4,954 Posts

Normal Joseph Gastaldo, MD
dr.infection This patient has tense ascites & had a paracentesis 3 days ago; patient has advanced liver disease with cirrhosis, portal hypertension, chronic thrombocytopenia, coagulopathy, & h/o esophageal varices (had banding done). It is always VERY important to consider spontaneous bacterial peritonitis (SBP) in this demographic. Signs/symptoms of SBP are often quite subtle compared to other patients with secondary peritonitis. Patient presented with abdominal pain; paracentesis done (BEFORE antibiotic Rx) revealed 300 PMNs/mL with GPC in chains on the gram stain (likely with enterococcus or S. viridans group). Aerobic & anaerobic cultures were sent; we'll see what the cultures reveal. Hospitalist started clindamycin, vancomycin, & ciprofloxacin (unique antibiotic choice) & consulted me. I stopped this regimen & started IV piperacillin/tazobactam as sole antibiotic. 2h
  •   ghadine @houdabac .... 59min
  •   brittas87 Why not amp/sulbactam? 42min
  •   orlalriv.pharmd Awesome post @dr.infection. Besides avoiding unnecessary added fluids, I can see that Zosyn basically covers what the other abx generally cover (except vanco, where I agree there is no reason to suspect MRSA). Zosyn covers some anaerobes (like clinda), as well as common gram negatives (like cipro) which is as you said what we need to worry most about in this case. I think these posts go hand in hand with what @idstewardship posted last night. Pharmacists like us, need to practice our skills and always think, what is this medication doing here? Love it! 35min
  •   dr.infection @orlalriv.pharmd Thanks. You got it ! 19min
  •   dr.infection @brittas87 In my neck of the woods (central Ohio), Unasyn wouldn't be a wise choice for empiric enterobacteriaceae coverage based on our antibiogram. However, I'm totally fine with de-escalation to Unasyn based on final culture information if appropriate. Ampicillin/sulbactam: fine for entercococcus, strept viridans group, and Bacteroides. 14min
  •   frankharvey1 Yea! Ascites. It's a type of edema in the abdomen 8min
  •   dr.infection @frankharvey1 you could say that, Yep. 5min

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tra.maine Apparently, we intubated half the county tonight.

Strong work team lol

#medical #futurepa #er #emergencymedicine #emergencyroom
8h

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blueyedgurl1987 Today I am on cloud nine! I can't stop smiling, I am through the roof excited... My life is taking a turn towards forever greatness and all the hard work of raising my son as a single mom, going back to school for 2 semesters of chemistry, and working a full time job as a RT has paid off! Today I received my official acceptance letter to the University of Utah School of Medicine Physician Assistant Program, the number two program in the ENTIRE nation! This is the best Christmas present I could have ever imagined, I'm ready for this once in a lifetime opportunity to do what I love most for the rest of my life (which is helping people medically) and having the ability to be a great example to my son and show him that there are no mountains too high to climb, all you need is a great work ethic, dedication, and perseverance! The sky is the limit... A special thanks to everyone who has supported me along the way, I have the most amazing family, friends, co-workers, and son a girl could ask for.. An extra special shout out to my parents @utahgal53 and @jentryjo11 for always believing in me, helping me through very difficult times in my life, and always pushing me to achieve my dream! #UofU #iamaUTE #FuturePA #grateful #lifechanger #44outofa1000applicants #mynewadventure #bestchristmaspresent #class46 #instanttears #blessed #number2programintheNation #readyornot #RTtoPA #gradschool #instate #UtahUniversity #imadeit #FirstTimeApplicant 10h
  •   alexpaulwalker1 Congrats! 7h
  •   annieostler Fantastic news! You are one of the hardest working people I have ever met. You deserve it! 6h
  •   ash_h21 Congrats, you deserve it!! That's so exciting! 6h
  •   saraboulter Yaaaaaaay. Well done!!!! 6h
  •   makennacordingley Way to go Molli! So excited for you! 5h
  •   yaymrsj Correction!!! Pretty sure you're #1!!! Way to "Gitter Done" Sis!!! Blue skies ahead with occasional rain, but, Hey, you can get through an occasional rain storm!!' Put up your BUMbrella and GO FOR IT!!! ️USO!!! 4h
  •   mimons21 OH YA!! Way to go! 3h
  •   jerbear2413 Way to go Molli! So happy for you! 3h

