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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
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!

#MedEd #FOAMed #dermtwitter #medtwitter #derm pc:@dermnetnz
- 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.

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.
✅shawl sign
✅gottron papule
Read 13 tweets
1/ Goooood morning #medtwitter!

It’s #12LeadThursday, which means it’s time to bust out your calipers and get to work.

Here’s your tracing, and remember: you have a system. Use it!
2/ #12LeadThursday
🔘Rate: ~105
🔘Rhythm: Sinus
🔘Axis: Normal
🔘Intervals: normal
🔘Morphology: 🤔
3/ Brugada! The eponym comes from not one not two but three brothers who have published papers on the characteristic ECG findings and underlying genetic mutations that cause the syndrome, the first of which came out in 1992.
Read 4 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

For my first #Tweetorial, I will start with a question:

Which of the following medications from the SGLT2 inhibitor class have been shown to decrease cardiovascular morbidity and mortality?

#Diabetes #EndoTwitter #MedEd #MedTwitter #DM2 #T2D #CardioTwitter

Sodium glucose transporters (SGLT) in proximal tubules mediate glucose reabsorption.

Na/K ATPase moves Na out & K into the cell ➡️gradient for Na to flow intracellular

SGLT uses this potential to move glucose against its gradient from the tubular fluid into the cell.

SGLT2 inhibitors block glucose reabsorption
➡️renal glucose excretion
➡️glucose levels⬇️

Because this has nothing to do with insulin, they usually don’t cause hypoglycemia or weight gain.

Actually, because of the osmotic diuresis, they decrease blood pressure & weight.
Read 15 tweets
1. thread.

Nice @FrontPediatrics paper providing guidance for docs and #pwME in the diagnosis and management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome #MECFS

#MedEd #MedTwitter #chronicillness #chronicpain #SickNotTired…
2. #MECFS is commonly misdiagnosed as a #somatic disorder

#pwME "..have been humiliated or dismissed by other providers, so [doctors] will need to be.. nonjudgmental.. & acknowledge that #MECFS is not a #psychological condition but a real illness"…
3. #MECFS symptoms can be diverse, complex, fluctuate and overlap with many other conditions making the diagnosis difficult

This @FrontPediatrics paper lists 33 (!) co-morbidities commonly associated with #MECFS

#MedEd #MedTwitter #pwME #SickNotTired…
Read 8 tweets
Day 15/15 #PCPOnTheWards Two more admissions and I’m done! Going through my head:
❓1 week or 2 week stints next year?
❗️I’ve set the wheels in motion to go up for promotion!
📖Resident brought up desire for specific #EBM “rounds.” Brainstorming if after lunch best time?
(1/ )
📖Morning rounds/identify question/research #evidence/present to team ~130pm. Would #housestaff buy in?
🙌🏾Daughters coming home for weekend
💪🏽Workouts need to be kickstarted
🍩Food w holes (bagels, donuts) do help team morale.
Hope you all are having a great Friday!
(2/ )
Thoughts on the post lunch brief team rounds to run evidence for our decision making, #MedTwitter? #Twitternist @COREIMpodcast @ShreyaTrivediMD @medicalaxioms @cacace_frank @LaurenKuwikMD @ORourkeJr @meggerber @SusanHingle
Read 3 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!
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.
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?

Read 14 tweets
Introduced this week in the Tennessee House, a new version of the fetal assault law. I'm going to write here about it's history, and why I'm worried. Hoping you will help me spread the word. @DrJenGunter @choo_ek #medtwitter #tweetiatricians…
First, please don't attack my home state of Tennessee. Some on my twitter feed like to say negative things about my state ... it's not productive, it's insulting. The state is me, my family, colleagues and hundreds of public servants trying to do good.
Now to the history. From 2014 to 2016, Tennessee had a law on the books that a woman using a narcotic in pregnancy could be charged with a misdemeanor. It was essentially a special penalty just for pregnant women.…
Read 13 tweets
In preparation of my upcoming talk on #dermatology emergencies for the @SHMlive conference, I thought I'd put together my first #tweetorial on Stevens Johnson Syndrome (SJS). Having never done this, apologies in advance for subpar tweeting! Here we go!
#medtwitter #dermtwitter
SJS and its more severe cousin, Toxic Epidermal Necrolysis (TEN), are life-threatening dermatologic toxicities, usually caused by a drug trigger. In rare cases, they can be triggered by infection (more commonly seen in the #pediatric population).

