Discover and read the best of Twitter Threads about #FOAMed

Most recents (24)

1/13 #FOAMed #MedTwitter

Everything I've learnt about living and beyond #cancer research (#lwbc) over the last 3⃣ years in this 8⃣ minute video! #survonc #survivorship in primary care covering:

➡️ Research
➡️ Policy
➡️ Practice
➡️ Future Directions


I wrote a couple of articles in:

@BJGPjournal 🔗:…

@CHematology 🔗:…

👆🏽 But summarised the content in the video above 👆🏽


🤔 What is "living with and beyond cancer" or #cancer #survivorship#survonc #lwbc

The definition depends on who you talk to! Is it at diagnosis, at the start of treatment or after treatment has finished?


Read 14 tweets
Let's start with a question: Have you ever overshot your goal for hyponatremia correction ?
Hyponatremia overcorrection ↗️ is one of the most common dyselectrolytemia which keeps us on our toes.

✅ Let's discuss some strategies to prevent overcorrection ↗️
Read 16 tweets
Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but off meds due to insurance. See thread. POCUS DVT #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #FOAMcc @ACEP_EUS @medpedshosp @cianmcdermott @jminardi21 @grepmeded @siddharth_dugar @msiuba @NephroP @SonoStache
What POCUS DVT protocol to use? 2-point or 3-point or extended? With or without Doppler? Meta-analysis showed good performance of 2 and 3 point POCUS but need to understand POCUS compression limitations if only compression used:…
Adhikari and colleague article showed 6.3% false neg rate due to prox isolated DVT with 2-point compression. Limitations of POCUS prox compression DVT exam go beyond just missing isolated/focal DVT.
Read 9 tweets
Wetread Case 38 (Answer)

Hx: Chest Pain

Answer: Penetrating Atheromatous Ulcer (PAU) #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad

Original tweet:
L infrahilar mass - Does NOT obscure L heart border (blue) but does obscure aortic border (red - dashed lines being expected course and dark red line outlining mass).

Hilum overlay sign apparent as we still see hilar vessels through the mass (orange), ie mass is not the hilum
How about the lateral? While there may be some artistic license here, it suggests enlargement of the mid-descending thoracic aorta
Read 10 tweets
Patient with RUQ abdominal pain. Difficulty finding GB. Pt denies history of prior abdominal surgery and no scars seen. See thread. #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #MedStudentTwitter @medpedshosp @NephroP @grepmeded @cianmcdermott @ACEP_EUS @PhilipsPOCUS
GB Sag and TRV sweeps. GB not seen. No surgical clips seen. Contracted GB, agenesis of GB, ectopic location of GB, prior removal (and patient forgot--it does happen)?
On Sag image, don't confuse bowel contents with GB filled with sludge
Read 6 tweets
Wetread Case 37

Hx: abd/pelvic pain. Palpable mass

Please answer with professionally appropriate gif responses only. No spoilers! #WetreadCow #FOAMrad #FOAMed #radres #errad #bodyrad @RyanBPetersonMD @ER_Rad_Hanna @StefanTigges @AdamSingerMD
Wetread Case 37 Answer: De Garengeot Hernia with acute appendicitis

A De Garengeot hernia is a femoral hernia containing the appendix. Here we have that but the appendix is hyperenhancing with wall thickening and surrounding fluid consistent with acute appendicitis. #FOAMrad
De Garengeot hernias were named after a French surgeon from the 1700s. These are fairly rare (<3% of femoral hernias), with complicating appendicitis even more uncommon.
Read 12 tweets
📚⚽️#Covid19, #FOAMed
Considering similarities of Covid-19 to Dengue MOI

I also wonder if not very similar to Dengue- in the nature of different serotype presentations vs when two different serotypes result in antibody-dependent enhanced response.
Thoughts ? @farid__jalali
Proc Biol Sci. 2003 Nov 7;270(1530):2241-7.
Why are dengue virus serotypes so distantly related? Enhancement and limiting serotype similarity between dengue virus strains.
"light of a process of antibody-dependent enhancement (ADE) leading to increased mortality. Antibody-dependent enhancement results from a new infection with a particular serotype in an individual with acquired immunity to a different serotype.
Read 5 tweets
We advise clinicians to do the following to improve patient safety:

1) Limit the volume of administered gadolinium-based contrast agents when used…

#risk #management
#medical #ethics
2) increase patient education, incorporate informed consent and shared decision making when GBCA administration occurs;…

