Discover and read the best of Twitter Threads about #ICU

Most recents (7)

Citation counts come from OTHER RESEARCHERS. They are important, yes.

But, sharing #science on #SoMe=broad & instantaneous dissemination to those who focus their time AT THE BEDSIDE. Which may surprise some- but is MOST OF MEDICINE especially....#anesthesiology.(Thread) #AUA2019
A metric like the “Kardashian Index” *MAY* be relevant in genome biology where the proportion of basic/translational science is significantly higher and no immediate bedside application for a general practitioner is there. (and I’m making an assumption here) #medtwitter #aua2019
When your #research is relevant primarily to other #scientists who are also writing research papers then citation counts do more wholly reflect the paper’s impact. But in clinical research, it’s different. Bedside clinicians are looking to the literature for guidance & new ideas.
Read 13 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
THREAD
Recently in our #MICU, I took pics of the oxygen sats of patients on oxygen supplementation.

What is the optimal oxygen supplementation strategy for a clinically stable patient in the ICU?

Follow me down this #tweetorial rabbit hole. #medtwitter #pulmcc #AIMW19
1/
Given that population health improvements often come from small benefits in large populations, and the fact that #oxygen is one of the most commonly prescribed interventions in the #ICU, there is potential for benefit if we can correctly titrate our oxygen titration.
2/
I’m going to refer to hypoxia and hyperoxia in this #medthread, and I’d like to (somewhat arbitrarily) define these terms. I’ll call hypoxia anything below 90% and hyperoxia anything above 96%. This is based upon some of the literature I will discuss.
3/
Read 23 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
Cetoacidosis Diabética #DKA #CAD #AMTIP

Bases de la Enfermedad y análisis del Diagráma de Flujo @NICEcomms Diciembre 2018

Abro hilo, iniciamos👨‍💻y abierto comentadios

@MarianaPediatra @FOAMexico @CantillMauricio @Javier_Prego @erikablasco @pediatraweb10 @RobustosMD @carsolbal
Para ti #urgenciologos, #pediatras e #intensivistas

Daremos un repaso discreto de CAD y analizaremos el texto de la NICE Pathway

Comentaremos con relación a las guías @ispad_org, una de las más utilizadas a nivel mundial

En pocas palabras, el diagrama con relevante información
#CAD puede presentarse en #T1D y #T2Diabetes. Debido a obesidad, han aumentado los casos en esta última, presentándose también como debút.

#T1D es resultado de destrucción autoinmune progresiva de células beta. Ocurre a una tasa de 6-8%/año en aquellos con Dx establecido.
Read 39 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
#BigData #ICU #sepsis research I wish some1 would do

Optimal Duration of Time-Limited Trials in Critically Ill Patients

"If they are going to respond to this, we should see a response by ..."

What are median + 95th percentile for responses to common life-saving therapies?
I feel like we "know" this for lots of small things
- Lasix should make 'em pee within 20 minutes
- PEEP improves oxygenation in 20 minutes
- uroseptic shock should break within 24 hour
There are some scattered superb research projects:
- optimal durations of SBTs
- optimal time to neuroprognostication s/p anoxic injury
- Blood cultures will turn positive for MRSA w/i 48 hours if they are going to
Read 6 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!