Discover and read the best of Twitter Threads about #FOAMed

Most recents (24)

With an increasing number of #specialist & #advancedpractice roles emerging for #paramedics, I thought it might be useful to assimilate some thoughts on preparing yourself & your CV for these positions.
For me, it’s about a rounded approach. Undertaking every course under the sun is fine but won’t provide you with the breadth of development required. Consider the four pillars of advanced practice. This document from HEE is a useful guide hee.nhs.uk/sites/default/…
Read 9 tweets
🌸Kidney involvement in primary Sjögren Syndrome

🔥<10% cases (Underdiagnosed/ Neglected⁉️)
🔥Most frequent: TIN
🔥Prognosis👍
🔥Good response to steroid
🔥Cryoglobulinaemia in SS👉 Beware of Lymphoma/MPGN‼️

⚠️Always screen kidneys in SS

#NephroNotes #Nephpearls #FOAMed #MedEd
🌸Kidney involvement in primary Sjögren Syndrome

🔥Trigger: Environment/Genetics/Viruses
🔥Immune complex in glomeruli
🔥Autoab to specific renal transporters in DCT (Reason behind dyselectrolytemia‼️)

10.1038/nrneph.2015.174
#NephroNotes #FOAMed #MedEd #Nephpearls #NephTwitter
🌸Kidney involvement in primary Sjögren Syndrome

🔥Clinical presentation

♦️dRTA👉Nephrocalcinosis
♦️DI
♦️Fanconi Syndrome
♦️Bartter/Gitelman
♦️TIN
♦️MPGN

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
Read 6 tweets
🌸Aminoglycoside Nephrotoxicity

♨️Cationic Amino group on drug bind to anionic Megalin on PCT
👉Endocytosis (accumulate in PCT lysosomes @ 100-1000x serum concentration)
👉ATN

Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd Image
🌸Aminoglycoside Nephrotoxicity

♨️5% of dose retained in epithelial cells lining S1 & S2 segments of PCT

♨️Non-oliguric AKI after 5-10 days
♨️Distal tubular toxicity👉 Polyuria/ K & Mg wasting

Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedEd Image
🌸Aminoglycoside Nephrotoxicity

♨️Risk factor:
♦️Elderly
♦️Hypotension
♦️Pre-existing renal disease
♦️Duration>7days
♦️Concurrent nephrotoxin
♦️Liver disease
♦️Sepsis
♦️Divided dose regimen

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
Read 5 tweets
E hoje fazem exatamente 4 anos que publiquei esse vídeo pela primeira vez:
✨Manobra de valsalva modificada
Prós: barato, ñ causa desconforto como a adenosina, 40 a 50% de sucesso, vc se sente um mágico, mas é ciência 🤓
#FOAMed
Manobra de Valsalva Modificada 😎
.
👩🏼‍🍳Vc vai precisar:

- Paciente com diagnóstico de TSV ESTÁVEL

- Seringa de dez ml
- paciente monitorizado
- maca reclinável ou equipe treinada
- saber contar até 15 🤣
- Equipe linda empenhada e vibrando 💖
1/
🤔 Como fazer:

- Paciente sopra a seringa por 15seg (a idéia é criar uma pressão de aproximadamente 40mmHg, a força necessária para empurrar o embolo da seringa)
- ao final dos 15seg, deitar o paciente e elevar os membros inferiores aprox 45 graus por 15s
2/
Read 10 tweets
Getting the most out of your monitor: a tweetorial thread. Inspired by a twitter question from @mork66236485 and @GongGasGirl's chairing of the @aagbi's latest recommendations on monitoring. Lets start with a series of #OnePagers on aspects of the ECG #FOAMed #MedTwitter
One more on the ECG. So much of what we do is pattern recognition, so the next three look at waveforms for three of our most used monitoring devices; arterial/SaO2, capnography and CVP. #FOAMed
NMT and EEG are becoming more and more ubiquitous. Here's a pair of #Onepagers. And we're now going to move on to the information we can get from the monitoring that's part of our ventilators. #FOAMed
Read 5 tweets
Patient with epig pain and multiple ED visits with neg CT and non-specific labs - but persistent pain. What do you do? GI cocktail + famotidine and discharge? How about a little #POCUS first. #FOAMed #FOAMus #Ultrasound #MedTwitter @mtabbut @laurarbrownmd @RJonesSonoEM
And the transverse view. What do you think now? Poll below in thread. #Whatsthedx #EmergencyMedicine @DianeGramer @SLWerner_EM @ClaridgeJeffrey @vanessapho @ladha_prerna
What do you think?
Read 9 tweets
Radiology in ICU - 1 - A Tweetorial of some interesting (and some very rare!) cases relevant to ICU on @Radiopaedia #FOAMed #FOAMcc #FOAMrad
Can we just take a minute to appreciate the tremendous resource of @Radiopaedia - the best radiological resource of our age - #FOAMed. Shared and open learning. #FOAMcc. Follow the links to see the cases in beautiful detail with Radiological commentary. radiopaedia.org
Empyema necessitans (EN)=rare complication of empyema with extension of the fluid collection and infection to the subcut soft tissue. Most common cause = Mycobacterial infx. Others = actinomyces, streptococcus, and staph infection. radiopaedia.org/play/35878/ent… (Dr J Yeung rID: 13415)
Read 22 tweets
Mucormycosis in ICU - A Tweetorial (Relevant due to #COVID19 in India) #FOAMed #FOAMcc
It's an invasive mould. Mucormycosis is a unifying term for infections belonging to 'Mucorales' - (so, Rhizopus, Mucor, Absidia etc). The fungi are filamentous. It's also all around us. pubs.rsna.org/doi/full/10.11…
Pulmonary infection is clinically indistinguishable from more common moulds such as invasive pulmonary aspergillosis (IPA) - PLUS, it's not a reportable disease, which makes it (obviously) underreported.
Read 30 tweets
Guillan-Barré Syndrome (GBS) in ICU - a Tweetorial. #FOAMed #FOAMcc
First to note - is that there is no apparent association between GBS and #COVID19 #FOAMed #FOAMcc ucl.ac.uk/news/2020/dec/…
GBS is an ACUTE polyneuropathy (peripheral nervous system). Symmetrical in distribution. The onset is often over about 4 weeks and recovery often begins 2 weeks after progression has completed.
Read 35 tweets
Join here tomorrow for the launch of a new accredited tweetorial on the expanding role of #SGLT2i in CV disease! Earn 0.5 CE/CME credits: physicians, nurses, pharmacists! Expert faculty @mvaduganathan. #medtwitter @academiccme #diabetesmanagement @endocrinenetwrk
1) Welcome to a Tweetorial on #SGLT2i & CV health. “Flozinators of the world, unite!” Accredited for 0.50h by @academiccme: #physicians, #nurses, #pharmacists. I am @mvaduganathan . . . Image
. . . and this educational activity, which is intended for healthcare providers, is supported by grants from Abbott, AstraZeneca, Bayer, Chiesi, and NovoNordisk.
Read 25 tweets
1/
📢Tweetorial alert!
Hey #medtwitter! Have you checked out @TheskeletonKG latest case - a rare cause of hypokalemia?
renalfellow.org/2021/05/22/ske…

Let's go through it together
#NSMC #FOAMed #NephTwitter @NSMCInternship
2/
A 32-year-old woman, presented to the clinic with B/L lower extremity weakness & upper limb cramping for 2 weeks. Motor power 3/5 in lower limbs & 4/5 in upper limbs. B/L ankle & knee jerk reflexes were absent. She had 1 such episode in the past which recovered spontaneously.
3/
She denied using any medications before the onset of symptoms. She had no family history of kidney disease. Her labs showed ⏬K⏬Mg, normal TSH and negative ANA. USG of the abdomen was normal.
Read 20 tweets
👇👇 Live Thread for the great topics of #C19marathon, 22/05/2021 - #COVID #ICU @ESICM 👉👉 Watch the conference live here: esicm.org/events/lives-c… Image
Today, we'll be using the hashtag: #livesc19 for all content.
#livesc19 We'll kick off by looking at what went well and what we can do better together, accompanied by a global update on #COVID19. A focus on the science used to fight the pandemic and the successes/difficulties we had throughout the world. @DrMCecconi @msh_manu @strachanjamie
Read 70 tweets
#Covid19 is probably the greatest debunker in #medicine we have seen...

Read this ... 👇🏾
🧵 *** The researchers found no evidence of a difference in response in biochemical markers of #inflammation between patients with #MIS-C/PIMS-TS who were treated with #IVIG, #steroids, or #biologics, compared with those who were not.
*** Despite a lack of evidence, 🇬🇧 and 🇺🇸 treatment guidelines for MIS-C/PIMS-TS have become very similar.