#SJS usually presents with an atypical targetoid macular (flat) eruption with +nikolsky. This is in contrast to another entity on the ddx, erythema multiforme, which has classic target papular (raised) lesions. See the difference? (hands are EM, back is SJS). CC @dermnetnz!

Read 11 tweets
18 myths & misconceptions of Post-Exertional Malaise #PEM in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome #MECFS

#PEM (aka PENE, "flare" or “crash”) is seriously debilitating symptom caused by exercise

#SickNotWeak #SickNotTired #pwME #chronicillness #medtwitter #MedEd
1. #PEM is just tiredness


#pwME experience <pathological> fatigue after #exercise which can be long-lasting and includes debilitating fatigue, flu-like symptoms, cognitive impairment, #sleep disturbance

@PNASNews #MECFS #MyalgicE #MedEd #medtwitter…
2. #PEM is not a real


“there exists no medical condition.. where exertion.. causes #immune/ inflammatory-related symptoms like sore throat, tender lymph nodes, or flu-like feelings, yet 60%.. of.. [#pwME].. reported these symptoms”

Read 20 tweets

Remarkable @bmj_latest @BMJCaseReports report documenting the extreme lengths a bedbound patient went through to get a diagnosis of #POTS, #MCAS, #SIBO and #tachycardia

read her story here

#MedEd #MedTwitter @MayoClinic…
2. After suffering for 16 years, seeing 19 docs with repeated misdiagnosis:

Her cardiologist couldnt diagnose #POTS

Her gastroenterologist couldnt diagnose #SIBO

Her immunologist couldnt diagnose #MCAS

Her neurologist referred her to a #psychiatrist!…
3. Patient: the "neurologist was out of ideas and suggested I get a psych evaluation, which I declined"

the patient <referred herself> to @MayoClinic

#SickNotWeak #chronicillness #chronicpain #MedEd #medtwitter…
Read 10 tweets
Inpt Day 4: Will my patient have severe alcohol withdrawal while hospitalized?

Consider using the PAWSS screening tool to identify if high-risk. If screen negative, likely do not need CIWAs.

Specificity 99.5%, Sensitivity 93.5% (approaches 100% when combined w EMR review).
PAWSS = Prediction of Alcohol Withdrawal Severity Scale

PAWSS 4+ is positive
PAWSS <4 is negative…. #foamed #medtwitter
Read 3 tweets
CLINICIANS: The Trump admin is about to eviscerate the Privacy Rule. We have until February 12, 2019 at 11:59PM ET to flood @HHSGov with comments telling them that #PatientPrivacyIsPatientSafety. Vulnerable patients need you. A thread on commenting effectively:
Here's the bottom line: if @HHSGov makes the changes they're thinking about, patients who have a diagnosis of serious mental illness (SMI) or opioid use disorder (OUD) could have their medical records released without their consent.
@GilmerHealthLaw is a brilliant attorney and a leader on HIPAA issues (she's why you're seeing this thread). She's also written an in-depth series of posts explaining the "Request For Information" issued by @SecAzar's @HHSGov, if you want more info:…
Read 38 tweets
1/ #medtwitter if you care about #metoostem #meded #equity #burnout please follow along. Gender violence is pervasive in medical training.

#sciencetoo #meded #medtwitter #medtoo #timesup #beethical #heforshe #timesup
2/ “…we may hear and intimately know the experiences of gender violence, but we are unable to share. Our voices are trapped and silenced, exacerbated by the hierarchical and apprentice-based training environment.."
3/ Over 50% of medical students experience sexual harassment from faculty and staff. The people who are entrusted to teach us how to be physicians.
Read 11 tweets
1/ Happy #12LeadThursday!

Practice your skills and take a swing at our latest EKG. What’s the diagnosis?

Use your system:

#FOAMEd #cardiotwitter #medtwitter
2/ We’re mixing it up today: we’ve got one finding that’s a throwback to a previous #12LeadThursday, combined with a new finding that’s a little more specific.

Low voltage + electrical alternans = ?
3/ Remember, specificity = true negatives / (true negatives + false positives). Highly specific findings rarely produce false positives, so you can be pretty sure this 🚴🏽‍♀️ has developed tamponade physiology.

What do you do next?
Read 4 tweets
I need to talk about some shit that just went down.

