Medicine- Day 7

One of my patients was discharged today and she was happy to go home.

I started a new patient work-up today and I am seeing a pattern in the conditions that most patients have when they get admitted to the medicine ward. They are usually as a result of falls, controlled diabetes or SOB ( pneumonia related).

I shadowed Beth during her presention at the Diabetes Education Center. The audience was a younger group who showed a genuine interest in learning more about the condition. The clinic is composed of a number of individuals from a variety of health disciplines, including pharmacist, podiatrist, diabetic nurse educator, dietitian, etc.  This interdisciplinary setup seems to benefit the patient greatly by providing a fuller picture about their condition.

I notice that the psych ward has a different computer system than the rest of the hospital. Beth tells me that the computer system is different because it uses the same program as those in the community. All the patient notes are typed up and the healthcare professionals are able to followup on patient notes in both the hospital and the community because of this unfied system.

It would be wonderful if this was the case all over the lowermainland or perhaps this may an opportunity for pharmanet to take part in a greater scope of practice.

AFib Didactics:

• irregularly irregular–> no pattern
• aka suprventricular tach
• HR=VR
• Define as HR greater than 120 ( critically ill) ; HR greater than 100 in normal pt
• aflutter: high rate, not irregular// rate control only
• atrial kick: accounts for 20% of cardiac output// contribution from atrium pressure
• AFFIRM: 7401 patients x 3.5 years ( not many CHF pt): 25% mortality, 8% stroke// no difference in efficacy/mortality/stroke between rate and rhythm control; however, rate control was better in secondary outcomes (ie. decrease hospitalization, decrease SE, decrease qt)–>SS
• Verapamil causes diarrhea and causes more hypotension then diltizam
• digoxin is not effective in controlling exercise induced tachycardia// not used in young, active pt
• rhythm control use in severe sx, hemodynamically compromised pt ( decrease BP)
• electroshock–> severe sx
• amiodarone: SE: tremor ( feet), green/yellow halos, pulmonary fibrosis, blue skin, thyroid prob
• amiodarone: 50 day half life ( x5 half lives to excret drug)// long term use associated with SE above //long term: 6 months
• TEE : see clot before electrocardioconverstion
• stroke: 4.5% in afib pt
• warfarin is bad for pts with a hx of falls????