Internal Medicine Commons^™

A Case Of Succinylcholine-Induced Postoperative Myalgia, Nancy Ha, Stephanie Griffith

Providence St. Vincent Internal Medicine 2021

Introduction

Succinylcholine is a commonly used depolarizing neuromuscular blocking agent in anesthesia for relaxation of the skeletal muscles during endotracheal intubation. It is ideal for use in shorter surgical cases and situations where a rapid sequence intubation is warranted due to its quick onset and short duration of action. One documented side effects of succinylcholine is postoperative myalgia, which was first described in the literature in 1952.

Case Report

An 88 y.o. male presented two days following transurethral resection of a bladder mass with complaints of diffuse myalgias that were severely limiting activity. The pain was greatly exacerbated by any …

Overloadipine–Emerging Therapies To Treat Refractory Shock, Stephanie Barayuga, Irene Hendrickson

Providence St. Vincent Internal Medicine 2021

Introduction

Refractory vasodilatory shock develops from uncontrolled vasodilation and hyporesponsivenessto vasopressors. •Management of calcium channel blockers (CCB) toxicity can be difficult because it can result in refractory vasodilatory

Case Presentation

•21-year-old male with history of depression and prior suicide attempts presented after intentional ingestion of amlodipine (300 mg) and metformin (150 tablets of 1000 mg). •Presented with slightly altered mentation and hypotension, then quickly deteriorated and required intubation and high vasopressor requirements. •Transferred to PSVMC for consideration of venoarterialextracorporeal membrane oxygenation (VA-ECMO). Since he was hyperdynamic on echocardiogram, our team did not feel he would benefit from VA-ECMO. •His vasopressor …

Avoiding Rash Decisions: A Guide To Adverse Cutaneous Drug Reactions, Caleb Freeman, Tom Chau

Providence St. Vincent Internal Medicine 2021

No abstract provided.

Intestinal Dysbiosis Disguised As A Rectal Fistula Treated With Autologous Fecal Microbiota Transplantation, Nicolina Scibelli, Pratishtha Singh, Kathleen Raynor

South Atlantic Division GME Research Day 2021

No abstract provided.

Leveraging Spiritual Care Resources To Reduce The Number Of Behavioral Events On An Acute And Intermediate Medical-Surgical Unit, Natasha Bartlett, Tia Jamir, Sally Langerak, Heather Weidemann

Costas T. Lambrew Research Retreat 2021

In 2018, R4/AVU an acute and intermediate care medical unit at Maine Medical Center (MMC), had a high level of distressing behavioral events (Code Grays) and staff stress.

Institutional Experience With Primary Interventional Radiology Sclerotherapy For Lymphatic Malformation, Obiyo Osuchukwu, Brenton Reading, Charlene Dekonenko, Wendy Jo Svetanoff, Jeff Thekkekara, Douglas C. Rivard, Charles L. Snyder, Tolulope A. Oyetunji

Costas T. Lambrew Research Retreat 2021

Interventional Radiology Sclerotherapy is effective for treatment of primary and recurrent lymphatic malformations

Phq 9 Utilization In Maine Health, Steven Gerrish, Kerri Barton, Neil Korsen

Costas T. Lambrew Research Retreat 2021

The PHQ is a brief patient survey for diagnosing depression and monitoring response to treatment.

A Retrospective Review Of Outcomes In Intensive Care Unit Patients Infected With Sars-Cov2 In Correlation To Admission Acute Physiologic Assessment And Chronic Health Evaluation Ii Scores, Pratishtha Singh, Kayle M. Warren, Hannah Adler, Andrew Mangano, Jilian Sansbury, Richard Duff

South Atlantic Division GME Research Day 2021

No abstract provided.

Dry Eye: Patient Education, Mark Oet

Family Medicine Clerkship Student Projects

Recent literature has shown increased incidence of dry eye and eye strain symptomatology during the COVID-19 pandemic, coinciding with an increase in screen time for almost all populations. This project aims to address this observation at a community level by creating a patient-friendly education pamphlet for Newtown Primary Care about dry eye and digital ocular strain based on American Academy of Ophthalmology guidelines.

