Discover and read the best of Twitter Threads about #ccc50

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Here's a little #Tweetorial of my presentation at @SCCM #CCC50 earlier today (available on demand!)

Here are "10 Tips for Better Presentations: Lessons from Storytellers" that can help improve your #MedEd, #Research, #Academic, & #Professional #presentations

#FOAMed #htdap
Our presentations suck. Period.

Presentations are fundamental to medical education. High volumes of information are โ€œdeliveredโ€ in lecture halls and medical conferences, but the uncomfortable truth is that very little of that information is actually retained.
Some reasons why:

- Our lecturing style has remained stagnant despite the fact that our understanding of how people learn has changed.

- Most presentations make the supportive media (i.e. slides) the focus of the presentation without thought about the story or the delivery.
Read 28 tweets
Challenges, hurdles, and lost opportunities but substantial contributions nonetheless
Thank you to the many many special nurses that have lead, supported, cared and better changed my career
Read 4 tweets
Dr. Cook begins her #CCC50 Lifetime Achievement Award talk with reflection on her own 1st presentation ever as an #ICU fellow- at an @SCCM Congress! She was struck by the interprofessional group of attendees.(Thread)

#NationalWomenPhysiciansDay #WomenInMedicine #clinicalresearch
Her first lesson learned to impart to us.

BE BRAVE.

An early senior researcher said to her early in career:
"I just don't think research is in your future"

Imagine what #CriticalCare world would have lost if she had listened.

#CCC50 #pulmcc #PedsICU
Dr. Cook: Sometimes dialogue is more important than consensus. You have the TRUST YOUR GUT. #CCC50

You're not growing until you're changing. Defining moments for bravery may come along when you least expect them. Be brave. #WomensPhysicianDay #PedsICU #pulmcc #ICU
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๐™๐™ƒ๐™€ ๐™ˆ๐™๐˜พ๐™ƒ ๐™๐™Š๐™๐™‚๐™Š๐™๐™๐™€๐™‰ ๐™๐™‘

1/5
Dif Approaches to Optimizing PEEP

PEEP and RV Function
Clifford Greyson @SCCM #CCC50

#PedsICU #PedsCICU #PedsCards
2/5

โ–ซ๏ธFrank-Starling law is more reflective of LV physiology
โ–ซ๏ธ RV normally unstressed at end diastole
โ–ซ๏ธ RV maladapts to volume overload overtime
โ–ซ๏ธ Distorted RV balloons impedes LV
โ–ซ๏ธ RV perfusion occurs during ventricular systole
โ–ซ๏ธ Vicious cycle ๐Ÿ”„ of RV dysfunction
3/5

