Discover and read the best of Twitter Threads about #Medtwitter

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Seeing Red: Managing Multidrug
Resistant Gram-Negative Infections
@SIDPharm @ProCEhealth @OncIDPharmd @ErinMcCreary
#IDTwitter #medtwitter #ASHP19
Mechanisms behind antibiotic resistance. #IDTwitter #ASHP19
Surprisingly! #IDTwitter #ASHP19
Read 4 tweets
#tweetorial time for SUPER FAST, no WINTER or (difficult) MATH evaluation of Anion-Gap Metabolic Acidosis:


The metabolic seesaw:

(more BC)

dAG = delta Anion Gap
dBC = delta Bicarbonate.
Toward the Center = more bicarbonate

This will all make sense in a moment.

Scene: patient w/ anion-gap metabolic acidosis

Your ?: is their compensation appropriate? Do I need more labs? Who and what is a winter and why do they have a formula?!?!

Answers: seesaw only, a chemistry is all you need!

Read 12 tweets
Ever wondered why doctors and people with type 2 diabetes are getting so excited about low carbohydrate diets? 🤔

73 patients at my surgery have now reversed their type 2 diabetes 🙌

#medthread #tweetorial #medtwitter

Here's a tweetorial of how it's done👇
As Diabetes Lead GP at my surgery for 25 years I achieved little/no success with @PHE_uk recommended "Eatwell Plate"
One day @lowcarbGP shared some success he had with offering LCHF (low carb, healthy fat) eating to people with type 2 diabetes

Does it work?🤷‍♂️

How? 🤷‍♂️
Important to understand if there's > 1 teaspoon (5g) sugar/glucose in your blood then insulin PUSHES it into cells where it is deposited as FAT and TRIGLYCERIDE
Read 16 tweets

Ever wondered about the evidence base for longer [or shorter] GP consultation lengths and how they impact on healthcare outcomes?⏱️

The evidence is fascinating and well worth considering in relation to your own practice.💡

#medthread #tweetorial #medtwitter

First, lets take a look at average consultation lengths around the world.

⏱️ There is considerable variation internationally ranging from less than a minute in Bangladesh and Pakistan to 22.5 minutes in Sweden!

🌍Over half the worlds population have a consultation length less than 5 mins!
Read 19 tweets

AKA "jams" (XR neg)

Often worse than they seem

EXAMINE the patient
Check FDP & FDS, EDC, and CENTRAL SLIP (Elson test) as well as jt stability

"XR neg, go home" = WRONG ANSWER

Acute tx much easier & more reliable than chronic
#medtwitter #foamed
If missed, central slip tears progress to BOUTONNIERE deformity

Perform Elson test to check CS integrity for all "jammed fingers"

Flex PIP over a table edge and hold down P2. Ask them to extend DIP. If they CAN, it's ABNORMAL & sign of tear (2/3) #medtwitter #foamed
Or, "Modified Elson test"

Align P2s back to back

Ask pt to extend DIP

Normally unable to, but if central slip torn, they can extend the DIP through the lateral bands

Either learn this or send all to hand for eval

Acute treatment = easy
Chronic = not (3/3)
#medtwitter #foamed
Read 4 tweets
Hello! Here's another very important  Sex-Ed thread on all available contraceptive methods in Sri Lanka!  

Ad = Advantages 
S/E = Side Effects 

#PatientEd #Tweetorial #SexEd #Contraceptives #SriLanka
¤ Condoms - Efficacy 98% 

Ad - ONLY method to offer protection from sexually transmitted diseases and also provide contraception 

S/E - None
¤ COCP/POP - Combined Oral Contraceptive Pill, Progesterone Only Pill - Efficacy 99%