The Preventative Healthcare Shortage: A Look At The Vt And Ct Community Perspectives And Medical Student Interest, Michael J. Lawler

Family Medicine Clerkship Student Projects

We adapted and modified a previously generated survey to better understand the motivations and barriers of medical students to enter primary care. The survey was dispersed to all medical students at LCOM as well as third and fourth year medical students at Ross University and American University of the Caribbean (AUC). We analyzed preliminary data from 100 respondents. Notable barriers identified included cost of medical school, stigma associated with primary care, and inadequate time spent with patients. Recommendations for possible intervention were discussed.

A Rare Case Of Leprosy In West Florida, Adrian Lugo, Taylor Studsrud, Nemer Dabage, James Demaio

West Florida Division GME Research Day 2020

• Leprosy is caused by acid-fast bacilli of the M. leprae complex, which includes M. leprae and M. lepromatosis.
• Transmission in the U.S. is rare, but has been documented in hunters who handle wild ninebanded armadillo.
• The origins of M. leprae infection among armadillos, the geographic range of the infected animals, and the potential risks infected armadillos present to people have been topics of concern.
• The infection originated amongst armadillos decades before they were ever used in leprosy research, and numerous surveys have confirmed that armadillos in the southern United States are a large natural reservoir for M. leprae; its prevalence …

Thinking Outside The Box In Liver Tox, Kimberly Brizell, Geoffrey L. Goldsberry

West Florida Division GME Research Day 2020

DILI is the most common cause of acute liver failure in the United States. However, it is important to consider that the agent at play may not be common to the United States. We aim to highlight the importance of using a "global mindset" when treating international and frequent traveling patients, but also demonstrate the severe hepatotoxic risks associated with Nimesulide.

Impact Of Order Set Use On Stroke Care, Bilal Nadeem, Edward Waseleski, Meryem Maras-Casey, Sabih Alam, Adnan Faruqui, Michael Gutierrez, Maruthsakhi Molugu, Christina Oricompil, Ashar Mahmood, Katherine Torralba, Fatima Agha, Nour Tlimat, Olu Oyesanmi, Irina Davis, Salman Muddassir, Nikolay Mitzov

West Florida Division GME Research Day 2020

• A case control study on stroke patients was recently completed for a quality improvement (QI) investigation.
• The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations

A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel, Ravi Patel, Marek Krysztofiak, K V. Sundaresh

West Florida Division GME Research Day 2020

Pott’s disease (PD), also known as tuberculosis spondylitis, is a rare disease of the spine which is typically caused by extraspinal infection. The basic lesion in Pott's disease is a combination of osteomyelitis and arthritis, usually affecting more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is commonly involved. Spinal TB can include any of the following: progressive bone destruction leading to vertebral collapse and kyphosis, cold abscess formation (due to extension of infection into adjacent ligaments and soft tissues), spinal canal narrowing by abscesses, granulation tissue or direct dural invasionresulting in spinal …

Kounis Syndrome, Charles Doerner, Mark Sawh, Tamer A. Amer, Konstantinos Marmagkiolis

West Florida Division GME Research Day 2020

Kounis syndrome, also known as allergic vasospastic angina, is a type of acute coronary syndrome caused by an allergic reaction or immune response to a substance.[1] It is essentially an “allergic angina” which is believed to be caused by mast cell activation and release of cytokines and histamine causing spasm of the artery leading to acute coronary syndrome and acute myocardial infarction. Stress cardiomyopathy (Takotsubo syndrome), which predominantly affects post-menopausal women, may also occur in anaphylaxis where transient ventricular dysfunction associated with regional ventricular wall abnormalities extending beyond the regions of coronary blood supply ensues.[2] The suspected prevalence of Kounis …

Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu, Andrea Hernandez, Bassem Zeidan, John T. Young, Johnathan Frunzi

West Florida Division GME Research Day 2020

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses ^{(1, 2)}. Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin ^(3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state ^(3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive care unit …

Initial Evaluation Of A Wellness Game, Bing Parkinson, Bruce St. Amour

Capital Division GME Virtual Research Day 2020

Physician wellness has recently been a topic of significant national interest.^1-8 The term “wellness” has many definitions, and was best defined by Around et al. ¹ as “one’s personal recipe for thriving and not just surviving.” Wellness refers to interconnected dimensions of physical, mental, and social well-being that extend beyond the absence of illness. Wellness has traditionally been measured in the negative sense by assessing rates of burnout, emotional exhaustion, and depersonalization. It is known that physician burnout is at its highest point during residency^{1, 4, 5} and burnout is linked to many negative outcomes including: substance abuse …