#risk #management
#medical #ethics
3) maintain careful institutional records of administered agents along with the volume and frequency,…

#risk #management
#medical #ethics
Read 4 tweets
#CHEST bronchoscopy guidelines fir #COVID19 patients. The 6 statements in a thread .. #MedEd #FOAMed #MedTwitter #StaySafeForScience #EBM #CriticalCare…
1-Use full #PPE and #n95Masks with confirmed and suspected #COVID19 cases undergoing #bronch.
2-Check nasopharyngeal swab test for #COVID19 first, if more deep samples are indicated, bronch + BAL can be performed.
3-Use #n95Masks during #bronchoscopy procedures to asymptomatic patients in areas with #COVID19 community spread.
4-Test patients for #COVID19 prior to #bronchoscopy in areas with community spread.
Read 5 tweets
Wetread Case 36

Hx: Several weeks of worsening wrist pain

How specific can you be?

Please answer with professionally appropriate gif responses only. No spoilers! #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad
Yeah! We have a lot of widened scapholunate distance references, aka:

Terry Thomas Sign
David Letterman Sign
Michael Strahan Sign
Madonna Sign

referring to their diastema (or increased gap between their front teeth)
Answer: Dorsal Intercalated Segment Instability (DISI)

1) Widened scapholunate distance from full thickness tear
2) Abnormal scaphoid - old fx perhaps? (m/c carpal fx goes with prior injury) 🤔
3) Dorsal rotation of the lunate on the lateral exam
Read 10 tweets
Now that we have several #VExUS #POCUS resources from different educators, I'm going to put them together as a thread and pin to my profile #IMPOCUS #FOAMed
1/ Recent case showing improvement in Doppler indices (helped guiding decongestive therapy in a pt. with minimal symptoms)
2/ What is included in venous excess grading by ultrasound? Landmark paper by @WBeaubien @ThinkingCC @khaycock2 @EMNerd_ @Ad12Andre et al.…
Read 12 tweets
Proposed COVID-19 Pathophysiology [Part 3 of (now) 4]:

Coagulopathy Strikes Back.

What happens when #COVID19 clashes with the world of hematology?

Buckle up again for a long one.

...let’s dive in like this macrophage (exploring all directions):
First, what do you think is the predominant mechanism by which thrombosis occurs in COVID-19?
Where does thrombosis typically first occur?
Read 38 tweets
D-Dimer: D-dimers are a degradation product of fibrinogen, a mesh of fibrils that stabilises platelet plugs. They represent two D-domains of fibrinogen joined together, and a cleavage point in fibrinogen releases them into the wild. #FOAMed #medtwitter
In an otherwise 'healthy person' an excess of D-dimer likely represents an ongoing thrombotic disease process such as DVT. However it is going to be high in any disease where there is increased turnover of clot - even if a clinically relevant clot itself never materialises
There are a huge number of diseases where the coag cascade is highly active even if it is degraded before achieving a fully occlusive thrombus. Pregnancy is one such, DIC of course, and inflammation of any kind.
Read 11 tweets

We just published the largest, most detailed case series of mechanically ventilated #COVID19 patients with ARDS in a western country and with the longest follow-up.

Read our infographic & the article on @CCRJournal

Mortality of ICU mechanically ventilated patients with #COVID19 ARDS is as high as 23% at the 20 days follow-up.

Acute kidney injury (75%) and secondary bacteremia (37%) are the most frequent complications of #COVID19 ARDS.

Also, pneumothorax, pneumomediastinum, and thromboembolic complications were relatively common.

Read 7 tweets
Wetread Case 35

Hx: chest and neck pain.

What are the important findings? Recommendations?

Diagnosis? 🤔

Please answer with professionally appropriate gif responses only. No spoilers. #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Answer: Thrombophlebitis of the left bracheocephalic vein with mediastinitis (variant of Lemierre's syndrome)

New X-ray: widening of the upper mediastinum. Can we be more specific? Did you go with aortic etiology?

#WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad #Neurorad
We can see on our current exam that the contour of the aortic silhouette (red arrow) is maintained thus it should not be adjacent to the aorta. If fact it actually obscures the left subclavian artery silhouette (yellow arrows) so it has to be in the anterior mediastinum.
Read 9 tweets
I was feeling overwhelmed by all the laypress articles about #moralinjury and #burnout in frontline health care workers during #Covid_19 so I decided to do a deep dive into the literature on the mental health of workers during pandemics.