*** By the end of the study period, most patients had received immunomodulation.
#AcademicChatter #AcademicTwitter #MedTwitter #foamed #MedStudentTwitter #LongCovidKids
Read 5 tweets
Guillain-Barré-Strohl is a series of acute immune mediated demyelinating polyneuropathies, which are most commonly caused by some infectious episode. #Thread re how to NOT miss this dx! #MedTwitter #MedStudentTwitter #FOAMed @RosenelliEM @EMBoardBombs @MedTweetorials @Lmellick
Progressive, ascending symmetrical muscle weakness beginning in the legs, absence or depressed deep tendon reflexes, & paucity of sensory findings = hallmarks of GBS. Bladder/bowel dysfunction is RARE at presentation & suggests other diseases.
It is the most common cause of acute flaccid paralysis in children in the post-polio era.
C jejuni is the most commonly assoc. pathogen in the U.S., & might be associated w/worse prognosis. ~60% of cases will have a history of recent URI or GI infection.
Read 9 tweets
Acute Kidney Failure

OR 🤔

Acute Kidney Success?

…bare with me while I explain 🧵

#NephTwitter #MedTwitter #Physiology #askrenal #tweetorial #aki #MedStudentTwitter #meded #FOAMed
We make 1-2 L of urine per day to eliminate

❎excess solutes
❎H2O
❎toxins

AND

✅maintain homeostasis.

This process is accurate to the T.
To achieve this accuracy, plasma is continuously filtered and reprocessed by the kidneys. ♻️

How much plasma is filtered per day, you ask? 😳

Roughly 200 LITRES! 🌊
Read 15 tweets
1/8 When might an FeUrea not be as useful as FeNa? Let's explore briefly!

#NephTwitter #MedEd #MedTwitter #Tweetorial #FOAMEd @MedTweetorials
2/8 First of all, a quick reminder that the utility of the FeNa and FeUrea in evaluation of AKI needs to be carefully considered before they are ordered (I'm a big fan of looking at UAs). journalofhospitalmedicine.com/jhospmed/artic…
3/8 You might see a table like the one below that can be used to (cautiously) interpret FENa and FEUrea.
Read 8 tweets
💥Tweetorial on C3 Glomerulopathy (C3G)
⚡️what is C3 Glomerulopathy?
⚡️how to establish the diagnosis?
⚡️what is the role of Complements?
💥C3 Glomerulopathy (C3G) represents rare kidney diseases affecting both children & adults
⚡️It encompasses 2 distinct conditions:
1- DDD (dense deposition disease)
2- C3GN (C3 Glomerulonephritis)
💥C3G is...
⚡️driven by dysregulation of alternate complement pathway
⚡️mediated by genetic mutations or acquired defects of complement cascade
⚡️characterized by deposition of (sole or dominant) C3 in kidney tissue
⚡️presented with clinical features of glomerulonephritis
Read 21 tweets
- Conceptos básicos para la guardia de Ventilación mecánica en Urgencias.
🧵#abrohilo
#FOAMed Image
🔘Resistencia de la vía aérea
- las fuerzas a las que resiste el paso del aire durante el ciclo respiratorio (normalmente <5 cmH2O)

🔘compliance pulmonar-CP
-propiedad que permite la distensibilidad de una estructura (CP ⬇️ dificultad para inhalacion = "rigido" - px fibrosis) Image
CP ⬆️ - alta distensibilidad = dif. Para la exhalación.

Se debe de usar de manera Ideal para el cálculo de parámetros el
Preso predicho.
🚺45,5 + 0,91 [altura (cm) - 152,4]
🚹50 + 0,91 [altura (cm) - 152,4]
( imagen @vm_aventho ) Image
Read 17 tweets
A little thread hypothesising why some of the beliefs about science can be polarising in the misinformation world (with some sneaky underpinnings of research paradigms).

