Presbyterian Internal Medicine Inpatient Rotation
Location:
Patients can be on Cupp 3rd or 4th floor and Scheie 3rd floor.
Setup of Rotation:
There are four different teams two A teams and two B teams. Each team consists of an upper year medicine resident(2nd or 3rd year) two interns(medicine, FP, prelim, transitional or sub-I) and a third year medical student. Each intern carries typically between 2-6 patients. Call is every fourth night and you take call with your whole team, you and the other intern typically alternate between admissions. You leave between noon and 1 on your postcall day.
Attending rounds are at 8am, so you should finish pre-rounding before then. Notes are printed through the medview computer system, accessed through your login and available at each computer. Attending rounds typically consist of either walk or sit rounds on the patients followed by a teaching session. Attending rounds usually end by 11:00. The rest of the day consists of floorwork and/or admissions if you are on call. There is often lunch available at intern conference at 1pm on the 1st floor of the Wright Saunders Building The attending is usually available on the floor all day. Many residents will hold their interns’ pagers during that time. Sign-out is basically when you finish doing your work for the day. One day a week, you will have your PFC continuity clinic, usually a pre-call day.
Computer Systems:
Sunrise: this is used to put in all orders, check results, meds etc.
Medview (including sign-out): this is used to see more extensive records on a patient. Also this is how you will sign-in/sign-out. Go to housestaff, then signout, then select your name, and you will see your sign out sheet. You and your resident share the responsibility of keeping the signout up-to-date. To print it, go to “view as Microsoft word document”, then print. You can see anyone’s signout sheet by searching under their name. You will also be able to print your notes out through Medview. After signing in, click “my notes” tab and you will be able pull up pre-made notes including medications and recent lab values for patients assigned to you.
Presby-cards: Here is where you can access all cardiology reports on a patient including echo, EKG, cath lab reports. Website is http://pmc-card.uphs.upenn.edu
Geocities.com/pennmedicine: this is a link where you can find pager numbers on EVERYONE in the internal medicine department.
Magicweb: this is where all the radiology images are. This system automatically interfaces with Medview.
Charts:
Paper charts that are located at the nurse’s station. All orders (including medications) are done in Sunrise, not on the chart. There is also a bedside vitals chart, usually outside the patient’s room.
Call rooms:
6th floor of the Wright Saunders building, only accessible by the Saunders elevators which are adjacent to the cafeteria. The universal code for all call rooms is 7171. There are two AB intern call rooms for you to use-you and the other resident will decide who uses which one.
Parking:
1. On non-call days, park in the Powelton/39th Street lot
2. On call-days, park your car in the covered Presbyterian lot that patients/visitors use. Pull a ticket as you go in. When you leave the next day, you affix a parking validation sticker on the back and give it to the attendant as you leave. Your parking should be totally free.
3. On weekends you can park in the covered Presbyterian lot anytime and just swipe your presby ID to get in and out.
4. On weekdays you can also park in the covered Presbyterian lot after 2pm and be out by 9am. Again, use your presby ID to get in and out.
5. The parking validation stickers are available in the internal medicine administrative office on the first floor of Presbyterian main building. Talk to Kathy the administrative assistant to get the stickers.
Cafeteria:
Meal tickets are available for on-call days. You get $7 for dinner and $4 for breakfast. Make sure you use up all the money, as you don’t get change from the ticket. The tickets are available in the internal medicine administrative office on the first floor of Presbyterian main building. Talk to Kathy the administrative assistant to get the tickets. Lunch is sometimes free in the medicine conference room – you will usually be mass-paged if there is a lunch. The conference room is on the first floor of Presbyterian and the code to get in is 642.
Primer of Medicine Service Frequent Admissions
A. Change in Mental Status
B. R/O MI
C. Sepsis (aka “Fever” in a nursing home patient)
D. Syncope
A. Change in Mental Status
1. Delirium-little reserve so even a UTI can hit hard
2. Seizure – post-ictal, witnessed event?
3. CVA – focal signs, risk factors, sudden onset
4. Adverse Drug Reaction –anti-cholinergics, betablockers, psych meds
5. Progressive dementia (Alzheimers/Lewy body dementia)
B. R/O MI
1. You will need a “cardiac profile” (= CK and Troponin I) x 3 in the 1st 24 hours of admission
2. Serial EKGs should be done with each cardiac profile
3. Once patient is “ruled out”, schedule a stress test.
4. Many times we get an ECHO while they are waiting to be ruled out – just for completeness sake.
5. If there is unstable angina – call cards, start a heparin drip
C. Sepsis
1. Sepsis Workup = Pan-culture
a. CXR
b. UCx/UA
c. BCx (they come in sets of four and Presby has a surveillance blood culture team that draws them during the day hours, not after hours so hold out for the morning)
d. Presby does not record negative preliminary cx results in the computer, just a no-growth at 5 days result
e. For difficult ABx questions, call “Nish”, a PharmD ID specialist 306-7732
f. Cx results are sent to HUP micro 662 3406
D. Syncope
1. Arrhythmia – history, risk factors (ie sleep apnea, valvular disease), NO prodrome
2. Orthostatic hypotension
3. Vasovagal – micturition syncope, vasovagal usually has a prodrome
4. Hypoglycemia – sulfonylureas?
5. Seizure activity – witnessed event? Tongue-biting, incontinence, post-ictal state?
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