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tra.maine Not trying to be a tech forever. School is coming so I gotta step my game up so I can widen my practice. 15h

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jmarie630 Rotation 4, check! Can't believe how much I liked surgery. I mean, I saw a beating heart today and held lots of intestines. #hadanawesomeday #surgeryrotation #PAstudent #clinicalyearFTW #futurePA #maybesurgicalPA 20h
  •   bchristoffersen Yay! I'm glad your OR experience was much better than our previous terrifying OR time :) 14h
  •   jmarie630 @bchristoffersen Um, yeah. It was pretty much the exact opposite experience, haha. 5h

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dr.infection I see many patients with a variety of chronic medical conditions. Two of the more common chronic medical conditions I see are morbid obesity & diabetes. Both conditions have unique issues with infectious disease presentation & management. DM: hyperglycemia, neuropathy, chronic kidney disease, vascular disease. Obesity: antibiotic dosing & clearance. The person in the picture was actually admitted for an MRSA back abscess that was debrided; I was consulted. Examination showed impressive areas of erythematous, excoriated skin under various skin folds: cellulite folds on back, on abdomen, & beneath breasts. Some folds had creamy white discharge. This is not bacterial cellulitis; this is Candida intertrigo. Intertrigo occurs in warm, moist, areas of the body where 2 skin surfaces rub/press against each other. In obese diabetes, this is a GREAT culture media for overgrowth of Candida. Remember that Candida species are part of normal skin, oropharyngeal, & GI flora. Treatment is usually local car; topical antifungals. For severe cases (this person), I will prescribe a sort course of PO fluconazole. 1d

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selfmade_bambam_ Idk how I did it but thank God , all i need is my English teacher to come through in clutch man . #blessed #FuturePA 2d
  •   yq_dimez You better work 2d
  •   leogodoi__ Mine was looking like that....until my econ professor posted my grade lol 2d

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dr.infection Wow; what a difference 2 days make; this is a follow up picture of the patient I showed 2 postings ago; this is cranial nerve V-1 distribution left sided Zoster. Ophthalmologist saw him; thankfully no examination findings of Zoster ophthalmicus. Patient tolerated IV acyclovir & IV cefazolin (he had a secondary bacterial cellulitis) well; creatine clearance remained unchanged. Acyclovir now stopped; isolation stopped. Vesicles with fluid can transmit VZV; once scabbed over, isolation can stop. Remember, primary VZV infection can be very serious in adults/pregnant women/immunocompromised hosts. When caring for Zoster hospitalized patients, do not be in fear ! Unless you know you have not had primary VZV infection (chickenpox) or the varicella vaccine (Varivax), you cannot "get" this viral infection from the patient. If you are an adult & do not know this information, request a titer/blood draw: VZV IgG; if this is negative, seek evaluation for immunization. 2d

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jody123p Seems like just last week we were taking this guy out for his 21st birthday and now he's starting PA school at UAB in just a few months! So proud!!! #christmasparty #morganpedwards #soproud #UAB #futurepa #lovehim 2d

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ambercolbacchini First day as a phlebotomist! #delraymedical #scrublife #futurePA #soearly 2d
  •   _tashalopez Scrub life is a comfy life 2d
  •   itsclaudiaaaaa Whoo! You look so cute! Don't forget to send me the address of the scrub place! 2d
  •   sunshine3767 Best of luck Amber! 2d

