Discover and read the best of Twitter Threads about #FOAMed

Most recents (24)

Thanks, @MelBreggs for the mention, and thank you to @gopiastik for a great #tweetorial on #AGEP (acute generalized exanthematous pustulosis). I would add a couple thoughts here. Please read on!

#MedEd #FOAMEd #derm #dermatology #dermatologia #medthread PC: @dermnetnz
1/
First of all, the name AGEP can be confusing, but really all it is a description (we dermatologists just like to sound #fancy). If you break it down, Acute (really quick onset) generalized (everywhere), exanthematous (rash-y), pustulosis (pustules)!
2/
The exam is red plaques studded with pustules (see photo). These pustules can coalesce and become "lakes of pus!" The 2nd picture doesn't have pustules b/c all of them came together, lifted off, and left the "collarette" of scale (which means there's a footprint leftover!
3/
Read 12 tweets
Inspired by a question from @Econdoor , a #tweetorial about instrumental variables and the exclusion restriction.

#econtwitter #epitwitter #FOAMed
First, instrumental variables and causal graphs:

An instrument is a special type of variable that is associated (causally or otherwise) with the exposure you’re interested in.

The directed acyclic graph (DAG) below shows the basic required structure.
There are three key requirements for a variable to be an instrument:
•it is associated with the exposure
•it is not associated with the outcome EXCEPT through exposure
•it does not share any causes with the outcome (ie unconfounded).

We have these 3 properties in our DAG👇🏼
Read 26 tweets
I’m LJ, a UK Respiratory doctor & medical education enthusiast. I’m here to share my experience of creating respnetlondon.com #RespEd #RespisBest #MedEd #FOAMed #PressEdConf19 /1
UK medical doctors in training must navigate a complex landscape of changing accreditation requirements. Vital information is often dispersed across multiple emails & websites e.g. JRCPTB & PGMDE #RespEd #MedEd #PressEdConf19 /2
I built Respnet as a practical way to centralise information, but also to inspire #trainees & create a sense of belonging. Belonging, connection & community are important for motivation, fulfilment & #wellness, & help prevent #burnout. #RespEd #MedEd #PressEdConf19 /3
Read 16 tweets
1/ Why is lactate elevated in sepsis or septic shock?

@dolan_russell & I explore this common #ICU pimp question via #tweetorial.

We're taught that ↓O2 revs up anaerobic metabolism causing ↑ lactate. But wait, there's more...

#medtwitter #FOAMed #meded #FOAMcc #criticalcare
2/ In homeostasis, lactate is continually produced and metabolized; serum concentration is at steady state.

Which of the following organs is responsible for the majority lactate consumption and metabolism?
3/ The liver is responsible for ~70% of lactate metabolism.

Patients with hepatic dysfunction can have ↑ lactate 2/2 ↓ clearance or ↑ production. Also, cirrhotics are more prone to hyperlactatemia in setting of sepsis.

Diving deeper, how does the liver metabolize lactate?
Read 13 tweets
A short #tweetorial about how to quantify harms (or benefits) to help make decisions, inspired by that @BillGates tweet...

#epitwitter #FOAMed
If we want to use evidence to make decisions, the first step is to describe the problem. And the first step in describing the problem is to count how often it happens.
If we want to decide how to spend money to prevent the most death, counting deaths from shark bites & mosquito bites is a good place to start.

As Bill Gates did, we’ll find the number of mosquito bite deaths is much higher! Mosquitos are probably a good place to spend our money!
Read 10 tweets
Just wrapped up 2 weeks on the @MGHMedicine service! Let's celebrate with....

#CELLULITIS - a #tweetorial/#medthread!

#MedEd #FOAMEd #dermtwitter #medtwitter #derm #dermatologia #dermatology PC:@dermnetnz
1/
What is cellulitis? It's a bacterial infection of the deep dermis & subcutis. Every year, there are ~ 14.5 million cases diagnosed in the US, leading to >600,000 admissions! What does it usually look like? Remember: Tumor, rubor, color, dolor (swelling, red, warm, painful)!
2/
Most likely organisms are staph or strep. Abx choice targets those organisms. For a non-purulent cellulitis in a non-sick pt (1 or fewer SIRS criteria), oral abx are good. IV for non-responders or those with 2 or >SIRS. Check out the algorithm from: jamanetwork.com/journals/jama/…
3/
Read 17 tweets
1: What causes WBC/PMN elevation (neutrophilic-predominant pleocytic) ascites? The differential is broad and extends beyond Spontaneous Bacterial Peritonitis (SBP).

