Discover and read the best of Twitter Threads about #FOAMED

Most recents (24)

#tweetorial time for SUPER FAST, no WINTER or (difficult) MATH evaluation of Anion-Gap Metabolic Acidosis:

THE METABOLIC SEESAW. YEE HAW.

1/12
The metabolic seesaw:

dBC dAG
———————🔺———————
(more BC)

dAG = delta Anion Gap
dBC = delta Bicarbonate.
Toward the Center = more bicarbonate

This will all make sense in a moment.

2/12
Scene: patient w/ anion-gap metabolic acidosis

Your ?: is their compensation appropriate? Do I need more labs? Who and what is a winter and why do they have a formula?!?!

Answers: seesaw only, a chemistry is all you need!

3/12
Read 12 tweets
FINGER "SPRAINS" (1/3)

AKA "jams" (XR neg)

Often worse than they seem

EXAMINE the patient
Check FDP & FDS, EDC, and CENTRAL SLIP (Elson test) as well as jt stability

"XR neg, go home" = WRONG ANSWER

Acute tx much easier & more reliable than chronic
#medtwitter #foamed
If missed, central slip tears progress to BOUTONNIERE deformity

Perform Elson test to check CS integrity for all "jammed fingers"

Flex PIP over a table edge and hold down P2. Ask them to extend DIP. If they CAN, it's ABNORMAL & sign of tear (2/3) #medtwitter #foamed
Or, "Modified Elson test"

Align P2s back to back

Ask pt to extend DIP

Normally unable to, but if central slip torn, they can extend the DIP through the lateral bands

Either learn this or send all to hand for eval

Acute treatment = easy
Chronic = not (3/3)
#medtwitter #foamed
Read 4 tweets
1/
“The Erythemas” – A #dermatology #meded #FOAMEd #tweetorial. pc:@dermnetnz

Ever get all the different #dermatologic terms jumbled up? Was it erythema nodosum, erythema migrans, or erythema multiforme?

Honest poll – Ever write “rash” b/c you couldn’t remember the diagnosis?
2/
All kidding aside, these terms can get confusing. Remember though, derm terms are usually just descriptors of what you see. The name tells you all you need to know.

For example: Acute Generalized Exanthematous Pustulosis (AGEP) = pustules suddenly appeared everywhere!
3/
So, the “erythemas.” First off, what does “erythema” actually mean? Well, according to my Google machine, it's from the Greek root “eruthros” meaning “red.” So "erythema" doesn’t add much to our knowledge of what the rash looks like other than it’s red, and so, likely inflamed
Read 15 tweets
@BenTritle presenting an Update on IR-guided central line access! #meded #foamed @CleClinicMD
Different central line access:
Dialysis catheters and Port catheters:
Read 10 tweets
"What is the best Venous Access Device for my patient?"

An #InterventionalRadiology (#Irad) #Tweetorial to address a frequent clinical dilemmas for #Medtwitter and #NurseTwitter

#FOAMed
1a/

Type of VAD:

PIV: 3-6 cm, enter and terminate in peripheral veins.

US-PIV: US to reach deep veins when superficial veins difficult to palpate, ≥8 cm

Midline catheter: 7.5-25 cm, inserted basilic/cephalic vein), terminating short of subclavian. 🚫 vesicant infusions
1b/

CVC: duration 7-14 d, direct puncture of internal jugular, subclavian, or femoral veins.

