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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
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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)!
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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/…
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Read 17 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
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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.
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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.
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Read 23 tweets
A new #echofirst #POCUS #medthread CASE!

55 yo woman with hx of metastatic lung CA, known malignant pleural/pericardial effusions presents as a transfer in shock with associated encephalopathy. HR 120s-130s (sinus), cool extremities, MAP 65 on 8-10 mcg/min norepi. O2 4L NC.
What are you going to do based on the above image?
The LV cavity appeared small/underfilled to you in the first image, not sure why, but you elect to bolus IV fluids while you complete your exam. You move to the A4C view and notice this:
Read 9 tweets
1/ Belated #MedThread from Dr. Rob Rope’s excellent @OHSUSOM Dept of Medicine Grand Rounds last Tues. @ETSshow & @AdamRodman got some history in here for you! @OHSUnews @PDXkidney
2/ If US citizen or perm resident progresses to End Stage Kidney Disease (using terms from @NephMadness @AJKDblog), there is pathway and multi-disc team. SPEAKING OF @NephMadness...sad lung US couldn't carry New school to the win, but was a good run! @kidney_boy @Nephro_Sparks
3/ But what if you are an undocumented immigrant (UI)? You are SOL, as my departed and lovably frank father would say. And apparently this is typically a younger population.
Read 15 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
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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!

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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?

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Read 17 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!

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#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
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Read 13 tweets
I’ve been musing re aortic stenosis so it’s #periopmedicine #tweetorial #MedThread time!
This is a composite of multiple patient encounters w common themes:
Goals:
-review periop guidelines re aortic stenosis
-some physical exam teaching
-discuss role of patient counseling 1/N
2/N
First, how good are we at diagnosing severe AS by exam?
3/N Hypothetically:
patient comes for a preop evaluation/risk assessment (not “clearance”) and reports a history of a murmur
You ask more Qs-how long have you know, what have you been told about it, when was your last ECHO, what kind of follow-up were you were told you needed?
Read 20 tweets
Thanks to all for the encouragement after my first #tweetorial on SJS/TEN! I thought I'd keep the momentum going with #dermatology emergencies with a new #twearl aka #MedThread on #DRESS Syndrome, Drug Rash with Eosinophilia and Systemic Symptoms! Thanks to @dermnetnz!
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DRESS is a life-threatening drug reaction that, as the name implies, can cause systemic/end-organ damage. Although less flashy than SJS/TEN, it's much more common, occurring 10x more frequently! With a mortality estimated to be up to 10%, admission is usually recommended.
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Clinically, the name DRESS can be misleading. Let's try a quick poll:

Which of the following features is REQUIRED for the diagnosis to be made?

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Read 14 tweets

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