Before heading down for the final day of sessions I thought I’d mention a few noteworthy items from the course content that particularly impressed me (now that we’ve gotten the woo out of the way). These were little ah ha moments for me and are not necessarily representative of the best of the course content:
In its checkered history hospital medicine has gone through many transformations but three lessons seem to have endured the test of time: Wash your hands. Seek the evidence. Examine the patient.
Acute phosphate nephropathy, thought to be rare, is now an emerging issue in hospital medicine. Associated with sodium phosphate based bowel cleansing products, it can result in permanent renal failure.
Enoxaparin dosing guidelines do not call for renal adjustment until the creatinine clearance drops below 30ml/min. However, bleeding complications with enoxaparin begin to rise precipitously as GFR falls below 80ml/min/1.73m2.
The colloid/crystalloid debate is still unresolved. We lack high level evidence to favor colloid over crystalloid.
Almost every hospital medicine conference contains a talk on in patient pain management, including this one. Having listened to many such lectures and noting the widely varying opinions and biases of the speakers it is my considered opinion that current recommendations regarding pain management are based 45% on the art of medicine, 45% on dogma and 10% on science.
Enough for now. I’ll post additional impressions and a wrap up, time permitting, after today’s sessions.