Discover and read the best of Twitter Threads about #PulmCrit
Most recents (5)
(Inspired by recent talk)
Skilled proceduralists are often asked to help other providers/teams, such as placing a tough line. Here are some important points for this. It is NOT the same as doing procedures on your own patients. (🧵):
#medtwitter #FOAMcc #FOAMed #pulmcrit
Skilled proceduralists are often asked to help other providers/teams, such as placing a tough line. Here are some important points for this. It is NOT the same as doing procedures on your own patients. (🧵):
#medtwitter #FOAMcc #FOAMed #pulmcrit
1. You are asked to "help," usually verbally, but you're still responsible for your own care. So this is actually a consultation of sorts. Does the patient actually need what they thought? Usually they know their problem ("we need access") but not always the best answer.
They also may not be aware of all relevant contraindications or technical obstacles... or they may simply not care. In other words, they're expecting YOU to consider these. If you do something dumb, you can't just say "well, someone told me to do it."
‼️ #CriticalCare #Tweetorial ‼️
🫁 Tracheostomy Basics & Trach Emergencies 🫁
Join me on a review tracheostomy tube basics and can't miss emergency situations!
#EmoryNCCTweetorials
#FOAMcc for #CritCare #EmergencyMedicine #HospitalMedicine #MedEd #Neurocrit #PulmCrit
1/🧵
🫁 Tracheostomy Basics & Trach Emergencies 🫁
Join me on a review tracheostomy tube basics and can't miss emergency situations!
#EmoryNCCTweetorials
#FOAMcc for #CritCare #EmergencyMedicine #HospitalMedicine #MedEd #Neurocrit #PulmCrit
1/🧵
Goals for this #Tweetorial
1-Review basics of the tracheostomy tube
2- Review anatomy relevant to tracheostomy placement
3- Safety tips for your inpatients with trachs
4- Review emergency situations relevant to trachs
2/🧵
1-Review basics of the tracheostomy tube
2- Review anatomy relevant to tracheostomy placement
3- Safety tips for your inpatients with trachs
4- Review emergency situations relevant to trachs
2/🧵
Lets start with a case...
60s y/o male with a left basal ganglia ICH 🧠 who is now s/p bedside percutaneous tracheostomy placement 4 days ago. You are called into the room for a high pressure alarm 🚨
What is your first step?
3/🧵
60s y/o male with a left basal ganglia ICH 🧠 who is now s/p bedside percutaneous tracheostomy placement 4 days ago. You are called into the room for a high pressure alarm 🚨
What is your first step?
3/🧵
PSA: You *CANNOT* use a "bougie" or Eschmann Intubating Stylet to do an endotracheal tube exchange. I have seen this mistake twice in the past 6 months. You will lose the airway. A simple look at the length of the bougie and an #ETT will make this clear.
The length of an adult ETT is about 32 cm and the length of the #eschmannstylete is 70 cm. This leaves no room in the center for you to grab it. When you retract the #ETT to the end of the stylet, its distal tip is still in the patient's mouth & entire stylet is covered
To do a tube exchange, you need 2x the length of the ETT and then some additional length to work with, else you risk retracting the exchange device too far and losing the airway. This is why they make an "airway exchange catheter" and its length is 83cm: cookmedical.com/products/cc_ca…
Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary
#pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate
(Like on Tinder, the more criteria you require, the more you narrow your pool, compromising sensitivity for specificity.) Transudates I will skip over. Most common #exudate is #parapneumoniceffusion #PPE. If there is or is likely to be #pneumonia, it's PPE. Next task is to...
This was a *CRAZY* busy week. I must have done 900 thoracenteses this week, so I had some questions about pleural effusions and their effect on dyspnea based on things I observed. Here are my take aways. #MedTwitter #MedEd #PulmCrit #FellowLife
1/ I felt like a hero - swooped in, did a thoracentesis, drained 1.5L... and her breathing didn't get better. I was like... 😕wtf. It turns out size of pleural effusion correlates poorly with dyspnea. This holds true for reduction in symptoms after thoracentesis.
2/ Did another thora, and his SpO2 was WORSE after. 😖I'm like... WHAT'S WRONG WITH ME? Things can actually worsen immediately after thoracentesis (even without mucking it up) for a few hours. Also, gas exchange issues DON'T correlate with the symptom of dyspnea!