S/E - Increased risk of breast and cervical cancer,  Acne, Risk of blood clot formation leading to strokes, Heart disease
Read 12 tweets
#Hahnemann is a cautionary tale of for-profit companies plundering a #SafetyNetHospital for a land deal. After speaking with several former physician trainees and the Internal Medicine PD @DaveAizenberg. The stories were disheartening. We must do better. #HahnemannStories 1/
#Hahnemann #tweetorial-In all the talk of policy changes and corporate malfeasance, the personal impact cannot be undersold. One story that needs to be shared is that of Erika Correa (permission given to share her experience). #HahnemannStories #medtwitter #MembersMoveMedicine 2/
Dr. Correa was starting #HemeOnc fellowship orientation at #Hahnemann when the closure was announced on June 26. She was suddenly without a program, funding, or health insurance. She had bought a house in Philadelphia, planning to stay at least 3 more years. #medtwitter 3/
Read 19 tweets
1/ #MedTwitter, we have a new blog post from @zoemarklyon and @StephenieLe11.

Before diving into the blog, let’s warm up with a case that spans the lungs, the skin, and maybe more!

2/ A 43 yo woman presents with 9 months of worsening dyspnea on exertion, fatigue & a dry cough. She is hypoxemic to 87% on room air.

Pause and reflect on how you’d approach her dyspnea with the help of our dyspnea schema by @BBroderickMD
3/ She notes swollen hands & skin discoloration, which is especially worse in the cold weather and lasts up to 2 hours. She shows you a picture, which is also shown below. (Image courtesy of @NEJM).
Read 14 tweets
1/ Cognitive Bias in Clinical Medicine

I love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine 🧑🏻‍⚕️👩🏽‍⚕️👨🏼‍⚕️

🤔Now which bias that?!

2/ Intended Learning Outcomes

💡To recognise common cognitive biases in clinical medicine

💡To identify strategies to overcome them

#MedTwitter Ready? Let’s go!
3/ Cognitive Biases

💡Are cognitive shortcuts
💡Used to aid decision-making
💡AKA heuristics

✅Helpful time-savers
❎Risk leading to diagnostic errors
❎Diagnostic error rate in Australian #PrimaryCare is ~15%…

Let’s look at common cognitive biases 🧐
Read 12 tweets
“The Erythemas” – A #dermatology #meded #FOAMEd #tweetorial. pc:@dermnetnz

Ever get all the different #dermatologic terms jumbled up? Was it erythema nodosum, erythema migrans, or erythema multiforme?

Honest poll – Ever write “rash” b/c you couldn’t remember the diagnosis?
All kidding aside, these terms can get confusing. Remember though, derm terms are usually just descriptors of what you see. The name tells you all you need to know.

For example: Acute Generalized Exanthematous Pustulosis (AGEP) = pustules suddenly appeared everywhere!
So, the “erythemas.” First off, what does “erythema” actually mean? Well, according to my Google machine, it's from the Greek root “eruthros” meaning “red.” So "erythema" doesn’t add much to our knowledge of what the rash looks like other than it’s red, and so, likely inflamed
Read 15 tweets
I am sad because of the conflict between supporters of @writingblock and @DrJenGunter. Block’s book “Pushed” was instrumental in my career, and Gunter has been a hero since my blogging days.

(A thread)
My passion has involved a focus on women centered, autonomy promoting, evidence based, trauma and social justice informed health care in the challenging and wonderful sacred realm of sex, reproduction and birth
I trained as an out of hospital midwife and in an allopathic obstetics and gynecology program. I did a research fellowship on how physicians attitudes towards birth interventions are influenced by their loss of power.
Read 14 tweets
1/ Tweetorial alert 🚨🚨

Why does propofol burn so much?

It turns out the answer is not what you might expect. We'll cover some literature exploring the question and some evidence-based strategies to prevent it.

#Tweetorial #medtwitter

Propofol was developed by John Glen, a veterinarian and researcher at the Imperial Chemical Industries. Yes, that's him down there.

Propofol was originally formulated with a castor oil (Cremophor EL).

