American journal of hospital medicine, volume 6, issue 2 (2022 April-June)
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Item Acute chest syndrome: a narrative review to guide inpatient management(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04) Wang, Kevin; Das-Ireland, MonishaACS is defined as a new infiltrate in a chest radiograph involving at least one broncho-pulmonary segment in an individual with one additional clinical finding. There are multiple causes of ACS which include infections, pulmonary edema, pulmonary infection, hypoxemia and hypoventilation. The goal is to quickly diagnose and treat this condition to prevent irreversible lung damage and mortality. In this narrative review, we discuss why a balanced approach to fluid and pain management will provide better outcome for patients, and the evidence behind using antibiotics, steroids, bronchodilators, nitric oxide, incentive spirometry, as well as the current management of patients with concomitant ACS and SARS-CoV2.Item Nighttime resident supervision and education: results of a national survey of internal medicine residency program directors(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04) Bruti, Christopher; Tuck, Matthew; Harrison, Rebecca; Smith, Dustin; Kisielewski, Michael; Catalanotti, Jillian S.; Burger, AlfredOver the past several years, the Accreditation Council for Graduate Medical Education (ACGME) has issued new restrictions on resident duty hours while calling for increased supervision to ensure patient safety. To meet these requirements, some hospitals have hired overnight in-house hospitalist physicians, also called nocturnists, while others have continued a traditional model wherein a resident in-house can access a supervisor at home by phone as needed. This study examines the current state of internal medicine resident supervision and teaching at night.Item Partial anomalous pulmonary venous return mimics arterial positioning after central line placement for plasmapheresis(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04) Griffith, Alex J.; Ray, Victoria; Glazer, Joshua M.; Rose, William N.Case: A 61-year-old male who was status post right single lung transplant complicated by grade three primary graft dysfunction was admitted and mechanically ventilated for hypoxic respiratory failure. Donor specific antibody testing to human leukocyte antigens was positive. The protocol for antibody-mediated transplant rejection was initiated. One aspect of the protocol was a series of plasmapheresis procedures. In advance of the first plasmapheresis, central line placement was attempted via the left internal jugular vein. A chest x-ray showed a line that terminated to the left of the midline and raised concern for arterial placement (Figure 1). Blood gases from the line were: pH 7.72, pCO2 21 mmHg, pO2 369 mmHg, bicarbonate 28.4 mmol/L.Item Do no harm: health systems' duty to promote clinician well-being(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-04) Agarwal, Anish K.; Gallagher, TheaBurnout and mental health disorders plague the health care workforce. Since the pandemic began, there has been an uptick in symptoms of anxiety, depression, and suicidality among health care professionals. These threats to the workforce existed before the pandemic, have been exacerbated by the pandemic, and are likely to persist for years ahead.