Tag Archives: medicine

Calcium Chloride Injection Shortage

Calcium Chloride syringes and vials are on backorder until mid-December. With reduced supply, pharmacy would like to reserve supply for use in code trays. At this time, P&T has approved the following substitution during the shortage:


Pharmacy is being alerted to begin this substitution for orders received that are outside of code situations. If there is a definite need to use Calcium Chloride injection on a patient, please discuss the need and availability with pharmacy so that auto-substitution does not take place. Please be aware that pharmacy has limited supply of the Calcium Chloride.

Proton Pump Inhibitor Use & Clostridium Difficile

A message to the medical staff from:
Dr. Irfan Hafiz, Chief Medical Officer
Dr. Amit Shah, Chair, Department of Medicine – Woodstock
Dr. Linda Alic, Chair, Department of Medicine – McHenry

Clostridium Difficile is responsible for up to 250,000 infections and 14,000 deaths annually in the hospital setting and we are beginning to see a rise in our inpatient population at Centegra. The elderly and those receiving antibiotic treatment are at highest risk of developing infection. The FDA released a safety announcement in February 2012 cautioning the increased risk of developing C-Diff while taking Proton Pump Inhibitor drugs.


During times of acute illness, stress ulcer prophylaxis is recognized as an important component to support good patient outcomes. Adequate prophylaxis can be achieved using histamine H2 receptor blockers such as Pepcid. Use of these H2 blockers is preferred, even in the ICU setting if there is no known history of peptic ulcer disease or other condition necessitating PPI therapy. Examples requiring PPI include coagulopathy, history of GI bleeding/ulcer within one year, traumatic neurological injury and hepatic failure. We encourage cautious use of PPI’s and recommend limiting therapy to the prescribed course during acute hospitalization when the medication is indicated.

Ebola Awareness

At this week’s Open Forums, you’ll hear information about Centegra’s preparation for the possible event that we encounter a patient suspected of having the Ebola virus. Centegra Health System is prepared. Key leaders are regularly meeting to ensure best practices are in place that align with the current recommendations from the Centers for Disease Control and Prevention (CDC).

Centegra takes this threat seriously. Our teams are working with the McHenry County Department of Health, Illinois Department of Health and other local agencies to ensure our response is well coordinated with our community partners. Please talk to your leader about your department’s role in our process.

Immediate isolation will be implemented for patients who have traveled to high-risk areas in Africa in the last 21 days and present with the following symptoms:

  • A fever of 100.5 or higher
  • Flu-like symptoms

All Associates and Physicians will wear Personal Protective Equipment (PPE) until Ebola is ruled out. Patients who call our facilities with these complaints will be triaged and directed through the Centegra Hospital-McHenry Emergency Department for instructions prior to arrival at the hospital.

Key contacts for more information:
CH-McHenry: Karen Van Buren, RN, Infection Preventionist 815-759-4574
CH-Woodstock: Cindy Schweder, RN, CIC, Infection Preventionist 815-334-3916
CPC and Centegra Immediate Care: Basia Scherbaum, RN, MSN 815-337-1985
Media Inquiries: Michelle Green, Senior PR Coordinator 847-341-0274

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Doctor, My urine is blue!

The complaint

65 yr old man presented to the office complaining that his urine is blue after realizing that he was not joking I asked if this was something new to which he replied that it began about 2 months ago. He added that it was painless and without any fever or chills and denied any new medication which excluded inflamatory and drugs as causes respectively.

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Updated Guidelines for the Diagnosis and Management of Lung Cancer

Updated Guidelines for the Diagnosis and Management of Lung Cancer

As lung cancer is the leading cause of cancer related deaths worldwide American College of Chest Physicians have released updated guidelines of the diagnosis and treatment of lung cancer.

These guidelines specifically address:

  • Epidemiology of Lung Cancer
  • Molecular Biology of Lung Cancer
  • Chemoprevention of Lung Cancer
  • Treatment of Tobacco use in Lung Cancer
  • Evaluation of Pulmonary nodules
  • Clinical evaluation of patients with Lung Cancer
  • Establishing a diagnosis of Lung Cancer
  • Physiologic evaluation prior to surgery
  • Stage Classification of Lung Cancer
  • Lung Cancer treatment


Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Frank C. Detterbeck, MD, FCCP; Sandra Zelman Lewis, PhD; Rebecca Diekemper, MPH; Doreen Addrizzo-Harris, MD, FCCP; W. Michael Alberts, MD, MBA, FCCP
Chest. 2013;143(5_suppl):7S–37S. doi:10.1378/chest.12–2377

Refractory oral ulcers

40 yr old previously healthy female presents with “resistant” herpes. She has been having oral and genital ulcers that have been treated with valacyclovir for the past 4 weeks without improvement.
The oral ulcers are without vesicles or necrotic areas. They are painful, making it difficult to eat.
Below is a photograph of her tongue.

A tzanck smear of the lesions did NOT reveal any inclusion bodies.

  • Q. What is you diagnosis?
  • A. She has Behcet’s disease.


Behçet’s Disease, Tsuyoshi Sakane, M.D., Ph.D., Mitsuhiro Takeno, M.D., Ph.D., Noboru Suzuki, M.D., Ph.D., and Goro Inaba, M.D., Ph.D.
N Engl J Med 1999; 341:1284–1291October 21, 1999DOI: 10.1056/NEJM199910213411707