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63. For Part 4 of our #Tweetorial on the basics of mechanical circulatory support (MCS) we will look at some case examples and clinical indications. 🏥

Follow along below ⬇ Image
64. This 71 yo man had chest pain, shortness of breath, and inferior STEMI & based on BP has what looks like an RV infarct. Treatment began with IV fluids, and vasopressors but BP remains low & HR is actually low for the condition. What do you do? 🤒 Image
65. I know some have used left-sided Impella for this type of shock patient with RV infarct, but I would not choose this path as unloading the LV would not help without RV function. Image
Read 19 tweets
re: ICH Prevention in People w ⬆️Risk MRI findings in @American_Heart updated 2022 ICH guidelines🧠🩸

📌 Refers to incidentally found MRI markers of small vessel disease (SVD) - a common question

Prompted by @interneurona unpacking below (short 🪀) Image
For context:
🚫MRI is not routinely done for risk stratification of first-ever spontaneous ICH risk

🔮MRI is occasionally available in certain people/pts w/o ICH: may show SVD markers concerning for future ICH risk

〽️These markers are: microbleeds, superficial siderosis

1/
The populations that this might be relevant to are:
- healthy elderly
- ischemic stroke
- memory clinic
- any pt who got a brain MRI for a different indication (e.g. migraines)
- non-ICH cerebral amyloid angiopathy (CAA)

#neuroradiology #Alzheimers #stroke

2/
Read 12 tweets
ESR-CRP discordance,a #MedTwitter #tweetorial

First off, let’s talk about ESR physiology.
ESR is the rate at which RBCs settle in plasma of an anti coagulated blood sample.
(-) charged RBCs repel each other thus ⬇️ ESR.

(1/12)
In the presence of (+) charged large asymmetric proteins, ⬆️ neutralization and RBC aggregation causes ⬆️ ESR. Which of the following physiological conditions would have an increased ESR ?
(2/12)
That’s right. Pregnancy. In the 1900s, based on differences in ESR between pregnant and non-pregnant women, it was used as a test of pregnancy. This was due to physiological increase of fibrinogen production in pregnancy.
Other proteins like Immunoglobulins also ⬆️ ESR. (3/12)
Read 17 tweets
1) Welcome to our #accredited #tweetorial on optimal mgt of #hyperkalemia in the patient with #CKD. Earn 0.5h #CME/CE credit by following this thread. I am Sourabh Sharma MD DNB FASN 🇮🇳 @iamnephrologist & u have found the ONLY source for CE credit delivered entirely on Twitter!
2) This program is supported by educational grants from AstraZeneca and Bayer & is intended for #healthcare providers. See faculty disclosures ckd-ce.com/disclosures/. Educational credit for #physicians #physicianassociate #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧
3) Potassium was first isolated by Humphry Davy in 1807 by electrolysis (Coined word from “Potash” [Dutch]). The periodic table symbol K was derived from kali (alkali) [Arabic].
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
Read 36 tweets
1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Cardiologist’s Perspective! Our expert author is Giuseppe Galati MD, MMSc in Heart Failure, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies Image
2) @GiuseppeGalati_ is at San Raffaele Research Hospital, Milan 🇮🇹 @SanRaffaeleMI. This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺.
3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, & Chiesi. Earn credit from archived programs at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/.🙏 FOLLOW US !
Read 56 tweets
1/
Why is cranial nerve 6 uniquely affected by⬆️ intracranial pressure? Why is it special? A common question after the CN6 tweetorial.
Here is a maybe #tweetorial, but maybe a🧵about why CN6 is alone affected by ⬆️ pressure. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter Image
2/
Think of the intracranial CSF space like a balloon, distended by CSF instead of air. Cranial nerves begin inside the balloon, and then they exit as they begin their extradural portion Image
3/
Most cranial nerves move immediately away from the CSF space after they exit—usually going out through their respective foramina. However, CN6 uniquely runs along the outside of the “balloon” in Dorello canal Image
Read 7 tweets
1/
It is rare a patient tells you where their pathology is—but they do when they tell you they have a cranial nerve palsy—you just have to know where to look!
A #tweetorial about the Six Syndromes of the Sixth Cranial Nerve. #FOAMed #medtwitter #Medstudenttwitter @medtweetorials
2/
To understand the six syndromes, you have to know the anatomy of the 6th nerve. It starts in the brainstem, at the facial colliculus—what looks like the butt of the brainstem. It then travels anteriorly through the brainstem to exit out the ventral surface of the pons.
3/
It exits the brainstem at the inferior aspect of the pons—under what looks like pot belly of the pons and then travels anteriorly in the subarachnoid space towards the clivus
Read 17 tweets
32. For Part 3 of our #Tweetorial on the basics of mechanical circulatory support (MCS) we will look at PV loops. ➰