(A #MedTwitter and #Tweetorials contribution). Appreciate edits by @ebtapper.
2: 26yoW w/ cirrhosis 2/2 congestive hepatopathy 2/2 hypoplastic L heart syndrome s/p Fontan presented to OSH with fevers, abdominal pain. Prev tx by PCP for ?PID w/ IM CTX, doxycycline. Dx para shows WBC 2480, PMN 74%, total protein 4.3, SAAG >1.1. What is cause of ascites here?
3. Portal Hypertension (PH) due to liver dz causes albumin- and protein-poor ascites. This is due to sinusoidal scarring causing reduced albumin and protein translocation into ascites [Serum-Ascites Albumin Gradient (SAAG) >1.1]. But this case is not due to cirrhosis...
Read 25 tweets
1/ We're Fe(eling) pretty excited about today's #triviatuesday on iron supplementation!

We’ll post our answer and discussion in the afternoon. Until then...debate!
2/ That’s right! As @InduPartha and @DrPoorman point out, we might feel bad for clogging up our patients pipes for so many years. The good news is, now you can dose iron every other day - it’s better tolerated, and better absorbed!
3/ And as @Veg_MD and @gregorykatz point out, we should encourage our patients to find vitamin c in whole fruits like oranges or strawberries rather than the processed juices.
Read 5 tweets
Right, #MedTwitter: what clinical presentations (i.e. combinations of symptoms/history/signs) that *aren’t* in the textbooks have you learned to be very, very wary of? Can we make this a #FOAMed thread?
I will kick off.... PE presenting as “SOB ?anaemia”... as soon as you realise they aren’t anaemic, be very careful!#scarypresentations
Actually perhaps we should use #cautionarytales?
Read 4 tweets
1/
#Dermatology #tweetorial time! Let's spend some time on the autoimmune blistering diseases. There are many, so this will be a broad overview of the approach to a the bullous disease patient.
#dermtwitter #FOAMed #medtwitter #medstudenttwitter #MedEd @healourskin pc:@dermnetnz
2/
The first ? we usually ask: "What is the level of the split?" That helps to distinguish between the #pemphigus group of diseases where the desmosome is involved in the epidermis, and the #pemphigoid group where the hemi-desmosome is involved at the basement membrane zone.
3/
This correlates with the exam! Higher up in the epidermis means a thinner walled blister that's more fragile. So these are usually flaccid bullae. Deeper down means tense bullae. Photo 1 is pemphigus - see how droopy the bulla is? Vs photo 2 of pemphigoid, which stands up.
Read 17 tweets
After long overdue, I am hopping on the #tweetorial bandwagon @tony_breu @AdamRodmanMD. So here goes nothing! #FOAMed #MedEd #Physiology
I’ve often been told not to order an ESR because it is a nonspecific test. In fact, our hospital doesn’t even run it anymore, it's a send-out!

So, what are the factors that influence ESR to make it non-specific?

(written alongside @AndyHale33 @FreedoBaggins)
In 1897, Polish pathologist Edmund Biernacki noticed that buckets of blood separated into the red blood cell (RBC) and plasma components at different rates in different disease states.

ncbi.nlm.nih.gov/pubmed/?term=K…
Read 23 tweets
There is one topic that combines essential components of #MCAT and #STEP prep into a beautiful package: ✨BREATHING✨. Without further ado, here is my (FIRST #FOAMed) thread for respiration novices, people studying for the MCAT, and med students 1/
The lungs have two big purposes: (1) get oxygen, (2) get rid of CO2 (which your body makes a lot of, recall the Krebs Cycle). CO2 is a product of cellular respiration, which is the reasons our cells have energy to function. Thanks, Mitochondria! So kind of you. 2/
The Krebs Cycle is omnipresent. Thus, there are countless cells all producing CO2 at the same time, so the blood returning to the heart from the rest of your body has a pretty high concentration of it (compared to the blood leaving your heart for the rest of your body). 3/
Read 18 tweets
All right! Better late than never! Time for today’s #TwitterReport

Case: A gentleman is brought to the ER after being found down. He was reportedly walking around a Target parking lot without clothes on just before collapsing. He has no ID.

