Discover and read the best of Twitter Threads about #Periopmedicine

Most recents (7)

A #periopmedicine #tweetorial/#medthread

It’s that time of year again!
Sunday football?
ERAS applications?
Girl Scout cookies?
Well, yes…but for the purposes our discussion, it’s “COLD & FLU SEASON”

What do you do if a patient scheduled for surgery has a URI?

1/N
what is the theoretical concern?
That presenting for surgery, and the anesthetic management including intubation required to facilitate it, will lead to #perioperative complications if the patient has (or has recently had) an upper respiratory tract infection.

2/N
these concerns include the risk of periop pulmonary complications:
🔘respiratory failure
🔘airway hyperreactivity (during induction or emergence) ➡️laryngo/bronchospasm
🔘deeper infection like pneumonia

does this “biologic plausibility” translate into real-world events?

3/N
Read 23 tweets
#Periopmedicine #Medthread!
Based on requests (esp @JenniferBrokaw), a long over-due #tweetorial with my advice & pearls for providing patient-centered care for the surgical patient with #ParkinsonsDisease
1/x
@JenniferBrokaw Caveats
1⃣I’m not an anesthesiologist & don’t care for pts w PD #intraoperatively
2⃣I practice outpatient #PREoperative medicine, so I am not providing inpatient postop care
3⃣There are several high yield publications/resources, & much of this is pulled from my own experience
2/x
@JenniferBrokaw Caveats out of the way, let’s chat about why understanding #periop #ParkinsonsDisease management is so foundational.
Remember how Osler said to know syphilis is to know all of internal medicine?
Yeah…PD meets #periopmedicine is potentially THAT informative.
3/x
Read 28 tweets
A Monday #Medthread:
#medtwitter colleagues—what gets your BP and HR up the most in terms of delivering “bad news”?
in my #periopmedicine world, it’s telling a patient we might need to postpone or cancel their surgery
So…a #tweetorial to share my learnings over the years
1/x
Take a step back—remember that there’s no such thing as “preop clearance”.
The value added is preoperative evaluation and risk assessment, with patient + procedure-specific optimization
Inherent to this is communicating risk and concerns for it
2/x
The overwhelming majority of patients I evaluate in preop clinic are stable/optimized at the time of my evaluation, though my assessment still adds value by empowering intraop and post-op care, as well as facilitating pre-op patient instructions and empowerment
3/x
Read 23 tweets
A Thursday #MedThread #Tweetorial. Consider this an “ode to uncertainty and curiosity” meshed with my clinical practice passion #periopmedicine inspired by many recent #medtwitter, podcast, & IRL role models and conversations about… 1/X
* Stepping into the tension of clinical uncertainty
* Self-reflecting & identifying when we’re on
the edge of uncertainty
* Being able to say “I don’t know”
* Seeing what’s on the margin of our knowledge
* What it means to be “curious”
@ETSshow @CPSolvers @DxRxEdu
2/X
Also drawing from @Gurpreet2015 OHSU #GrandRounds week—as adult learners & clinicians, we must create micro-learning challenges for ourselves:
* What’s the next step
* What else
* What if
* What’s the next logical question to ask the patient, myself, a colleague?
3/X
Read 22 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
THREAD Friday mini #tweetorial! Despite having a learner w me in #periopmedicine clinic the last two days, I neglected to tweet any #postitpearls (though lots of great learning + pt care!). BUT had 2 back-to-back cases raising questions of weight we place on self-reported pt info
2/ will be intentionally vague to protect PHI without diluting learning value...for all the talk re #EHR clutter, EHRs helping propagate accurate info but also "chart lore" false info, #backtobedside, #patientsbeforepaperwork...when can you "take a pt's word for it" in preop?
3/ pt A-early 50s, elective ortho surgery (though pain affecting QOL & activity levels), VERY vague "MI" and "CAD" history in chart from decade ago, no immediately available records, some risk factors for premature CAD (tobacco) but no interval events...
Read 18 tweets
#periopmedicine clinic #postitpearl with new learner type for me—NP student all day! Great conversation even before 1st patient of the day, starting with best case/worse case model
here's the link to the article itself ncbi.nlm.nih.gov/pubmed/26280462
my NP student also found this great youtube video walking through the conceptual framework!
Read 3 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!