Here's what I found. #thread

Seriously, so many laypress articles.

What evidence do we have on this, and further, what evidence do we have on strategies that mitigate these mental health issues in health care workers?

I presented these data the @UChicagoMed @UCCancerCenter grand rounds last week.

@UChicagoMed @UCCancerCenter But first, some definitions to set the stage:

Burnout, initially described by Dr. Maslach as the prolonged physical and psychological exhaustion related to a person's work. Not specific to medicine, although the definition has been honed for medicine (see slide). #burnout

Read 44 tweets
Ok a few things have been moving in the world of paediatric #COVIDー19 literature

Time for an updated #tweetorial on SARS-CoV-2 infection in children!

#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter

So there are fewer cases in children. How much fewer?

Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital


COVID-19 is less severe in children, but often is it severe?

From a Chinese cohort 0.6% needed PICU but lots of community testing involved…

US CDC data has 2% of admissions in PICU (limited data)…

Read 12 tweets
Okay #medtwitter and #dermtwitter, you knew it was only a matter of time, didn’t you?! Let’s do this #COVID19 themed #medthread:


#MedEd #FOAMEd #dermatology #dermatologia @AADskin @AADMember @Meddermsoc @dermhospitalist
First, a word of caution – this is one person’s thoughts on a new skin finding reported in a new disease that the medical community is still learning about! As such, nothing in the #tweetorial should be regarded as definite. Just wanted to share a thought process!
So, who cares? #COVID19 is devastating, at times even for the young & healthy! But it’s all respiratory, right?

Well, as we're learning, there's so much more to #SARScov2, and as a #dermatologist, this is the perfect example of how the exam helps frame possible mechanisms.
Read 12 tweets
T-Cell megathread. (More informative re T cells than covid19 but I've put covid19 stuff at bottom, must emphasise that's me playing with theories, the FACTS are at the start, for transparency.)
White cells: innate immune system like neutrophils, macrophages, dendritic cells - antigen presenting cells, activate the adaptive immune system - B and T cells. Roughly speaking B cells make antibodies, T cells cytotoxic/destroy infected cells.
For viruses T cells are a helpful thing - viruses use nucleus to replicate as don't have transcription/translation machinery of their own. They are intracellular (antibodies are extracellular.)
Read 24 tweets
The medical community is divided when it comes to treating #COVID19. Various debates/theories dominate #MedTwitter & #FOAMed. Im glad to see these discussions & our progress, however patients sometimes get caught in the middle….

@cameronks @srrezaie @emcrit @EMNerd @airwaycam
This thread’s intention is to simply share observations & the experience of a #COVID19 patient code named “Halo” (yes consent received by mother) whose story might seem unique but sadly a common occurrence throughout many NYC hospitals

@sinaiem @jacobi_EM @LincolnEM @NYEmergency
Halo, A mid 30 year old w/#COVID19 symptoms (Febrile/SOB) for a week presented to the ED & had this CXR👇
As ED physicians, the difficult decision of disposition has never haunted us more these days when they’re like Halo: alert, talking & do not appear clinically ill

Read 15 tweets
Thank you @NSWOC who have produced a great powerpoint, summarised below, on Prevention and Management of Skin Damage Related to Personal Protective Equipment (PPE) 👇👇 #FOAMed #FOAMcc #COVID19 #PPE
Read 5 tweets
What is the anechoic tubular structure? - IVC with a catheter or something else 🤔
Clue: @PittIMPOCUS recently shared a similar image.
Answer: In thread #POCUS #IMPOCUS #FOAMed
That's duodenum with a feeding tube #POCUS
Anatomic image👇showing the relationship between liver & the duodenum (courtesy: Gray's anatomy)
Here is the #XRAY demonstrating the tube in duodenum
Read 4 tweets
Can you be in shock and HYPERtensive?

I think so. Our patients teach us many lessons


A patient presents with 7 days of dyspnea, LE edema and fatigue. They have run out of all meds 2 weeks ago #COVID. They had an MI with ishcemic cardiomyopathy EF ~30%, also has a-fib.
Afebrile, BP consistently >160/110, HR 110 afib, RR 30, POx 86%-> 94% 4LNC

Mild confusion
Mild resp distress, crackles BL
No murmur
Hands, legs COLD and mottled to knees, toes and fingers purple, cap refill delayed
Pitting LE edema
Read 8 tweets

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