Iatrogenic Pneumothorax With Subsequent Subcutaneous Emphysema, George Michael, Eric Yuschak, My Myers

West Florida Division GME Research Day 2020

Lung cancer is the leading cause of cancer-related death in the United States, accounting for 13% of all new cancer diagnoses and 24% of all cancer deaths.1 Transthoracic CT-guided biopsy (CTGB) is commonly used as a diagnostic tool for lung cancer, with high diagnostic accuracy, sensitivity, and specificity. 2 This procedure, however, is not without its risks which include pulmonary hemorrhage and iatrogenic pneumothorax (IPNX). Emergent chest tube placement is standard care of treatment for massive or symptomatic IPNX, commonly with the use of smaller caliber chest tubes. 2 There is, however, a growing discussion over use of larger caliber …

A Case Of Medication-Induced Diffuse Alveolar Hemorrhage In Neurofibromatosis Type 1, Ashar Mahmood, Liz Palmer, Rebecca Schuyler, Svitlana Sharpovalova, Bilal Nadeem, Mukesh Mehta, Salman Muddassir, Nikolay Mitzov, Monicka S. Felix

West Florida Division GME Research Day 2020

• Amiodarone, an antiarrhythmic and apixaban, an anticoagulant have been associated with diffuse alveolar hemorrhage (DAH).
• Cases have been documented demonstrating DAH in the setting of amiodarone and apixabantreatment, however there are few cases examining DAH in combination therapy.
• We present a case of diffuse alveolar hemorrhage in the setting of amiodarone and apixaban treatment for paroxysmal atrial fibrillation.
• NF1 is know to have higher risk for major bleeds due to their friable vasculature.

A Rare Cause Of Pneumoperitoneum, Robert Zusman, George Michael, Anna E. Augustin, My Myers, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

Pneumoperitoneum is most commonly associated with a perforated viscus. When free air is seen on imaging, the most common course of action is an emergent exploratory laparotomy. However, pneumoperitoneum may not always be indicative of a perforated bowel. In the case described below, we will discuss a patient who developed acute peritonitis and pneumoperitoneum after undergoing chest compressions during cardiopulmonary resuscitation (CPR) and positive pressure mechanical ventilation.

Progressive Collateral Stenosis Leading To Symptomatic Chronic Total Occlusion, Farhan Shah, Andrew Maiolo

Capital Division GME Virtual Research Day 2020

Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.

The Difficult Airway: Developing A Consistent Approach, Catherine Divingian, Tammy Ferro, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

The primary objectives were to determine the best practices in managing difficult airways (DAs) and to generate a simplified algorithm for a consistent approach. Additional objectives included organizing a DA cart, and integrating the information into the electronic medical record (EMR).

Idiopathic Chylopericardium: A Rare Entity, Seema Jaga, Joseph Namey, Christiano Caldeira, Salah Al-Andary

West Florida Division GME Research Day 2020

• Idiopathic chylopericardiumis a rare entity in which the acculumation of chylousfluid surrounds the pericardial space.
• Herein, we present a case of a 50 year old healthy female patient with no known past medical history that was diagnosed with idiopathic chylopericardiumand was successfully treated using a pleurXcatheter drainage for two and a half weeks and a low fat diet.

An Atypical Presentation Of Neuroleptic Malignant Syndrome, Rudy Forte, Shiwani Kamath, Debra Angelo, Johnathan Frunzi

West Florida Division GME Research Day 2020

Neuroleptic Malignant Syndrome (NMS) is a rare, but potentially life threatening condition associated with dopamine blockade, particularly first-generation antipsychotics. The complex pathophysiology of NMS remains somewhat unclear and debatable as the symptoms are not fully explained by dopamine blockade alone.¹ D2 dopamine receptor antagonism remains responsible for most cases of NMS, however a few cases have been reported in which little to no D2 blockade activity was present.¹

This poster is about an atypical presentation of NMS.