Ambulance toned out for an infant in cardiopulmonary arrest.

Not known when they were last seen normal.

A fucking infant.
There’s snow on the roads. No helicopters are flying. I don’t have an ICU.

Right now it’s on us.

We got ready:

ET tube
Broselow Tape
All the trimmings
Read 15 tweets
I’d like to talk about the finances - and potential financial conflict of interest - at the National Board of Medical Examiners.

This is gonna be a long one - but thanks for hearing me out.

Yesterday, I started a discussion about how our focus on #USMLE Step 1 was hurting both undergraduate and graduate medical education.

It’s gotten a lot of attention, probably because I highlighted a comment from the CEO of the NBME that touched a nerve for a lot of you.
Beyond that quote, when I read the article, what struck me was this:

The CEOs of the NBME and FSMB expressed numerous concerns about adverse effects of making USMLE Step 1 pass/fail...

...but loss of revenue to the @NBMEnow was not mentioned.
Read 37 tweets
Apple has a section of their website answering questions doctors may have regarding their latest #ECG technology. Where are the answers to the REAL questions #patients want to know about? For example, if I get an alert:

#AppleWatch #digitaltech #wearables #PatientAdvocacy
2) when do I confidently ignore, act upon, or wait to make actionable decisions about alerts I’ve received? #AppleWatch #digitaltech #digitalhealth #wearables #Innovation #PatientAdvocacy #healthcare #medtwitter
Read 7 tweets
Today in my role as nurse I wore many hats. Let me tell you a story about how the day went... #NurseLife
Came in this am to discover my pt from yesterday had imaging overnight that revealed catastrophic injuries, along with her sepsis and multi-system organ failure
Within 1/2 hr her fiance approached me about calling in a chaplain, which I assume is to do final prayers. He informs me that he wants to marry her. Today.

I'm not sure b/c pt is sedated and fully ventilated, with no hope of waking up.
Spend next few hours calling chaplains/priests/ministers. Keep in mind it's Sunday AM and church is happening soon.
I find out that if we can show "intent to marry" that a ceremony can be performed. Photos of pt trying on dress are used. A minister agrees to come after church.
Read 19 tweets
I had a career in software before I became a doctor. I wasn't really suited for that life, but I did learn some valuable lessons from corporate America that I can apply to medicine:


Nothing gets accomplished in meetings, except scheduling more meetings. Never trust anyone who is always in meetings and never take a job that requires you to be in endless meetings

The best skills you can have in most jobs is being able to write clearly and effectively (especially in email); and the ability to formulate a thought and speak convincingly in front of groups of people (large or small)

Read 8 tweets
1/ Happy #12LeadThursday!

Here’s a chance to practice your skills. Make sure you don’t miss a beat...or drop one 😜

Step 1:

#FOAMEd #cardiotwitter #medtwitter
2/ Is this what you identified?

If yes: good work! What’s your ddx? What additional history do you want?

If no: take a moment to review the ECG. What did you get right? Where did you go wrong? If it hurts, good; that’s what learning feels like!
3/ Major development!

Take a moment to refine your ddx.

What’s your next step?
Read 5 tweets
TOPIC: P-Values In Table 1 of RCT's. Time to revisit this poll.
Thanks very much to the clinicians that responded. This came out better than expected, albeit the selection bias of “clinicians that follow statisticians on Twitter” suggests that the respondents are collectively better versed in data analysis than general research population
Anyways, putting p-values in Table 1 of RCT’s is an inappropriate use of significance testing, yet remains prevalent in medical literature, because it SEEMS to make so much sense (at least, the way most people have been taught p-values and statistical significance…)
Read 55 tweets
I’ve been amplifying the #DoctorsAreDickHeads hashtag the last few days but haven’t actually shared my own story. It starts there, traverses through #DoctorIRespect and #DoctorsAreAwesome and ends with #DoctorsAreHuman (something for everyone!)
And of course it is not the entire profession, but the profession has a major systemic problem when it comes to disabled patients and those with #chronicillness that it seems to have little to no knowledge or self-awareness of. THAT – not the hashtag – is the problem #medtwitter
#MedTwitter, your patients have been trying FOR YEARS to speak out on hashtags like #spoonies #pwd #medtrauma and no one has listened (on this platform) at this scale until patients got....confrontational #DoctorsAreDickheads
Read 46 tweets

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