happy families from the DOC who benefitted from your efforts, as well as some veterans! As far as the Stead competition goes, here is the breakdown: Winner:  Kerby Society! Congratulations on the owning the Stead Cup! Second place: Kempner Society - can't wait till the Stead Tread! Third place: Smith Society Fourth Place: Rankin Society Fifth Place: Orgain Society In other exciting news…Kristin DeHaven Greyshock was born on Dec 26th. Welcome to our newest Duke residency family member! Everyone is doing great. Congratulations Nicole and Dave. Looking forward to the second half of this year….lots to happen, including inservice scores (as a program, we did VERY WELL!), continued work on the milestone evaluations for next year, the final month of interviewing, EPIC training for inpatient, continued efforts on the hospital wide QI incentive program, presentations at the NC ACP meeting, submission of resident research grants, social events (look for an IM-EM happy hour soon, plus several exciting parties planned by the Residency Council, the Match Day Party  on March 15 and more!), our spectacular annual Charity Auction, the ever-impressive Humanism night, the Stead Tread, and more.  The DOC leadership team is working hard on the DOC reorganization plan, with more information to follow soon.  Also look for additional QI opportunities with Jon, George and Ryan and an update from Jon Bae on the > 1500 charts reviewed in Sharepoint for Sharepoint Phase 1.  Your APDs and I will be working hard on getting us ready for the ACGME's "Next Accreditation System" which involves milestone evaluations and reporting on how we train you all to be the best physicians you can be.  Look for more information on this to be coming your way in the next few months. PLEASE get your schedule requests in ASAP! We would like to get a jumpstart on next year's schedule, and it is best done with your requests in mind. Thanks again for a fantastic first half of the year.  You guys make it super easy for me to tell the applicants that we have the best residents in the country! Happy New Year to you and to your families. Best, Aimee

What Did I Read This Week (by, Aimee Zaas, MD )

[box]       Albuterol-induced lactic acidosis,   Liem EB, Mnookin SC, Mahla ME        [/box]   

We had a patient admitted on gen med with a severe asthma exacerbation. Interestingly, his blood gas was 7.15/35/86 and he had an anion gap....lactate was 9.3.  Why? He'd been using his albuterol continuously for 5+ hours.  What happened? There are a lot of articles on this, so here is one we read:  Anesthesiology. 2003 Aug;99(2):505-6. What happened to our patient is a "type b" lactic acidosis, not the usual type a that is from hypoxia/hypo perfusion.  Albuterol stimulates a lot of gluconeogenesis and glycolysis. Therefore, lots of pyruvate is made. Pyruvate typically is broken down to acetyl CoA by pyruvate dehydrogenase as part of the citric acid cycle. Albuterol blocks this, leading to lactate production. To make matters worse, the lipolysis induced by b- agonists makes more Acetyl CoA, which may further block pyruvate entering the citric acid cycle. You have to be careful in this situation because its already hard for your patient to get rid of one acid source (CO2) and tired muscles make more lactic acid. Plus, there are plenty of reports of ex laps, abdominal CTs and other searches for ischemic gut in this setting. What did we do? Gave steroids, less beta agonists and some ipratropruim. Lactate normalized overnight. More importantly, this prompts me to add in the NHLBI asthma guidelines. This reference as definitions, action plan samples, a corticosteroid relative potency calculator and more. http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf

From the Chief Residents

Grand Rounds

Grand Rounds will resume on January 11, 2013

Noon Conference

Day Date Topic Lecturer Time Vendor
Monday 12/31 HOLIDAY   NA  
Tuesday 1/1 HOLIDAY   NA  
Wednesday 1/2 HOLIDAY   NA  
Thursday 1/3 SAR talks Bonike Oloruntoba, Jason Rose 12:00 The Picnic Basket
Friday 1/4 No Chair's Conference Today Chiefs 12:00 Chick-fil-A
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From the Residency Office

Liability Insurance

We are providing the following information for all of our SARs who are now in the process of completing applications for fellowship or medical staff privleges: Insurance coverage provider - Durham Casualty Company, Ltd. Policy Number - 12PL1022-P Mailing Address - DUMC Box 3811, Durham, NC 27710 Phone Number - 919-684-3277 Fax Number - 919-684-6543 Per claim amount - In excess of $3M Aggregate amount - In excess of $20M

MKSAP

Reminder - If you participated in the MKSAP order in August, the books are available for pick up in the Med Res office.  Please note that they are individually labeled so look for your name.    If you chose MKSAP complete or the electronic version, digital orders will be available at the end of January – you will be emailed.

Recruiting Dinners and Tour Guide

If you haven't done so already, PLEASE sign up for a Recruitment Dinner and/or to be a Tour Guide on a Recruitment day!  The links to sign up for both are below! http://www.signupgenius.com/go/60B084FAEAE2CA13-december http://www.signupgenius.com/go/60B084FAEAE2CA13-december1 Note: The MedRes office will be closed (no admin staff on duty) December 24 - January 1, 2013

Contact Information/Opportunities

North Carolina Internal Medicine Idaho Internal Medicine

Useful links

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