Discover and read the best of Twitter Threads about #FOAMed

Most recents (24)

“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
There are two systems for the processing of illness presentations:
1) Intuitive: rapid, high-capacity, low-effort
2) Analytical: slow, cognitively taxing
In the emergency department, system 1 and system 2 processes are often initiated in parallel and may recur during the ED course.
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:…

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:
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
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?
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.
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....


#MedEd #FOAMEd #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
Before we get too far into it, how do we think about #scale? Meaning, which one of the following is it?
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.
Read 15 tweets

Dorsal most common
Patients often reduce themselves

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

Is this a concentric reduction? High-5 time?


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"

PIPs aren't simple!
=Presents Incredible Problems
Read 3 tweets
great teaching yesterday w/ @sanjayvdesai in the MICU @OslerResidency!

say you get called overnight (aka tonight for me) re: alarms for a pt on mechanical ventilation (MV): what's a systematic approach to addressing this problem?

Don't memorize, think physio!

three important concepts for mechanical ventilation: PEEP, PIP, Pplat

PIP: Dynamic pressure needed to inflate the lung (resistance/elastic forces)
PPlat: Alveolar distending pressure (compliance)
PEEP: alveolar pressure at the end of expiration.

so you get the call, 2 things you should ask (you know PEEP based on sign-out):
❓ any change in the PIP and PPlat

They tell you:
❌🔼PPlat, ⬆️PIP

This = ⬆️Resistance

NOW make your ddx:

ddx: tube dislodgment (biting), secretions, bronchospasm, migration of ETT
Read 10 tweets
I'm going to go outside of my regular comfort zone a bit today, and try out a #tweetorial/#medthread a bit more applicable to #medtwitter in general. So here goes....

A beginner's guide to the use of #PREDNISONE!

#MedEd #FOAMEd #dermtwitter #dermatology PC:@dermnetnz
Ah, prednisone. One of the most frequently used drugs in our specialty, and in many across the board in medicine. Useful for quick suppression of an overactive immune system, whether that be because of autoimmunity, or acute infection. But how does it work?
The point is that there are so many potential mechanisms, that it's hard to point at one particular enzyme or pathway to explain all its effects. This paper address many of them, but my main takeaway is that we don't know everything!…
Read 20 tweets
History of Diabetes. A thread.

1550 B.C: “Too Great Emptying Of The Urine”

First ever recorded mention of diabetes in Ebers Papyrus, written around 1550 BC, excavated in 1862 AD from an ancient grave in Egypt.

#EndoTwitter #Diabetes #MemoryLane
@JoyYWu @StanfordMed @MedscapeEndo @TheEndoSociety @Endocrine_News Around the same time, Indian physicians seemed to stumble upon a mysterious illness with "Honey Urine" which attracted ants and flies. They started to use the ants to diagnose the illness.

#EndoTwitter #Diabetes #MemoryLane
@JoyYWu @StanfordMed @MedscapeEndo @TheEndoSociety @Endocrine_News 230 B.C

Egyptian healer/historian, writer of 'On the Names of the Parts of the Human Body', Apollonius of Memphis, names the illness "Diabetes" (dia – through, betes – to go].

#EndoTwitter #Diabetes #MemoryLane #MedTwitter
Read 13 tweets
Not every day you get to speak to the Medical Deans of Australia and NZ on disruption and #MedEd #FOAMed & #SoMe in a plenary chaired by the indomitable @forrest_kirsty together with @LSchuwirth and Dr Joe Kolars from @umichmedicine 🙏🏽@forrest_kirsty for this opportunity.
Shout out my @MedEdStuffnN partners in disruption @GongGasGirl @hypoxicchicken including @char_durand @drlauraduggan & @MedEdUnicorn for their input. Plus thank you @aoglasserfor sharing & 🙏🏽@NEJM @tony_breu for impeccable timing ... why is a cow indeed?! Let’s embrace curiosity.
@MedEdStuffnN @GongGasGirl @hypoxicchicken @char_durand @drlauraduggan @MedEdUnicorn @NEJM @tony_breu A few people have asked for the talk so here you go a thread on disruption in #MedEd. Challenges facing medical education: medicine, social media and the digital age. Session moderated by @forrest_kirsty Prof KForrest Dean of Medicine @BondUniversity #MDANZ19 @MedicalDeans
Read 33 tweets
1/ Yday on micro rounds we discussed Group A streptococcus (GAS). We briefly touched on the rationale behind using adjunctive clindamycin for severe forms of invasive GAS. So here is a short tweetorial on the topic. @CarlosdelRio7 @Dr_AmyKacin @colleenkraftmd
2/ GAS is an aerobic GPC. GAS invasive disease (iGAS) is defined by isolation of GAS from a normally sterile body site. The most severe of these invasive disease entities are generally thought to be necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS).
3/ Currently, the addition of clindamycin therapy to B-lactams and surgical debridement is recommended by the IDSA for Necrotizing fasciitis and used routinely in management of STSS, despite low rates of PCN resistance . What is the rationale?…
Read 11 tweets
A #tweetorial/#medthread on…

CONSULT ETIQUETTE – for the consultant!

