Posted in Flagyl on May 26, 2015

As sub-division of the McMaster Physician Assistant Education Program course of studies, each student shadows a professional in the domain relevant to the unit being wilful that month. These are called IER placements and students are assigned a half-day shift at a hospital/clinic in Hamilton. IER stands because Interviewing, Examining, and Reasoning.

For this IER Placement:

Medical Foundation Unit: Infectious Disease

Professional Shadowed: Physician Assistant – Maureen Taylor

Date of Placement: Friday, May 1, 2015

Where: Toronto East General Hospital

Read additional about what I learned in my placement!

Infectious Disease

Infectious ail is one of my favourite units. I like acquirements about the different pathogens and which pathological conditions they can cause. At the same time, I’m worried about my avow health…what if I get infected myself?? This was a house of mine until I knew more about infections and infection control.

We got the firm Infection Control Education Session at the Juravinski Hospital. Healthy folks with an intact immune system and who practices virtue hand hygiene will not get infected that easily. After this unit, I definitely am more self-persuaded about using alcohol-based sanitizers in the rear of every patient interaction, before eating…making infallible I rub it in my hands on account of the full 15 seconds.

Personal Protective Equipments and Different Precautions

Precautions are interventions to resolve the risk of transmission of microorganisms. Precautions indigence to be taken when interacting through patients. Not only are we protecting ourselves, but that we are also protecting patients who be delivered of a weak immune system…which is toward everyone in the hospital.


Hospital Acquire Infection is the 4th chief cause of death in Canada (succeeding Cancer, Heart Disease, and Stroke). Where work out patients get HAP from? Direct junction from health care professionals and contaminated of medicine equipment.

Put them PPEs on!

Hand science of health is a must! Do it:

Before interacting with patient

Before antiseptic procedure

After corpse fluid contact

After leaving patient environment/juxtaposition

After using washroom

After blowing nose

After eating

Anytime hands are visibly soiled –> use soap and water!

Additional precautions are needed then hand hygiene is not enough! There are some bad bugs out there…

Droplet forethought = for patients with respiratory secretions

Contact provision = for patients with resistant pathogens (MRSA, VRE, ESBL, C. diff) or courage, body fluids, excretions (vomiting, diarrhea) and secretions (purulent matter)

Airborne precaution = for patients with suspected/confirmed TB, Measles or varicella

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Seeing Patients with Maureen and Dr. Downey


This lenient that we saw is a woman in regard to 45 years old who presented with an erythematous rash on her ventral region that started that morning. On investigation, it is a raised lesion, enthusiastic to touch and appears to be in possession of spread to a larger area. She was diagnosed through cellulitis.

Cellulitis can present with a hurt that looks like an orange come off/skin

Cellulitis is a bacterial skin contamination. The most common pathogens that aim skin infections are Staph aureus and strep pyogenes. So the antibiotics ordered covered the couple these groups. It’s hard to culture the bacteria responsible for cellulitis after 1) staph and strep are institute normally on our skin and 2) it bequeath take days for the culture results to approach back.

Methicillin Resistant Staphylococcus Aureus

Staph. Aureus is a gram-actual bacteria. Most of them are resistant to penicillin inasmuch as they secrete penicillinase (an enzyme that breaks into disrepute penicillin….so there’s not theme in giving someone with a staph aureus pollution penicillin if the penicillinase will uncorrupt stop it from working)

Methicillin, Nafcillin are NOT penicillins, in the same state these are our second line antibiotics

The scariest of them are are Methicillin Resistant Staph Aureus or MRSA. It is a sprain that acquired resistance to methicillin and nafcillin. They wait on be to be developed in hospitals to which place broad-spectrum antibiotics are used. It is transferred from submissive to patient by hand contact of hale condition care workers (PREVENTION: good hand hygiene + the health care worker should gown up on the supposition that the patient is known to be the subject of MRSA…this can prevent spreading MRSA from this invalid to the next patient)

Vancomycin is single in kind of the few antibiotics that be able to treat infections caused by MRSA. It is some of the big guns in antibiotics. We try to obviate this for serious infections, just as a lot of pathogens are seemly more resistance to first line antibiotics. We don’t absence to overuse it though or otherwise these bacteria can become resistant to it being of the kind which well…and then we won’t wish any weapons against MRSA.

Red husband syndrome 

If vancomycin is infused moreover fast, an infusion reaction known for the re~on that Red Man Syndrome can occur. It’s not some allergic reaction. Just that infusing vancomycin in addition fast can cause mast cell degranulation –> histamine exoneration –> causing leaky vessels –> pruritis, erythema adhering skin

One of the patients we dictum had this reaction, but the support did not know if it was every allergic reaction or Red Man Syndrome. They asked a pharmacist to come in to watch a supervised vancomycin call for to see if it is a very well allergy (anaphylaxis) or just Red Man Syndrome.

C. diff

C. diff can cause a severe form of diarrhea. Our colon has worthy bacteria that keep the bad bacteria (like C. diff) from invading our mucosa. When patients, especially those in hospital, take coarse spectrum antibiotics for a long time, it kills not only the disingenuous bacteria, but the good ones because well. With not enough time instead of the good bacteria to replenish the colon, the evil bacteria takes advantage of the weakened defense and defile the colon!

C. diff releases toxins that occasion inflammation in the colon, allowing fluid loss. It also releases another toxin that kills colon cells

Patients through C. diff can shed the bacteria in their stool, which can infect hospital staff and other patients. (PRECAUTIONS SUPER IMPORTANT HERE to hinder transmission…GOWN UP!)

Diagnosis is made ~ means of stool investigation for the toxins

Treatment includes stopping the antibiotics to give permission to the colon flora to replenish, IV fluids (rehydrate sufferer since they are losing fluid end diarrhea), and metronidazole (Flagyl) ORALLY allowing that patient has fever and severe abdomen pain. Flagyl is an antibiotic except when taken by mouth, the medication goes straight to the colon lumen to have at C. diff and prevent it from growing.

One new treatment for recurrent C. diff bane is Fecal Microbiota Transplantation. The purpose is to recolonize the patient’s colon by bacteria from a healthy person via the healthy person’s feces. Read article about FMT procedures down in Hamilton through Dr. Christine Lee.

And guess that which? They’re training dogs to breathe out patients who have C. diff

Overall Experience

I enjoyed my placement at Toronto East General Hospital. I be of opinion learned a lot from Dr. Downey who quizzed me ~ward my knowledge. Other than the cellulitis enclose, the other patients were follow-ups or awaiting tests…so I did not win to see much there. However, I judge infectious disease is a very attractive area of medicine. It’s like detective moil, trying to find the culprit (pathogen) and killing it through the right antibiotic! (my analogy to this place is quite simplified!)

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