Follow along below. 🧵
33. Let’s start with the metrics of LV function.

Looking at the cycle🔁 of contraction you can see pressures using the Wiggers diagram, named after Carl Wiggers.
34. LV pressure isovolumetric contraction (a-b) begins after the A wave to AV opening at B. Ejection occurs across systole until AV closes at C. The T wave signals repolarization. Isovolumetric relaxation (c-d) follows, ending at MV opening & diastole refills the ventricle at D.
Read 31 tweets
-----KING PSEUDOMONAS------(after @DGlaucomflecken)
--A short #tweetorial on why Pseudomonas is so evil—
#medtwitter #IDTwitter
@ThinkingCC @iceman_ex @avkwong @ABsteward
/1 Image
Let's start with why it's green?
/2
Pseudomonads produce pyocyanin and pyoverdine that give it greenish colour on agar. Hence the name "aeruginosa" meaning "copper rust". Frank Pseudomonas pus can also look greenish for the same reason.
/3 Image
Read 25 tweets
1- Everything you need to know about ultrasonography of Superficial Soft Tissue masses in this #Tweetorial based on the Conference Consensus Statement published in @radiology_rsna: doi.org/10.1148/radiol…
#RadIntraining @RadITrainingEditor @RadiologyEditor @jjacobsn
🧵 1/15
2- In small superficial soft tissue masses, ultrasonography is an excellent examination, allowing real-time manual compression, direct patient interaction and study with Doppler. Deeper lesions often require MRI for further characterization.
2/15
3- Among the following ultrasound criteria, which one is atypical of lipoma?
A-Gently curved echogenic lines parallel to the skin surface
B-Non compressible mass
C-Iso or hyperechoic compared with adjacent subcutaneous tissue
D-No detectable internal blood flow on Doppler US
Read 15 tweets
1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Diabetologist’s Perspective! Our expert author is Melanie J Davies CBE FMedSci @profmjdavies, Prof of Diabetes Medicine, U Leicester, Leicester Diabetes Unit @LDC_Tweets
2) This program is intended for #healthcare professionals and is accredited by @academiccme for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺. FOLLOW US for #cardiometabolic education from expert authors!
3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, and Chiesi. See archived programs still available for credit at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/
Read 43 tweets
#Tweetorial 1/12
#Predatory practices in science communication!
Inspired by #Yash in #KGF2
"Predatory, predatory, predatory! I don't like it! I avoid...But, Predatory likes me; I can't avoid it!"
Sums up current status of predatory practices in India
tinyurl.com/c6txax6x
2/12 Mushrooming of #predatory practices!
Grabbing anything that comes just like that!
Everyone😑falls prey to #Invites from predatory groups
👨‍🎓Students (Undergraduate & postgraduate)
👩‍🔬Researchers (junior/senior)
👩‍🏫Faculty members (junior/senior)
They are Called by Many Names!
3/12 Prevalent predatory practices?

👉#PredatoryJournals/publishers
👉Others tinyurl.com/4d8jyx4z
*#fakepapers on demand  
*Fake qualifications (#predatoryPhDs)
*Predatory certificates, awards & medals
*Predatory pre-print servers
*Falsification of experimental evidence
Read 12 tweets
1/
My fellows complained they hate memorizing classifications, like LeFort. I thought, “There must be a better way—maybe understanding instead of memorizing.”

