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PRIME

VAMC Primary Care Clinic

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The Dallas Veterans Administration Medical Center (DVAMC) Prime Clinic #3, part of the Veterans Administration North Texas Health Care System (VANTHCS), is one of two resident continuity clinic sites for the University of Texas Southwestern Internal Medicine residency program. The clinic is one of several primary care clinics within DVAMC, a referral center for veterans in 38 counties in northern Texas and two counties in southern Oklahoma.

Residents assigned to this continuity clinic serve as the primary care providers for their panel of veterans throughout their three years of training and will take care for patients with diverse chronic medical conditions on a longitudinal basis, as well as for post-discharge follow up and urgent care needs. In addition, the residents will see patients on a short-term basis for preoperative assessment and management.

Last Updated on Tuesday, February 22 2011 15:23
 

Resident Expectations for PRIME

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Clinic Expectations:

  1. Arrive in clinic by 8:30 am (mornings except Friday which is 9 am) or 1:30 pm (afternoons) at the latest, call the attending if you are going to be more than 5 minutes late.
  2. No clinic cancellations within 30-days unless an emergency and approved by Dr. Mortensen.
  3. Be responsible for your patients in between clinic visits, including:
    1. Have VA VPN access and use it on a regular basis.
    2. Daily review of CPRS to address alerts.
    3. Respond promptly and appropriately to pages from clinic staff.
    4. Address secure messages within 24 hours of alert.
  4. Do not leave PRIME clinic until cleared by an attending.
  5. Notes/encounters must be completed on the same day as your clinic.
  6. Check clinic folders for any messages left by patients (refill requests, outside medical records, paperwork, etc.)
  7. Professional behavior with all patients and staff.

During the visit:

  1. Update the problem list.
  2. Refill medications so that refills will last until next appointment in PRIME clinic.
  3. Discontinue medications that are not taken/should not be taken.
  4. Medicine reconciliation notes completed, printed, and given to the patient before leaving clinic.
  5. Enter follow-up orders prior to the patient leaving the room and have the patient follow-up with clerks prior to leaving.
Last Updated on Friday, November 04 2011 10:37
 

Secure Instant Messaging with My HealtheVet

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This is MANDATORY training that you must complete.

Secure Instant Messaging Training

pdf Secure Messaging Training Handout

Once you have reviewed the Training video send an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it. to inform her that you have watched the video.

Last Updated on Friday, October 07 2011 12:01
 

PRIME Contacts

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Last Updated on Monday, April 25 2011 08:44
 
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Calculators

Patient age
Barometric pressure
PaO2
PaCO2
FiO2
A-a Gradient
Normal A-a Gradient
Serum sodium
Serum glucose
Serum BUN
Calculated Osm
Bilirubin
Albumin
INR
Ascites
Encephalopathy
Child-Pugh score
Scoring:
A: 5-6
B: 7-9
C: 10-15
Patient age
Patient sex
Weight
 
Serum creatinine
eGFR
Calcium
Albumin
Corrected calcium

Serum sodium or BUN
Serum creatinine
Urine sodium or urea
Urine creatinine
Fractional excretion (%)


Serum sodium
Ideal sodium
Weight
 

Free water deficit (L)


For ischemic CVA the heparin dosing is as follows: no bolus, and 600-1000 units/hr drip (not weight-based). For other indications, use the calculator below.
Heparin indication

(For ACS, strongly consider LMWH instead of unfractionated heparin. Also, if using a IIb/IIIa inhibitor with unfractionated heparin, dose the unfractionated heparin as though the patient has a STEMI.)
 
Patient sex
Weight
Height
Heparin dosing weight (kg)
Bolus dose
*
Initial drip rate
*


*Maximum doses:
VTE 9000 bolus, 2000/hr gtt
NSTEMI 5000 bolus, 1000/hr gtt
STEMI 5000 bolus, 1000/hr gtt


Patient's sex
Weight
 
Height
Weight (kg)
BMI
Ideal body weight (kg)


Patient sex
Patient age
African-American?
Serum creatinine
eGFR / 1.73 m2

Bilirubin
INR
Creatinine*
*If the patient has been dialyzed at least twice within the last week, enter "4.0" for the serum creatinine.
MELD Score
Three-month mortality risk based on MELD Score:
Score
Mortality
‹10
4%
10-19
27%
20-29
76%
30-39
83%
40+
~100%

First drug
First drug dose (mg)
Second drug
Second drug dose (mg)

Note #1: Opioid analgesics have widely variable half lives, and when you switch from one form to another, you should adjust the scheduling accordingly.

Note #2: Methadone should be dosed by someone with experience using the drug. Consult palliative care or pain management.


QT (msec)
HR (bpm)
QTc (msec)


First steroid
Dose to convert (mg)
Second steroid
Second steroid dose (mg)

Age over 65
3 or more CAD risk factors
Prior coronary stenosis (50% or more)
ST segment deviation on initial ECG
2 or more anginal events in previous 24 hours
ASA use in last 7 days
Cardiac enzyme elevation
TIMI Score
TIMI Risk for cardiac event (mortality, new MI, or need for emergent revascularization) in the next 14 days:
 
Score
0-1
4.7%
 
2
8.3%
 
3
13.2%
 
4
19.9%
 
5
26.2%
 
6-7
40.9%
Serum potassium
Urine potassium
Serum osmolality
Urine osmolality
TTKG

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