At my first site evaluation, I presented the following case:

LD is a 36-year-old female with a significant past medical history of anemia and presumptive diagnosis of Limb-Girdle Muscular Dystrophy (pending genetic testing) complicated by necrotizing myositis. She was recently hospitalized at NSHU from 1/17/2020-1/31/2020 for muscle weakness secondary to myositis and was discharged to acute rehab where she developed acute hypoxic respiratory failure from fluid overload (improved with diuresis) and Takotsubo cardiomyopathy in the setting of an acute myositis flare. She was brought emergently to the ED and transferred to the MICU on 2/11/2020, where she was initially intubated and extubated on 2/12 and put on BiPAP. Her hospital course was complicated by cardiac arrest likely due to hypoxia while on BiPAP on 2/18 with ROSC after 3 minutes of CPR and 1 administration of epinephrine. She was reintubated on 2/18 and sedated on ventilatory support. She is s/p 3 PLEX treatments (2/13, 2/15, 2/17) and is currently being treated for necrotizing myositis and possible pneumonia. LD is parainfluenza positive and on droplet and contact precautions. She had no acute events overnight. MRI of the pelvis and femur is consistent with a myositis flare.

Plan:

1. Necrotizing myositis:
   • Continue azathioprine 200 mg PO QD
   • Continue Solumedrol 1000 mg QD x 3 days (Day 2/3)
   • Further PLEX held as per neurology recommendation
   • Wean sedation as tolerated
   • Adductor magnus biopsy scheduled today (2/21) at 7:30 AM; follow-up with result
   • Continue monitoring creatinine kinase

The site evaluations for my first rotation were in a group setting, but this one with Professor Malavet was one-on-one. I really enjoyed this way because it allowed me to more deeply discuss the cases I had seen and ask the questions I had than I would have in a group setting because I would not have wanted to be inconsiderate of anyone else’s time with our evaluator. I appreciated the Professor Malavet took so much time out of his day to answer all the questions I had and teach me about the MICU setting since we do not really touch much on that in our didactic education. We discussed the pharmacology cards I prepared as well as the medications that were relevant to the case I presented. We also discussed alternative medications, which really helped broaden my pharmacological knowledge and understand why we choose to administer specific medications over others.