A #tweetorial about understanding the LeFort classification. #FOAMed #medtwitter #Medstudenttwitter @medtweetorials
2/
To understand LeFort, you need to understand facial buttresses.
These are not true anatomic structures but a way of understanding facial structure.
Facial bones support facial structures like a table supports food, with legs (vertical buttresses) and table top (horizontal)
3/
In the face, the two main structures the buttresses are supporting are the orbits and the alveolar ridges of the maxilla and mandible supporting the teeth
Read 12 tweets
17For Part 2 of our #Tweetorial on the basics of mechanical circulatory support (MCS), we will look at different device options. 🦾⚙
18We are in a wonderful time when we have many different devices available to us, so it is worth looking at the differences in these devices and what they can & can’t do. ⚖
19The balloon pump 🎈 produces counter-pulsation in the aorta, inflating during diastole, deflating in systole. It can be left in place for days & is relatively small. It requires cardiac synchrony or a rhythm to really function well.

Its output is modest at 0.5 L/min.
Read 15 tweets
1/
Awhile ago, on a triage call: “I’ve got a guy here, pretty young, came in looking terrible. GCS 4, we intubated him. Scan shows a big bleed. ICH score 4. Not sure much you’ll be able to do, but need to transfer him.”

A #tweetorial about the ICH score. @medtweetorials
2/
When you hear ICH score 4 you think...
3/
97% morality was associated with Score 4 in the original paper (pubmed.ncbi.nlm.nih.gov/11283388/)

The score, developed to be a reliable/easy to calc severity index, was determined from a

👉 Retrospective cohort
👉 By logistic regression analysis of independent predictors of mortality
Read 26 tweets
1) Welcome to a #tweetorial on what every #ICU #nurse should know about #hypertensive crisis, or #hypertensive #emergency as it is now more properly termed. I’m Bryan Boling @bryanboling, ICU #NP, & co-host of the @icuscenarios podcast. Follow this 🧵for 🆓CE/#CME credit!
2) This accredited educational activity is intended for healthcare providers & is supported by grants from AstraZeneca, Bayer, & Chiesi. Faculty disclosures cardiometabolic-ce.com/disclosures/. Like ❤️this topic? More CE/#CME on #hypertension mgt at cardiometabolic-ce.com/category/hyper….
3) So let's start with a case: 65yo ♂️, presents to the #ED with #headache, lethargy & confusion. PMH: #HTN, #hyperlipidemia, #DM2, COPD. Initial VS: HR 85, BP 205/120, T 37.2 RR 12, SpO2 92% on RA. Family reports that he has been more lethargic over the past 2 days.
Read 37 tweets
#Medtwitter, last week I posted about a talk I gave on teaching #clinicalreasoning

As promised, the accompanying #tweetorial

Come explore with me!
1/10
I described a gap between DOING and TEACHING reasoning

All of us DO reasoning every day

TEACHING what we DO is hard unless we
✔️have vocabulary to describe it
✔️know how to describe a process
✔️are ok being vulnerable in front of others
2/10
How do we make an invisible process (reasoning), visible?

Step 1: use specific words to describe steps to the cognitive process:

Problem representation
Schema
Illness scripts

Speaking these words signals their importance to your learners - use them!
3/10
Read 10 tweets
Gastric intestinal metaplasia (#GIM) is a histological finding which may identify pts at ⬆️ risk for Gastric AdenoCa. Follow our #tweetorial on quality metrics for #GIM management brought to you by the #AGAQuality team

1/12
Gastric cancer 🔥 facts

3⃣rd leading cause of #cancer death worldwide

May be ⬆️ in persons with specific genetic, environmental and #dietary risk factors

May be ⬇️ when specific testing & endoscopic surveillance strategies are followed

3/12
Read 13 tweets
Next up in the #Tweetorial series based on my Hemodynamic Rounds Live lectures I’ll be discussing the basics of mechanical circulatory support (MCS) 📚

There is a lot of info to cover so this #Tweetorial will be broken up into four parts.