TC : diff from CVC, seperate insertion site in upper chest and venipunture in neck
⬇️ risk of infection due to cuff
👍 location for catheter care
Read 15 tweets
Another day on service and you are starting with answering a page from PACU. "Hi this is nephrology fellow returning your page". "Great! This is Ortho, and our patient post op has low potassium here; I believe you call it HYPOkalemia" #Loveourorthopods #Tweetorial #medthread
Join us for our electrolyte abnormality du jour and learn how to break it down! #nephtwitter #medtwitter #FOAMED See our full post @RenalFellowNtwk > renalfellow.org/2019/11/14/the…
59 yo F with a hx of HTN, and HLP admitted for a left femur fracture; she was found down by her neighbor 3 days after her fall; awake and in pain. Now, patient is post op; and on labs: (baseline cr: 0.51). UA unremarkable.
Read 19 tweets
@tavrkapadia delivering @CleClinicMD Grand Rounds. On #TAVR. Starts by showing how morbid and complex the open surgery is. Many elderly patients are not candidate. Hence #TAVR was developed. #meded
The team that ensures ZERO percent mortality in #TAVR for any patient coming to @ClevelandClinic with Aortic stenosis. #meded
Heart is NOT stopped! After #tavr can see immediate hemodynamics improvement!
Read 10 tweets
1/
ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!

#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz

Let's warm up with a question for all y'all tweeps out there!

What is the most common trigger for erythema multiforme (EM) in adults?
2/
EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.

What primary lesions do you expect in EM?
3/
EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).

2nd photo: my.clevelandclinic.org/health/disease…
Read 10 tweets
Herniación Cerebral en Traumatismo Craneoencefálico
#PedsICU #FOAMed #MedEd

Abro hilo, iniciamos y abiertos los comentarios👩‍⚕️👨‍⚕️
Último hilo del año sobre la serie de #TCE.
Antes de iniciar, te dejamos los 4 enlaces de la serie completa (#tweetorial):

1. Abordaje Prehospitalario e Inicial en el TCE
Todo empieza antes de llegar al Hospital, así se logra el mejor desenlace.

2. Cuidados basales en el #TCE Severo
Lo que todo paciente con Escala de Coma de Glasgow igual o menor de 8 debe recibir.

Read 31 tweets
QUICK RANDOM HANDOM TWEETORIAL TIME

attention every1 in #primarycare #urgentcare #emergency care #EM or #ortho #radiology

Here's an injury that gets missed SO FREQUENTLY

but not by you anymore, bc now YOU'RE GONNA CATCH IT!

Hx: punched a wall, pain
1/3
#medtwitter #foamed
What's that? You want another view?

BRILLIANT SUGGESTION, here it is
Think you spot the problem?

Keep scrolling!
2/3
#medtwitter #foamed
CMC DISLOCATION

The MC5-hamate articulation is outlined in orange dots

Best appreciated on a 30 deg pronated oblique

Sometimes these are subtle on AP and LAT but always a dead giveaway on the oblique

Remember THREE VIEW HAND>>TWO VIEW HAND
#2viewisNoVIew
#medtwitter #foamed
Read 5 tweets
1/8 #FOAMPed #PEM #FOAMed

Another chat in CED last night about using Ibuprofen in chickenpox, and thought it would make a nice tweetorial! (for more detail check out end of thread for link to blog and podcast!)

Ever heard you shouldn't given ibuprofen to kids with chickenpox?
2/8
The concern is about increased risk of severe skin infections, in particular the dreaded necrotising fasciitis (nec fasc) with group A Strep (GAS).

This first popped up in the 60's with case reports of a GAS outbreak associated with ibuprofen.

journals.lww.com/pidj/Abstract/…
3/8
A few case control studies have been done since, with small sample sizes (Nec fasc is rare!) which seemed to confirm an association.

But, as you all know, correlation does not equal causation!

adc.bmj.com/content/102/10…
Read 8 tweets
Here is a gorgeous case of CTD-ILD. I found this whole entity very confusing at first. I’ll show images at presentation, 7 days, 2 months, and 6 months. I’ll also share PFTs, BAL, serology, and path report. Please comment on these if you like. #FOAMed #FOAMrad #radres 1/
The patient is a 45 yo male. Acute kidney injury and ? Pneumonia. The first image was at presentation. There is peribronchial consolidation with a nice perilobular appearance peripherally. Looks like organising pna. Cause could be infection, vaping, drug reaction, CTD...
Here is a similar level, 7 days later. Consolidation has progressed. OP is really just a type of lung injury. If the lung injury gets worse, we could get into ARDS/AIP territory. But, no septal lines and no effusion. So just bad OP. ANA is elevated.
Read 15 tweets
1/ A short #tweetorial introducing human leukocyte antigen (HLA) and typing...an important and often confusing topic in #transplantation #kidneytransplant