This formula was withdrawn due to anaphylactic reactions and re-formulated into a soybean emulsion.
Read 19 tweets
Ever wonder why magnesium (Mg) is used to treat Torsades de Pointes?

The answer is fascinating, elegant, and also explains why Mg treats another clinical entity - eclampsia

#medthread #tweetorial #medtwitter

First, let's find how torsades was originally described (and named!):

💡Francois Dessertenne noted "ventricular tachycardia with two variable foci" in a patient in 1966
💡He coined the arrythmia torsades de dointes, connoting "twisting peaks"

To understand how Mg treats torsades we need to understand the pathophys of the arrythmia itself.

▶️Torsades is a ventricular arrythmia of repolarization, occurring in patients with prolonged QT intervals (usually acquired from drugs, ischemia, or⬇️electrolytes)
Read 15 tweets
NEW 🔥in @CMIJournal
Vancomycin AUC/MIC area ratio predicting clinical outcome: a systematic review and meta-analysis with pooled sensitivity and specificity. #IDTwitter #medtwitter @IDpharmresearch…
Vancomycin AUC:MIC performance was modest and inconsistent. Analysis was limited by studies without sufficient data, therefore meta-analytic results may overestimate TPC values.#IDTwitter
Given this, as well as the lack of standardization of methods, widespread adoption of AUC:MIC as the preferred vancomycin monitoring parameter may be premature. #IDTwitter
Read 3 tweets
1/ So I got quite a bit of "pushback" when saying that I would probably/most likely/am considering no longer using the joined # of #hpm or #hapc ... when tweeting about #PalliativeCare exclusively...

I also said I would explain myself to those wondering why...
2/ Quick disclaimer: I will entertain thoughtful discussion and opinions in this thread...

I won't entertain one sided views that try to shut me down with that "I'm big & your small, I'm smart & your dumb..." talk

I am expressing MY thoughts, keep your gaslighting to yourself
3/ One of the #CAPCSeminar19 keynotes was on messaging and how we brand ourselves.

It was a great conversation with Diane Meier and Mark Ganz (intentionally not tagging them) with the sharing of ACTUAL CAPC data but also ACTUAL life stories involving Mark's parents.
Read 15 tweets
"What is the best Venous Access Device for my patient?"

An #InterventionalRadiology (#Irad) #Tweetorial to address a frequent clinical dilemmas for #Medtwitter and #NurseTwitter


Type of VAD:

PIV: 3-6 cm, enter and terminate in peripheral veins.

US-PIV: US to reach deep veins when superficial veins difficult to palpate, ≥8 cm

Midline catheter: 7.5-25 cm, inserted basilic/cephalic vein), terminating short of subclavian. 🚫 vesicant infusions

CVC: duration 7-14 d, direct puncture of internal jugular, subclavian, or femoral veins.

TC : diff from CVC, seperate insertion site in upper chest and venipunture in neck
⬇️ risk of infection due to cuff
👍 location for catheter care
Read 15 tweets
#medtwitter #orthotwitter Let's educate each other !
MIddle aged Shoulder Pain ...
The vast majority of shoulder issues that arise in middle-aged folks do not have a traumatic etiology. They are treated differently than traumatic shoulder issues. What are the most common Dxs?
"impingement" -Plz stop using that term. The lit has proven it doesn't exist. The dreaded "bone spur" is not a cause of shoulder pain. Subacromial pain syndrome probably a better name. Typical presentation: Pain along lateral prox humerus. Strength is often normal... 2/?
You should X-ray them... takes calcific tendonitis, OA, tumors, etc off the table. If strength is normal, do not send them for an MRI. Mny ppl at this age have rotator cuff pathology in BOTH shoulders... and ppl can't unsee their MRI report.… 3/?
Read 21 tweets
Another day on service and you are starting with answering a page from PACU. "Hi this is nephrology fellow returning your page". "Great! This is Ortho, and our patient post op has low potassium here; I believe you call it HYPOkalemia" #Loveourorthopods #Tweetorial #medthread
Join us for our electrolyte abnormality du jour and learn how to break it down! #nephtwitter #medtwitter #FOAMED See our full post @RenalFellowNtwk >…
59 yo F with a hx of HTN, and HLP admitted for a left femur fracture; she was found down by her neighbor 3 days after her fall; awake and in pain. Now, patient is post op; and on labs: (baseline cr: 0.51). UA unremarkable.
Read 19 tweets
1/ What trace element deficiency can cause a syndrome similar to vitamin B12 deficiency? #BroadenYourDifferentials #MedTwitter
2/ It is indeed Copper deficiency! A.k.a. hypocupremia.
3/ Copper deficiency can cause a syndrome which includes variable combinations of anemia, leukopenia and/or neuromyelitis. Both the peripheral (neuropathy) and central (myelitis w/ features similar to subacute combined degeneration) nervous systems can be involved.
Read 8 tweets
ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!