#MedTwitter #MedEd #NurseTwitter #FOANed #FOAMed White text on black background reads: “Why do we have such
Some of the challenges around misinformation and the conflict surrounding responding to hot topics is all about world views. In research world we call this paradigms.
What this means is that there is a set of agreements about how a problem is be viewed - a set of assumptions and beliefs. The nuance here is that this worldview CHANGES the interpretation and/or weight of the problem or data.
Read 15 tweets
1/ Prolonged APTT tweetorial

Quick tip; A prolonged APTT is more likely to indicate an underlying factor deficiency than a prolonged PT
BUT factor deficiency is not the most common cause for a prolonged APTT
2/ The most common causes include

- Heparin (either circulating in blood or in the line the sample was taken from)
- Lupus anticoagulant
- Liver disease (expect prolonged PT also)
- DIC (expect prolonged PT and low fibrinogen also)
- Factor deficiencies
3/ The coagulation factors associated with the APTT test are;

- VIII
- IX
- XI
- XII
Read 13 tweets
1/15 Hey #medtwitter! Have you caught our latest case for the month of April??Check it out 👉🏼

renalfellow.org/2021/04/23/ske…

🏁🏁Let’s Fill in the Gap together with a #tweetorial !

#NMSC #Nephtwitter #FOAMED @TheskeletonKG @NSMCInternship

#covid19 #acidbase
2/15
A 50-year-old man with DM on oral medications presented with respiratory distress and shock. He was diagnosed with #COVID-19 and ARDS requiring intubation. Labs are shown below 👇🏼

🤔🧐

🛑What would be your next step❓❓❓
3/15 You order an ABG:

ABG:
pH 7.14
pCO2 38.8 mmHg
pO2 80 mmHg
Bicarbonate: 16 mmol/L

My Approach:

⚡️pH acidemic or alkalemic ?

⚡️pCO2 respiratory or metabolic?

nephsim.com/acid-base/ h/t @jadav_md for the infographic
Read 15 tweets
1/ More 3D #POCUS models for educators + beginners! (𝗰𝗼𝗻𝗰𝗲𝗽𝘁𝘂𝗮𝗹𝗶𝘇𝗲 > memorize)

𝗔𝟰𝗖 and 𝗦𝗖 views
Major chambers in these 4C views:
➣LA
➣LV
➣RA
➣RV
2/ Deconstructing the 𝗔𝟰𝗖 view:

• The 𝗽𝗿𝗼𝗯𝗲 𝗺𝗮𝗿𝗸𝗲𝗿 𝗶𝘀 𝗼𝗻 𝘁𝗵𝗲 𝗥𝗜𝗚𝗛𝗧, or oriented toward the LA/LV relative to RA/RVx
• The top of the screen (𝗔𝗽𝗲𝘅) 𝗶𝘀 𝗰𝗹𝗼𝘀𝗲𝘀𝘁 to the probe and
• Atria are furthest
3/ With those constraints one can determine general 𝗔𝟰𝗖 probe location

• Probe marker ~3 o’clock (𝘶𝘴𝘶𝘢𝘭𝘭𝘺 2:30)
• ~5rd IC space
• ~Midclavicular line (𝘢𝘭𝘵𝘩𝘰𝘶𝘨𝘩 𝘗𝘔𝘐 𝘢𝘯𝘥 𝘢𝘱𝘦𝘹 𝘢𝘳𝘦𝘯'𝘵 𝘢𝘭𝘸𝘢𝘺𝘴 1:1)
• Probe tilted to head
Read 9 tweets
Time for another #MedTwitter #Tweetorial on murmurs.

You're examining a patient presenting with SOB. You get to the chest and you hear a blowing holosystolic murmur.

Now what?

@MedTweetorials
Consider the most common causes of a holosystolic murmur
- Mitral regurgitation
- Tricuspid regurgitation
- Ventricular septal defect
Response to manoeuvres is a useful point of distinction
- Louder on inspiration -> TR
- Louder on handgrip -> MR
- Louder on valsalva - HCM
Read 10 tweets
1/ Thought of doing a quick #tweetorial on image acquisition for #POCUS friends starting to do #VExUS
It's kind of "how I do it" guide and not necessarily optimized for research.
1st: Look at the IVC in both long and short axes
If big, do further scans 👇 #MedEd #FOAMed
2/ Lateral approach works best to obtain a straight segment of the portal vein (straight = best Doppler shift) and a nice hepatic vein too.
Place transducer approximately in the anterior axillary line pointing towards sternal notch. Then fan antero-posteriorly.
#POCUS #VExUS
3/ Forgot what is fanning?
Its also called tilting or some people say, "look" in a particular direction from the same spot.
#POCUS
Read 18 tweets

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