CASE-BASED APPROACH TO MANAGEMENT OF COMMON ON-CALL SCENARIOS. Lena Kawji, Thannon Alsaeed, Vinh Nguyen; Louisiana State University, Shreveport, LA.
Introduction: During residency training, residents are tasked with providing cross-coverage while on call, which can be intimidating especially as a new intern. Case: We developed a case-based session at the start of the academic year to address the common cross- coverage issues. Prior to the session, all residents were sent an anonymous survey asking what topics they would like to be addressed. Residents were also asked to rate from a scale of 1-10 as to how comfortable they were in responding to a page while on call, with (1) being not comfortable at all to (10) being very comfortable. The session was presented as case-based scenarios and covered topics such as how to approach arrhythmias, pain control, hypoxia, agitation, and pronouncing death. The session was interactive with residents discussing
how to navigate the different scenarios. Residents were then sent a post-session survey which asked residents on a scale of 1-10 how comfortable they were in responding to pages, if they found the session helpful, and if there were any topics they recommended changing/adding for the future. Discussion: The mean rating of the residents’ comfort level in responding to common scenarios prior to the session was 5.34, whereas afterwards the mean rating was 7.76 (p-value <0.01). One hundred percent of the responses stated that the session was helpful. From this review, we can conclude that a case-based review of common on-call scenarios at the beginning of the academic year allowed residents to feel more confident in addressing various situations.
CLOSTRIDIUM CADAVERIS BACTEREMIA – A LINK BETWEEN LIFE AND DEATH. Deekshitha Manney, Edward Pierce, Imran Ali Khan, Ram Kumar, Jessica O’Bryan; St Francis Medical Center, Monroe, LA.
Introduction: Clostridium cadaveris is a gram- positive, non-toxin-producing anaerobic bacterium that typically does not cause infections in living humans. However, in rare instances, bacteremia from C. cadaveris can be seen in immunocompromised patients and may be fatal. Due to the infrequency of infection, there are no established treatment guidelines on how to manage these patients. Case: A 71-year-old female with a history of endometrial carcinoma with bladder metastasis complicated by malignant right hydroureteronephrosis requiring placement of nephrostomy tubes and a ureteral stent, was admitted for a planned surgery to operate on her occluded right ureteral stent. Cystoscopy revealed necrotic bladder tissue with a foul odor and no visible ureteral orifices, necessitating an antegrade nephrostogram for nephrostomy removal, right ureteral stent replacement and ureteral dilation. Postoperatively, the patient rapidly developed hypotension progressing to septic shock, requiring intensive care unit admission and initiation of broad-spectrum antibiotics. Blood cultures resulted
positive for Clostridium cadaveris, and antibiotics were transitioned to piperacillin-tazobactam, after which her hemodynamic status improved slowly, and leukocytosis resolved. Repeat blood cultures were negative confirming resolution of bacteremia. The patient was maintained on piperacillin-tazobactam while inpatient and was ultimately discharged on intravenous ertapenem per infectious disease recommendations as there is data on effectiveness for various clostridium species and for ease-of-use in the home setting with it being administered once daily. Discussion: Clostridium cadaveris, an anaerobic bacterium that is typically found in decaying bodies, soil and cobra venom, is a rare cause of bacteremia in living humans. There are few published cases describing bacteremia originating from the gastrointestinal tract and even fewer pertaining to genitourinary tract involvement. In our case, the most likely source was the necrotic bladder tissue secondary to patient’s malignancy. Although infection is rare, the mortality rate for clostridium bacteremia approaches 58% making it crucial to discuss this species and any appropriate treatment 27
Made with FlippingBook Digital Publishing Software