#FOAMed @MedTweetorials

What is an "HLA"?
2/

HLAs = cell surface proteins encoded by highly polymorphic major histocompatibility complex (MHC) genes on Ch 6 🧬

In #transplantation, HLA proteins are #polymorphic antigens ➡️ alloreactive trigger for the immune response ➡️ can ultimately lead to organ #rejection ☠️
3/ The 2 primary classes of MHC molecules are 1⃣ and 2⃣.

Class 1⃣ MHC are found on the cell surface of ALL nucleated cells + platelets. Their role is to present intracelleular peptide fragments to CD8 #Tcells
Read 8 tweets
(Thread) Another week and another @MedTwitThisWeek #medthread. As a reminder, this is not all inclusive. It's a jumping off point. A continuation of the discussions from the week that I found interesting including conferences, #Tweetiorials and tributes. #medttw #FOAMed
2/ Conference Bonanza! Since last week, several amazing conferences took place (or just started). Each conference has their own hashtags and flavors of #SoMe. Here are some highlights...
3/ @jenreadlynn was at #midwesthospmed and did a great job of distilling @MelBreggs' talk on inpatient management of alcohol withdrawal.
Read 31 tweets
Watch this great video showing the Modified Valsalva Maneuver converting a patient in SVT to Normal Sinus Rhythm

If you’re not doing this, you’re not doing SVT right!

Video courtesy: @julesantosER
#FOAMed

In the REVERT Randomized Controlled Trial the success rate was 43% vs. 17% for the standard Valsalva Maneuver!

Read about it here: ncbi.nlm.nih.gov/m/pubmed/26314…
A lot people have asked about the physiologic explanation for why the Modified Valsalva Maneuver works. I’m gonna do my best to explain it as I understand it.

Let’s start by taking a look at the body’s physiologic response to valsalva...
Read 9 tweets
A little while ago I tweeted about drugs that scare me. As a tox fellow, I meant they scare me when I hear someone overdosed. I didn't write that specifically, and got questions and a request for a longer explanation (from @pgyfun) of why I'm concerned. So, tweet thread:
Propranolol: most beta blockers tend to do ok in overdose, likely due to compensatory increase in SVR that maintains BP. Propranolol is nasty though - it's lipophilic and a sodium channel blocker, so can cause seizures, coma, and QRS prolongation/dysrhythmias
#FOAMEd #FOAMTox
Bupropion: wonderful medication for depression, but is actually a pharmaceutical bath salt (has the same cathinone backbone). High risk of seizures in overdose, and large overdoses causes cardiogenic shock that we can't fix due to myocyte gap junction blockade
#FOAMEd #FOAMTox
Read 10 tweets
.@ammo_uw is kicking off the Educator’s Development PG course at #CHEST2019 with Mark Lavercombe (ML), @pkritek and @williamkellymd .. follow this thread for #CHESTMedEd updates from this day long session!
Also engaging us today will be Dr. Lisa Moore. Here are all the sessions for all you clinical educators at #CHEST2019 #CHESTMedEd
ML: is up next: Application of Adult Learning Principles

- Be aware of limitations of adult learners eg, limited time
- Be aware of limitations in environment: eg. Interruptions, clinical work, variety of learners

#CHEST2019
Read 41 tweets
“What does a surgeon look like?”

A story for all ages, written by @JJcolemanMD , illustrated by @gracie_leo

#ilooklikeasurgeon #womeninmedicine #medtwitter #meded #foamed #storytime
Story thread below...
She woke up one morning and asked the Mirror, “What does a surgeon look like?”

