PGY-2

Posts authored during my second year of internal medicine residency training.

A Thoughtful Gift!

Medical residency training is an amazing opportunity, filled with a lot of stressful scenarios that test your knowledge and grit.  I have had the pleasure of working with some excellent Fellows in the various subspecialty fields, including one in particular from the Critical Care Medicine department.  Knowing that I am pursuing a Gastroenterology fellowship position, he went through the effort to give me this textbook just a couple weeks ago.  Completely unexpected, and very thoughtful!  I’ll always remember this!

Graduating this June, one of my favorite Critical Care Medicine fellows gifted me this book.

The Maturation of a Physician

The Kilauea Lighthouse on Kauai, Hawaii. Copyright original photography Spencer C. Knox, MD

With the new year fast approaching, I felt that the weekly “New Horizon” photo challenge was apropos. Internal Medicine residency is a perpetual cerebral challenge, involving new and interesting medical cases and an abundance of clinical situations where knowledge is not only pushed to the limit, but expanded.  I love what I do, and the opportunity to train with many amazing physicians, as well as learn from helpful registered nurses.

Looking at the remaining fifteen days in the year 2016, I am reminded of the career decisions that await me.  Physicians in internal medicine residency training programs, like me, either graduate and work in primary care or as a hospitalist, or sub-specialize.

On December 31, 2016, I have set a firm deadline to decide whether or not I will pursue fellowship training.  A commitment is relevant now because my actions during the second-half of my PGY-2 (second year) will affect the next step in my professional maturation.  Will I go immediately from internal medicine residency to a fellowship training program?  Will I be able to find sufficient research opportunities early 2017?  There are many uncertainties that I must begin to answer in the next month or two in order to gain clearer insight into my chances of obtaining fellowship training.

 

ACLS Protocols

As a senior internal medicine resident on night float and overnight call, I’m responsible for running to codes and rapid responses.  Rapid responses at my institution are critical patient situations that require urgent bedside attention for things like symptomatic supraventricular tachycardia, new typical chest pain, hemodynamic instability, etc.  Today after work, I wanted to brush up …

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HFpEF Treatment

These patients tend to be very VOLUME SENSITIVE. Daily weight checks – get an accurate bathroom scale. No medications have proven mortality benefit. Treat causes Hypertension – lower the patient’s blood pressure Tachycardia – AV nodal blockade depending on etiology.   Bibliography ACP MKSAP 17:  Cardiovascular Medicine, pp. 32-34 Image credit (follow link)

HFrEF Medical Treatment

Heart Failure with Reduced Ejection Fraction (also known as systolic heart failure) is broken up into two phases of treatment:  the acute (on presentation to the hospital) and chronic (long-term to prevent re-hospitalization). Acute Exacerbation Treatment DIURETIC (urinate off all the excess fluid in a volume-overloaded patient) ACE inhibitor or Angiotensin Receptor Blocker (ARB) contraindicated if …

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