Follow along below for part 1. ⬇ Image
In this #Tweetorial I will go through the basics of LV function metrics – how do we measure them; how do we understand them & how do we apply them? 📊

Then we will examine what each device is supposed to do for LV function & understand a couple of pathologic conditions.
We’ll start by reviewing shock, its spiral down to death, & the factors involved. ➰ We’ll also see where hemodynamic support really plays a role. Image
Read 17 tweets
1) Welcome to our new #accredited #tweetorial on the Pathophysiology of #DKD in #T2D: Traditional Teaching and New Insights. Our expert author is Hans-Joachim Anders, MD, @hjanders_hans from @LMU_Uniklinikum of @LMU_Muenchen
2) This #accredited #tweetorial series on the foundations of #kidneydisease #DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers.
3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists 🇺🇸🇪🇺🇬🇧🇨🇦. Past programs still eligible for credit are at ckd-ce.com. Faculty disclosures are at ckd-ce.com/disclosures/. FOLLOW US for regular programs by expert faculty!
Read 48 tweets
1/ Did you know that rigorous, evidence-based methodology underpins the development of @JBIEBHC’s unique evidence-based resources to assist clinicians in their clinical decision-making and practice at the point of care? Learn how in the below #tweetorial for #JBIMethodology month
2/ Evidence Summaries and Recommended Practices sit within the JBI EBP Database available via @ovid_wkhealth. Specialty field experts from across the globe follow a rigorous editorial process to develop these resources jbi-global-wiki.refined.site/space/JED/4555…
3/@JBIEBHC Evidence Summaries are a comprehensive, concise overview of the best available evidence for specific care practices. Driven by a clinical question, a structured approach to searching, selecting, appraising and summarizing evidence is followed.
Read 10 tweets
What is Qualitative Evidence Synthesis? What role does it play in #healthcare? See below for a brief #tweetorial from @Catrin_notts for #JBImethodology month 1/10
#Qualitative evidence synthesis seeks to provide an understanding of meanings, practices and processes associated with social experience, behaviour and culture 2/10
Qualitative evidence synthesis involves the identification and synthesis of qualitative studies to provide insights related to a focused question 3/10
Read 10 tweets
Hi #MedTwitter #MedStudentTwitter #neurotwitter #MedEd #FOAMed! It's been too long since my last #EndNeurophobia #tweetorial so here's an introduction to brain imaging–thanks @sarrovasta for the request!🧠❤️
cc:@CPSolvers @rabihmgeha @DxRxEdu @AvrahamCooperMD @caseyalbin
1/🧵
Let's start w/CT. I'll focus on brain (and not bone or soft tissue). First:

* Identify normal structures and any abnormalities in:
- Size
- Shape
- Symmetry
(note *symmetric* abnormalities such as ventriculomegaly or diffuse cerebral edema may not be obvious w/o experience)

2/
Next:

* Identify abnormalities
- Hypodensity
- Hyperdensity

Broadly:

• Hypodensity:
- Ischemia
- Inflammation
- Infection
- Neoplasm

• Hyperdensity:
- Blood
- Calcification
- Hyperdense tumors (e.g. lymphoma)
- Thrombus in vessel
- Contrast enhancement

3/
Read 19 tweets
Part 6️⃣ in my extremes of animal physiology #tweetorial series:

Case 1: How low can PaO2 go?

You are called by the lab about an abnormal ABG result.
pH 7.5 / PaCO2 20 / PaO2 22 / HCO3 15

“That’s gotta be venous” they say.
“No” you reply, “Its from a ___"
1/
Answer: bar-headed goose!

The Himalayan summits are almost lifeless.

In the midst of this barren landscape, breathless climbers have heard the thrum of wings & the honking of geese above their heads.

How can these geese breathe so easily while flying at over 8000m?
2/
Bar headed geese have many amazing adaptions to altitude: large hearts, specialized hemoglobins, highly capillarized muscles with dense mitochondria, and cerebral insensitivity to hypocapnia.

But most of all they have amazing lung physiology!

ncbi.nlm.nih.gov/pmc/articles/P…
3/
Read 30 tweets

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