What else do you want to know?
1/x #TwitterReport

So this is a tough one for multiple reasons.

HPI: Patient responds with "Martha" to every question you ask, including asking about his name.

As a result, PMH, PSH, Social hx, Allergies, Family history are all unknown.

He has no ID, no collateral available.
Read 18 tweets
OK #hospmed19, I had told myself I wasn't going to make another #tweetorial until next week to give myself a break, but I can't help but be motivated by all the amazing #tweeps at this meeting. Long story short, here's a #medthread on #PSORIASIS!

#MedEd #FOAMed PC:@dermnetnz
1/
More and more, we are recognizing psoriasis to be a systemic disease. Aside from the psoriatic #arthritis we all know and love, there is more convincing evidence that psoriasis is linked with #cardiovascular disease and risk. As such, #multidisciplinary care is important!

2/
There are many different variants of psoriasis. The most classic is plaque psoriasis, described commonly as "salmon colored plaques with micaceous scale."

Q: Ever notice how psoriasis doesn't really get impetiginized/superinfected but eczema does? Why do you think that is?

3/
Read 17 tweets
Mnemotecnias Médicas👩‍⚕️👨‍⚕️🌏🌍🌎

Abro 🧵iniciamos👨‍💻y abierto los comentarios

#FOAMed #FOAMped #medtwitter #Urgenciologa #Urgencias #MedStudentTwitter #Pediatrics #Pediatria #FOAMex #UCIP #UTIP #PedsICU #ENARM2019 #MIR2019 #FACMED
Son tres los objetivos, donde el principal, es compartir y fomentar el conocimiento útil en la práctica médica
Saber que puede usarse tanto nemotecnia como mnemotecnia según @RAEInforma
Read 38 tweets
There are many advantages of continuous IAP measurement as listed in infographic #ISICEM19
Start measuring IAP (abdominal pressure) in ICU patients when there are 2 or more risk factors related to
-increased intra-luminal contents
-increased intra-abdominal contents
-decreased compliance
-fluid overload and capillary leak

#ISICEM19
Some causes of increased intra-luminal contents resulting in abdominal hypertension #ISICEM19
Read 11 tweets
Monitoreo de CO2 Exhalado

Abro hilo, iniciamos 👨‍💻y abierto los comentarios

#FOAMed #PedsICU #Urgencias #Pediatrics #SoMe #FOAMped #Pediatria

@sgdambrauskas @CantillMauricio @AMEEMCTI2018 @OlgaPena @diegovinci @ESACMex @SaidDLCR @Javier_Prego @erikablasco ¡Ayuda a compartir!
Un caso clínico no ayudará a entrar al tema, veremos conceptos básicos de #EtCO2, y algunas de sus aplicaciones clínicas en Urgencias y #UCI
Caso clínico
Read 42 tweets
I've always thought #dermatology's great because of the ability to understand what might be happening underneath the skin. Let's chat today about all things #paraneoplastic! Time to get our #tweetorial/#medthread on!

1/
#MedEd #FOAMed #dermtwitter #medtwitter #derm pc:@dermnetnz
Caveats:
- I can't cover ALL the paraneoplastic syndrome of the skin, so apologies if I miss your favorite!
- Management of these syndromes is variable, so I'm presenting what I've learned.
- Lots of one-off case reports. I'll focus on the more common paraneoplastic stuff.