But the Mirror did not answer.

She asked the World and asked “What does a surgeon look like?”

And the World did answer.
The World said,

“He is TALL and NOT small.”
“He is not too young or too old.”
Read 10 tweets
A quick thread on why I make and use algorithms for the evaluation and management of patients in the ED:
#FOAMed #EmergencyMedicine #Metacognition
1/8
There are two systems for the processing of illness presentations:
1) Intuitive: rapid, high-capacity, low-effort
2) Analytical: slow, cognitively taxing
2/8
In the emergency department, system 1 and system 2 processes are often initiated in parallel and may recur during the ED course.
3/8
Read 8 tweets
Finally, time to show some of my most used Powerpoint plugins, add-ins, and resources. All of them are free. Perfect for anyone in #MedEd who gives presentations. If anyone has anything they particularly love, please share! #FOAMed #Presentation #PowerPoint
First off, here’s how to add plugins from the office AppSource: support.office.com/en-us/article/…

AppSource: appsource.microsoft.com/en-us/marketpl…
PowerUser: The best “all in one” plugin. Templates, icons, diagrams, pics, & maps. You can automate formatting tasks (changing colors, font, charts or alignment) for your entire presentation automatically. Free, and premium free with a .edu email! Here: powerusersoftwares.com
Read 13 tweets
Syphilis! RMSF! Hand-foot mouth!

Slow down there, Tiger! Let's dive deeper into:

ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).

#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
1/
No where else on the body does a rash evoke more of a knee-jerk differential. That's not wrong per se, as we all learn this in med school, but it's more complicated then starting doxycycline and checking an RPR!

Let's start with a definition - what does "acral" actually mean?
2/
Technically, "acral" just means our distal body parts. So while we often think of palms and soles, it's actually inclusive of the whole hand, the whole foot, ears, and some include even the nose!

I actually didn't learn this until #derm residency, which was shocking to me.
3/
Read 20 tweets
Did my fellows' curriculum lecture today, "Images in #Nephrology"
Thought of sharing the slides as a tweetorial. Goal is to present some 'classic' images that aid in kidney-related diagnoses. Not exhaustive; plan to make 2nd part as well.
#MedEd #FOAMed Not much POCUS involved!
1st question. Classic image but rarely encountered. Note the super high blood urea nitrogen and serum creatinine.
Here is the answer.....
Read 61 tweets
Let's go back to the basics today, and talk about some #morphology in the #dermatology exam.

Today's #tweetorial/#medthread will be about evaluating....

SCALE!

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
1/
Before we get too far into it, how do we think about #scale? Meaning, which one of the following is it?
2/
When we say "primary lesion," we mean the most basic element of a lesion/rash (papule, macule, patch, plaque etc).

SECONDARY CHANGE (which scale is) means the extra exam element that occurs on top of the primary lesion!

Tertiary/Quaternary isn't a thing. I'm just a jerk.
3/
Read 15 tweets
#PIP #DISLOCATION

Dorsal most common
Patients often reduce themselves
DIGITAL BLOCK

Flex wrist & MP to relax flexors, then gently reduce by PUSHING DISTALLY on P2 base rather than just pulling traction

Volar&rotatory dislocations oft require open reduction #medtwitter #foamed
MUST assess stability & xray post reduction

Good lateral is vital to make sure jt is concentric & no fx

If stable even in extension & no fx, buddy tape x3-6 wks

If unstable, dorsal blocking splint at 10 deg more flexion than unstable point

Or just refer to Hand

#medtwitter
Is this a concentric reduction? High-5 time?

NO!

The "dorsal V sign" indicates subtle instability that if untreated would lead to PIP arthritis

PIP arthritis SUCKS

PIP is the "soul of the hand"

#saveasoul
PIPs aren't simple!
=Presents Incredible Problems
#MEDTWITTER #foamed
Read 3 tweets

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