#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz

Let's warm up with a question for all y'all tweeps out there!

What is the most common trigger for erythema multiforme (EM) in adults?
EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.

What primary lesions do you expect in EM?
EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).

2nd photo:…
Read 10 tweets
Great #urology #medtwitter case; 55y female h/o recurrent proteus UTIs, 40lbs unintentional weight loss, bouts of pyelo... felt awful. In ED, fever 🤒 102, u/a ➡️infected, & non contrast CT scan showing:
ED w/ concern for broad differential including ♋️ RCC or other cancers, etc. History and labs/ imaging highly suspicious for XGP, xanthogranulomatous pyelonephritis.
Gets drains (shows urine and proteus... lives with few drains for weeks and nutriton optimizes patient)...
Read 7 tweets
Our #BluePremier milestone is a celebration of our provider partners: health systems, independent PCPs, and advanced primary care providers. They share our vision of improved outcomes, experience, and affordability for our members.
We should never forget that, as hard as it was to get to this point, the hardest work lies ahead – in actually changing the way that we deliver health care. We will be with these providers every step of the way.
👏 👏 to the 7 of the largest NC health systems: @AtriumHealth @ConeHealth @DukeHealth @UNC_Health_Care @NovantHealth @WakeHealth @WakeMed. Together we’ll usher in an era of deep payer-provider partnership to deliver the right care at the right time in the right place.
Read 10 tweets
It’s tough to be an intern!
As a resident, 1st priority is to provide quality care for our patients & 2nd our interns.
Here is a series of tweets on ways residents (and staff) can take care of our interns 💛
#medtwitter #loveourinterns
#HappyTuesday #tweetorial
1. Give credit where credit is due. When your intern does a good job it’s best to give them props in front of the team! But if you give them props just to the attending make sure you tell them that you told the attending what a great job they did and that you appreciate them👏
2. Fall on the sword. The flip side of this is if you make a mistake as a resident make sure it’s clear to the team that it was your mistake, not your interns. This keeps morale high, and it’s honest. Nobody wants to get blamed, especially for something they didn’t do. ⚔️
Read 12 tweets
This week, I taught the @UCSF IM residents about tools for cognitive assessment in hospitalized patients. For my very first #tweetorial – I’m sharing my pearls with #medtwitter! #FOAM #geriatrics #MedEd 1/
@UCSF Throughout my training, I was taught to use the MoCA (Montreal Cognitive Assessment). But after a few months seeing patients at @VABostonHC, I noticed that most of my patients were getting a score of 21-23. Everyone especially seemed to think this was a hippo. 2/
@UCSF @VABostonHC I wanted to know why! So I looked into the development and validation of the MoCA a bit. Turns out, a cognitive test developed in a mostly white, highly educated, bilingual population (aka the people of Montreal) hasn’t really panned out for use among other groups. 3/
Read 16 tweets

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