2/
Let's start with one we tend to think of first - #dermatomyositis (DM)! This could be it's own tweetorial, so I'll be brief here. DM is a clinical diagnosis, no biopsies are necessary! If the skin exam is classic, that's all we need.
✅heliotrope
✅shawl sign
✅gottron papule
3/
Read 13 tweets
Question: Why do we worry about giving Ondansetron to patients with prolonged QT? What is the risk of cardiac arrhythmias in the average patient with long QT? Follow me down the rabbit hole of my first tweetorial! @tony_breu @thecurbsiders #MedEd #FOAMed
Case: You are the night float resident, and get called by the nurse for an 84 y/o patient with gastritis, having intractable vomiting. She asks you for an antiemetic. You go to order ondansetron, but stop b/c you notice the patient's EKG--the QTc is 495! What do you do?!!
Before we answer this question, lets review some cardiac physiology. Cardiac myoctes have a negatively charged resting membrane potential that is maintained by the active movement of charged ions, primarily via Na+/K+ ATPase, and Na+/Ca2+ exchange, across the cellular membrane.
Read 25 tweets
1: What causes triglyceride elevation in pleural fluid studies?

My previous understanding of this diagnostic test was recently challenged and lends credence to the fascinating diversity of pleural effusions/dz.

(A #MedTwitter and #Tweetorials contribution).
2: A middle aged woman OSH patient was transferred with LEFT pleural effusion that developed 5 days post-CABG.

Initial pleural fluid studies:
protein <0.8 LDH 2300 glucose 278 RBC 400 WBC 17.5k trigs 204 cholesterol 225 chylomicrons (-)

What type of effusion is this?
3: This is not a case of hemothorax despite the presence of (many) RBCs. A true hemothorax diagnosis requires EITHER of the following:
1.Pleural fluid hematocrit (hct) >50% peripheral hematocrit
2.RBC/100,000 (estimate for pleural fluid hct if not obtained) >50% peripheral hct
Read 19 tweets
#Cardiotwitter thank you for transforming the field of cardiology.

This paper is a testimony of that transformation brought upon by the use of #SoMe in #CV medicine. Published today in @JACCJournals

onlinejacc.org/content/73/9/1…

Here is a tweetorial on why #SoMe in #CVmedicine
If you are new to twitter look at this slide from my #SoMeGR at @LLUHealth
Engagement = Likes +Retweets
Impressions= Users that tweeted the tweet x no of their followers
More in the basics of #SoMe in onlinejacc.org/content/73/9/1…
@adityadoc1 @AdiAJoshi @poojaotherwise @almasthela
Make sure to use the hashtags to increase your engagement
List of the popular hashtags used on #cardiotwitter below- look at the reach of those hashtags!

Don’t forget Imaging hashtags: #echofirst #whyCMR #yesCCT #ACCimaging #CVimaging
More at onlinejacc.org/content/73/9/1…
Read 13 tweets
La definición es simple y fácil de recordar.

A pesar de existir muchas más, la definición de la #OMS es práctica y usada a nivel mundial.
La mayoría son extensiones <20%

En #Latam las lesiones por escaldadura son el tipo principal de quemaduras reportadas

Si hay afectación a vía aérea, los costos y morbi-mortalidad se incrementan.

>% afectada = >% mortalidad
Read 33 tweets
This is the bedside Echo of a critically ill young lady who presented to the ER in shock

[thread]
Those bright, whip-like structures emanating off the tricuspid valve are infective vegetations. They look similar to blood clots-in-transit except that instead of free floating you can see that they are tethered down.

[2/x]
The Right Ventricle (RV) should normally be about half the size of the Left Ventricle (LV). But here the RV is more than double the size of this underfilled LV!

Why would a patient with endocarditis also have right heart strain?

[3/x]
Read 11 tweets
#twitterjournalclub
The ANDROMEDA- SHOCK Randomised Clinical Trial
Thoughts by @z_cepillo
jamanetwork.com/journals/jama/…
Multicentre (28) open label RCT to determine if peripheral perfusion targeted resuscitation during early septic shock in adults is more effective than a lactate-targeted resuscitation for reducing mortality.
Inclusion criteria: adult patients with septic shock (infection, lactate >2, vasopressors to maintain MAP >65mmHg after IV fluid of 20ml/kg over 60 mins.
Read 26 tweets

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