(This is the 2nd in a series on consult etiquette. See the end of this thread for a link to my other tweetorial for primary teams calling consults).

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatology
So you just got paged for a consult…. What do you do?

Of course we all think #1, yes?! Realistically though, it can be stressful to get consults. They are unpredictable, can come at any time, & the primary team may or may not listen to what you have to say. Here are some tips I’ve come up with from my time on #dermconsults.
Read 12 tweets
Bit of a different #tweetorial today, on:


- TIPS for the PRIMARY TEAM calling the consult.

Caveat: Some examples are a little #dermconsult specific, but can be extrapolated to others!

#medthread #dermtwitter #medtwitter #meded #FOAMEd #tipsfornewdocs
As both a #dermatologist & a #hospitalist, I have the pleasure of being on both ends of the #consult game.

So, your team has decided to call a consult, and you are the intern or student who has been tasked with contacting the team. Don't be nervous! Try these tips!👇👇👇
First of all:

1)Have a consult question

Asking a consultant to see a pt w/o a ? is like having a pt see you w/o a chief complaint! The ? helps the consultant frame the note in a way that is most helpful for you & your team. Otherwise, I'm guessing at what you want to know.
Read 11 tweets
It is a bit ambitious to try and sum up the magic of MRI physics in one post but here goes! (Thread 1/11) #foamrad #meded #radiology #mri #foamed
Hydrogen atoms are abundant in all of us and are all made up of a single positively charged proton

Each proton has its own magnetic field

When placed inside a magnet (such as within an MRI scanner) the magnetic fields of the protons line up with the main magnetic field (2/11)
Whilst lined up the protons aren’t completely still but rotate 🌀(or ‘precess’) along the axis of the magnetic field

Read 11 tweets
I hope you brought your appetite and have a strong stomach for...


This 5 course menu is a culinary journey through food-named skin signs. Bon appetit!

#prixfixe #tweetorial #MedEd #FOAMEd #dermtwitter #dermatology #medthread h/t @AdamRodmanMD
N.B. The MENU. Skip this tweet if you prefer delightful surprises. If you're one of those people who prefers to know what's ahead, here you go.

CAFE AU LAIT MACULES (CALMs) are light brown patches seen in neurofibromatosis types I and II ("Coast of California"-type edges) and McCune-Albright syndrome ("Coast of Maine").

For NF, a diagnostic criterium is ≥ 6 CALMs of 5mm (prepubertal), 1.5cm (postpubertal).
Read 37 tweets

Today I saw a pat who presented in A&E with life-threatening asthma.

MET call. Hypoxic & acidotic & with a hx of asthma. They weren’t compliant with preventative inhalers.

@DrLindaDykes @drrobgreig @jfdwolff @iceman_ex @GongGasGirl @bagheera79 @MDaware
They were treated with back-back nebs, Mg2+, steroids etc.

Hx an hour after eating they had vomited & then went on to an asthma attack. An urticarial rash was also noted. Anaphylaxis was considered but dismissed as a differential. They were reviewed by ICU.
Anaphylaxis & Adrenaline (& this is documented) were discounted as i) No hypotension ii) 1 hour between the ingestion of food & onset of symptoms.

So certain were the teams this was *not* anaphylaxis the pat. was not sent home with Adrenaline. No tryptase was checked.
Read 8 tweets
1/ The answer to our last poll: cisplatin…

Below, a brief #tweetorial to walk through a simplified approach to #hyponatremia

Step 1: What type of hypoNa are we dealing with here?

Ex: Na 128 meq/L, glucose 500 mg/dL, BUN 20 mg/dL serum osm 292 mosm/kg

Remember the difference between tonicity (a measure of EFFECTIVE osmoles) & osmolality (measure of both EFFECTiVE & INEFFECTIVE osmoles)

Effective osmoles cannot cross between the ECF and ICF, thus draw water across the cell membrane.