Fracture Blisters, Jessica Khabra, Jinal K. Patel, Gauthier L. Stepman, Kulveer Dabb, Kenny Hernandez, Debra Angelo, Johnathan Frunzi

West Florida Division GME Research Day 2020

Fracture blisters are tense vesicles or bullae that develop on edematous skin following some acute long bone fractures. Fracture blisters are infrequently seen, as the reported incidence is 2.9% to 6.6%.¹ This rare complication, may not regularly be encountered by Physicians in the hospital. Fracture blisters typically occur within 24-48 hours following high energy trauma injuries & may last up to several weeks. Ultimately, this condition can lead to prolonged hospital stay due to an increased risk of infection and delay in surgical intervention.² Early recognition of this dermatologic complication may be helpful in reducing hospital stays.

Acute Hypoxic Respiratory Failure Due To Organizing Pneumonia With Lipoid/Cholesterol Component Caused By Thc Vaping With E-Cigarette, Jinal K. Patel, Kiran Tirumalasetty, Jessica Khabra, Imran Khan, Johnathan Frunzi

West Florida Division GME Research Day 2020

Vaping has been the new and deemed “safer” way to inhale addictive chemicals such as nicotine and tetrahydrocannabinol (THC), but it does not encompass the detrimental effects of other ingredients in these vaping cartridges that can cause lung injury[1,2]. Similar studies with dabbing (heating THC wax concentrate at high temperatures with butane) showcase rapidly progressing lung injury with massive consolidation and lasting effects on lung parenchyma over a period of time [3]. This case report aims to educate people, especially the younger generation, of the dangers of newer ways of combustible alternatives that have been marketed as a “safer” way …

A Case Of Babesiosis Seen Outside Of Its Endemic Area And Outside Of Its Incubation Period, Kiran Tirumalasetty, Jinal K. Patel, Gauthier L. Stepman, Bassem Zeidan, K V. Sundaresh, Parth R. Desai, Johnathan Frunzi

West Florida Division GME Research Day 2020

Babesiosis Microti is a parasitic alveolate that is usually transmitted by Ixodes scapularis ticks. In the United States, the endemic areas of Babesiosis include the Northeast and Upper Midwestern regions [1]. Symptoms include fever, malaise, fatigue, vomiting, and jaundice [1]. Current therapy primarily consists of a combination of azithromycin and atovaquone. Clindamycin and quinine may be administered in severe cases. For its emerging health risk worldwide, clinicians must be aware of the several presenting manifestations of babesiosis. Since 2017, the Centers Disease Control and Prevention (CDC) has deemed Babesiosis is a reportable disease. This case focuses on the importance of …

Cervical Cancer Recurrence In The Colon, Samantha A. Erb, Shreyash Pandya, Johnny Johnson

West Florida Division GME Research Day 2020

Cervical cancer is the fourth leading cancer worldwide in women, ranking only after breast cancer, colorectal cancer, and lung cancer. Because it is typically diagnosed at a younger age compared to other major cancer types, it leads to a proportionally greater loss in life-years. Most cancers occur in squamo-columnar junction, the transition point between squamous and columnar cells; squamous cell carcinoma accounts for approximately 70% of cervical cancer cases. Treatment options vary depending on the stage at diagnosis and include surgery (conization or hysterectomy), radiation, chemotherapy, targeted therapy, and immunotherapy. Prognosis is affected by stage, tumor volume, age and performance …

Impact Of Order Set Use On Stroke Care, Bilal Nadeem, Edward Waseleski, Meryem Maras-Casey, Sabih Alam, Adnan Faruqui, Michael Gutierrez, Maruthsakhi Molugu, Christina Oricompil, Ashar Mahmood, Katherine Torralba, Fatima Agha, Nour Tlimat, Olu Oyesanmi, Salman Muddassir, Nikolay Mitzov

West Florida Division GME Research Day 2020

A case control study of 118 patients from Oak Hill Hospital between the months of August 2019 and January 2020 was recently completed for a hospital research quality improvement study. The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations when compared to its disuse. Results indicate use of either the Hemorrhagic or Ischemic Stroke Order Set led to a decreased length of stay and an increased adherence to current stroke guideline recommendations. Limitations of the study included …

Carcinoid Syndrome Arising From The Descending Colon Causing Carcinoid Heart Disease, Julien A. Exposito, Adam Salomon, Oliver Fowler, Christopher Cooke, Joelle Ellis, Patricia Chun, Christiano Caldeira

West Florida Division GME Research Day 2020

No abstract provided.