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madamenatura @kimdmillerm omg lmao!
regram @mrs_angemi
Lillian has temporarily given up her armadillo and is walking around the house with some @martyrich63 severed heads! Next she'll be eviscerating people like her mommy!!!
#Iheartautopsy #heads #martharich #severedheads #psychobabies #futurePA
2d

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dpez1995 On hour 15 of studying let's see how long I will last this time #FuturePA #Physiology 3d

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dpez1995 Just one more test left then I get a month off.. This class was ridiculous please for the love of all that is good and holy let me get a good grade lol #FuturePA #Physiology #saveme 3d

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Normal Mortui Vivos Docent
mrs_angemi Lillian has temporarily given up her armadillo and is walking around the house with some @martyrich63 severed heads! Next she'll be eviscerating people like her mommy!!!
#Iheartautopsy #heads #martharich #severedheads #psychobabies #futurePA
3d

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marissapacheco Yesterday my best friend graduated from FPU & i got to celebrate her accomplishment with my favorite people. Love you Brianne! Stay excellent. #futurePA #Aristotle caniborrowatape #cbass #stilettoqueen 3d

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idstewardship Let's briefly compare cefepime and tigecycline...cefepime has activity versus Pseudomonas aeruginosa, tigecycline does not - this is the big whole in tigecycline's coverage...tigecycline has activity against anaerobic organisms (eg, Bacteroides fragilis), MRSA and Enterococcus species (including vancomycin-resistant Enterococci [VRE]), cefepime does not...tigecycline also has added coverage versus some beta-lactamase producing Gram negatives...so sounds like tigecycline is better, right?...not the case, cefepime is the one with what I would consider greater clinical utility...cefepime has good serum concentrations after IV infusion and can be used for bloodstream infection, tigecycline distributes rapidly into the tissues upon IV administration and should not be used for bloodstream infection...cefepime is used for a variety of infections from pneumonia to skin and soft tissue infections to bacteremia to meningitis, tigecycline is mainly used for intra-abdominal infections...tigecycline is associated with significant nausea and vomiting too.
#InfectiousDiseases#Microbiology#Pharmacotherapy#Pharmacy#Medicine#MedSchool#MedicalSchool#MedicineStudent#MedicalResidency#PharmSchool#PharmacySchool#PharmacyStudent#PharmacyResidency#PAschool#NursingSchool#PharmEd#MedEd#FutureNurse#FutureDoctor#FuturePharmacist#FuturePA#FutureDO#FutureHero#CollegeOfPharmacy#SchoolOfMedicine
3d
  •   idstewardship Absolutely, @amir022 😀 3d
  •   idstewardship @dr.infection I find it hard to say many positive things about tigecycline...we use it with little frequency in our large dynamic acute care hospital...indications have been non-Tuberculosis mycobacterium, VRE intra-abdominal infection with abscesses in multivisceral transplant patient and XDR Acinetobacter pneumonia. 3d
  •   dr.infection @idstewardship Same in my hospitals. My hunch is that that tigecycline is used more off label for various bizzaro/less common infections you mentioned. 3d
  •   tacosalas We have a physician at my institution who LOVES to Rx tigecycline... and for no particular reason. Its quite frustrating sometimes . 3d
  •   idstewardship @tacosalas That would make me crazy too. Luckily our restriction program allows us to work with our ID docs to help push decisions towards standard of care and away from "you want that for what??" 3d
  •   exxcentrica @idstewardship I've noticed more cefepime than Tygacil going out at my hospital these days too. So much that it's feasible to order both the 1 and 2gm duplex bags. 3d
  •   idstewardship Cefepime and pip-tazo are our go-to empiric anti-pseudomonas drugs, like many hospitals and I imagine yours too @exxcentrica 3d
  •   the_coffee_bond Good shot! 2d

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greatbritton89 ER christmas party! #christmas #ER #tech #futurePA 3d

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nigeee Double take! Internal medicine Christmas party #mycoworkersaredoctors #futurePA #claimingit #brains&beauty 4d

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