If serum osm not low with hypoNa, we must look for the presence of ⬆️effective & ineffective osmoles (that ⬆️osmolality)

-If we find⬆️ effective osmoles ➡️ HYPERtonic hypoNa

-If we find ⬆️ INeffective osmoles ➡️ HYPOtonic hypoNa

-If neither ➡️ PseudohypoNa
Read 9 tweets
SWEET SYNDROME - a #tweetorial/#medthread!

Join me for a discussion of this confusing eruption that we more commonly see on the inpatient side.

Bonus: a discussion on pathergy versus koebner phenomenon!

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatology pc: @dermnetnz
It helps to start by using the other name for Sweet Syndrome: Acute Febrile Neutrophilic Dermatosis. This pretty much sums up the whole syndrome.

Relatively sudden onset? ✅
Fever? ✅
Skin stuff? ✅

But what makes this diagnosis confusing is the differential diagnosis!
If a patient presents with a fever + rash, we often start to consider infectious processes first, which is totally reasonable. What helps though, is the exam.

The rash in Sweet Syndrome is usually described as "juicy edematous papules and plaques."
Read 15 tweets
Here we go. My first #medtwitter #tweetorial. A subject near and dear to my heart. Venous air embolism.

If I have an IV line and someone injects air into it, how much will it take to kill me?

#FOAMed #FOAMrad

This 2001 paper from the journal Anesthesiology puts the amount of air needed to kill at 200-300 mL or 3-5 mL/kg.…

But where is that air probably going to be when it kills you?

Read 20 tweets
CUTANEOUS LUPUS – a #tweetorial/#medthread!!

We all learn about Systemic Lupus Erythematosus (SLE) in medical school, but did you know there are multiple forms #lupus can take in the #skin?

#Meded #FOAMed #dermtwitter #medtwitter #rheumtwitter #dermatologia pc: @dermnetnz
It wasn’t until #dermatology residency I learned about all the subtypes of cutaneous lupus (CLE)! I thought it was all just one disease: SLE. But in reality there are many forms of CLE, each with its own implications on systemic involvement and effect on the patient.
Let’s start with the 3 subtypes:
Acute, Subacute, and Chronic Cutaneous Lupus Erythematosus (ACLE, SCLE, CCLE). CCLE is aka Discoid.
Each subtype "overlaps" with SLE in a different way.

Eg: ACLE overlaps completely with SLE, so they all have SLE! 👇…
Read 17 tweets
Medical visualizations (vizs; #visualAbstract, #infographic, or #graphicalAbstract) are ⬆︎popular. In this tweetorial I'm going to detail how I make vizs to help you in your #meded/#FOAMed endeavors. Here's my portfolio for background:…
There are four large domains that I consider when making a viz: Design, Structure, Content, and Textual Context (mostly in the parent tweet).
Let's go through each of these and discuss various facets that one might want to consider when designing a medical viz
Design: Audience
Know your audience, particularly if your audience is one that *doesn't* have access to the article that inspired your viz. If they don't, then recognize that your viz may be the 1st and only exposure to the science that the reader will have.
Read 22 tweets
#PedsICU #FridayQuiz
Sats85%(L=R)FiO2 15L/min
⬇️AE Lbase
pulses feeble-palpable
A)ETT plan-drugs/preox?
B)Post ETT plan
D)InterpretECG&identify intervention @Τ=5
F+W Fit&Well
♈️Responds to voice
L=R Equal bilaterally
⬇️AE Decreased air entry
Ddx Differentials
Cases from published peer reviewed reports
Answers next week
Focus on management
Tomorrow is the 1 year anniversary of the #PedsICU #FridayQuiz/2
🎈 🎉 🍰
It has grown into this collaborative #FOAMed clinical storytelling platform that is fun, evidenced based & credible.
It wouldn’t have been a success without all the people that supported it from the very beginning and all of you playing along /3
Read 13 tweets
All right #medtwitter, ready to feel itchy? Get your Sarna ready and read on for a #tweetorial/#medthread on....


#dermtwitter #dermatology #MedEd #FOAMEd pc: @dermnetnz #derm #itch #pruritus
What exactly is scabies? Sarcoptes scabiei var. hominis is the technical name of this parasitic mite that burrows into the skin (itchy yet?😆). It is notoriously difficult to diagnose, and has humbled many a #dermatologist.

It has a very characteristic look under the scope!
On exam, most know the classic distribution: interdigital spaces (pic1). However, other places to look include the areola, axilla, and umbilicus. In kids, the lesions tend to be all over the place (perhaps because they aren't as good at scratching them off! - pic2).
Read 17 tweets

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