RV afterload affected by
โ–ซ๏ธPVR
โ–ซ๏ธPul vascular compliance
โ–ซ๏ธLAP

all compromised with excessive PEEP
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Sevransky: rationale for Vitamin C in sepsis and shock #CCC50 #PedsICU
Sevransky: CITRIS-ALI #CCC50 #PedsICU 167 patients with Sepsis AND ARDS for < 24 hours.
Sevransky: it did raise Vitamin C levels but didn't modify SOFA or other scores. But interventional group had a lower mortality (not a primary outcome measure of the study though, one of 46 secondary measures) #CCC50 #PedsICU Billiard analogy of calling your shot -
Read 12 tweets
Next up Joel Feih, PharmD from Froedtert Hospital at MCW in Milwaukee on B12 and Methylene Blue in refractory vasodilatory shock #CCC50 #PedsICU
Feih: Methylene Blue #CCC50 #PedsICU
Feih: Methylene Blue has been studied for prophylaxis in high risk vasoplegic syndrome following CPB #CCC50 #PedsICU
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@KhannaAshishCCM reviewing stuff that I knew once upon a time... #CCC50 #PedsICU RAAS
Khanna: Is renin the new lactate? #CCC50 #PedsICU
Khana: case report of high renin vasodilatory shock in a COVID patient on VV ECMO aaa #CCC50
Read 5 tweets
Douglas White (UPMC): ICU triaging both on saving most lives and those with longest life expectancy, even based on SOFA scores invariably will bias against patients of color, or lower SES #CCC50 #PedsICU
White: 4 strategies for ICU triage that promote equity
White: Arizona as an example, some hospitals were overburdened, others had empty beds. Arizona surgeline addressed this to coordinate and facilitate transfer 5000 patient transfer so they didn't need to triage. #CCC50 #PedsICU
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Kicking off the Year in Review for #PICUQI and #PedsICU #MedEd #CCC50 Search strategy included a review of ALL tables of contents of major pediatric and critical care journals, PUBMED search, key collaborative search, asking on @twitter and discussion with experts in the fields.
First up, discussion of #PICUQI #CCC50.
First up by @ndean75, โ€œThe Late Rescue Collaborative: Reducing non-ICU arrestsโ€ in @PedCritCareMed Dean & colleagues saw decreased rates of non-ICU arrests & increased participation through @AAP #MOCPart4. #PICUQI #CCC50
journals.lww.com/pccmjournal/Fuโ€ฆ
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Katri Typpo presenting the basic science arm of the Peds Year in Review (it's not all SARS-CoV2) #CCC50 #PedsICU
Typpo: looking at mechanism of Cytokine Release Syndrome in CAR-T therapy #CCC50 #PedsICU by Liu at al Blocking GSDME may prevent CRS
Typpo: an animal model of Inhaled Vitame E Acetate and EVALI-like Lung injury #CCC50 #PedsICU
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Bembea presenting clinical arm of Year in Review, MIS-C, ARDS, here the PARDIE study #CCC50 #PedsICU
Bembea: PARK-PICU study looking at physical rehab point prevalence in the US from @SapnaKmd et al #CCC50 #PedsICU
Bembea: Canadian and European versions of PARK-PICU showed some similarities but some noticiable differences #CCC50 #PedsICU
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The legend Ann Thompson, MD, MHCPM, MCCM talking about her career in #PedsICU, including offering herself up as chief at Pittsburgh 6 months out of fellowship. #CCC50 #PedsICU (her caveat was that the division was 2 people with one fellow, 7 nurses, 10 PICU beds)
Dr. Laura Evans, FCCM asking Dr. Thompson about that transition from fellowship to leadership, the growth of the program. Dr. Thompson relying back on her guidance from Drs Raphaelly and Downes at CHOP who mentored her. "Holding on by your fingertips" at times. #CCC50 #PedsICU
Dr. Thompson points out that having a strong team helped them persevere. (A team of course that she built over the years). #CCC50 #PedsICU
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DeVita: Rapid Response System 20 Years Later #CCC50 #PedsICU
DeVita: critical illness is common, and it's a system issue #CCC50 #PedsICU
DeVita: early model of Rapid Response System structures #CCC50 #PedsICU Developed triggers for special teams, but the other piece was to collect the data for improvement
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Winterbottom: Rapid Response: Team Leadership how has it evolved #CCC50 #PedsICU
Winterbottom: How leadership has evolved, key drivers: looking at optimization of care, making it more timely and engaging patients and families #CCC50 #PedsICU
Winterbottom: preventing the slippery slope #CCC50 #PedsICU (graph looks familiar @patrickwbrady )
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Mesko: The Future of Critical Care Plenary #CCC50 #PedsICU
Mesko: how compassionate care can be combined with technology of the future. #CCC50 #PedsICU
Mesko: plays with the "what if" question. Science fiction is the engine that allows him to interact with current technologies #CCC50 #PedsICU
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Thanks to those of you who attended my M2M presentation. Iโ€™ll tweet out links to the animations and other resources I used in the talk in this thread #CCC50 #PedsICU
First, the longer version of this, with some older animations from our grand rounds presentation in 2019. Featuring @jeffcimprich our lead animator @CincyKidsMedArt #CCC50 #PedsICU cchmc.cloud-cme.com/course/courseoโ€ฆ
Our animation of atrioventricular canal defect #CCC50 #PedsICU
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Daniel Dante Yeh: In first 7 days of critical illness., hypocaloric (<70%) nutrition should be used, can advance to 80-100% after day 3. Use indirect calorimetry if you can. #CCC50
Use high-protein, hypocaloric feeding in obese patients to preserve lean mass while not overfeeding. If 30-50 BMI use 11-14 kcal/kg actual bodyweight, if BMI >50 use 22-25 kcal/kg of ideal bodyweight.
Generally use normal protein goals for kidney failure. If on CRRT, however, need to account for loss of aminos in the membrane, may be ~15-17%.
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John Teerlink: Cardiac calcitropes (catecholamines, PDE3 inhibitors) increase contractility, ischemia, arrhythmias, mortality. We use them anyway because it's what we've got. #CCC50
OPTIME-CHF: Milrinone for CHF exacerbation when NOT requiring inotropes. No clinical benefit but trend for more MI/death and significant increase in arrhythmias and hypotension.
OptimaCC: epi vs norepi in cardiogenic shock in MI: no difference in change in cardiac index, but discontinued for harm in epi group (tachycardia and increase in refractory shock). So maybe use norepi?
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Xavier Monnet: CNPN doesn't work for fluid responsiveness because it ignores the shape of the Starling curve, which varies by patient. You can't get the intersection of two lines if you don't know one of them. #CCC50
"Mini" fluid challenge (100-150ml) avoids as much overload if it proves negative, but requires very sensitive markers of cardiac output. Maybe pulse counter analysis...
PPV, SVV Uses the respiratory cycle as an intrinsic fluid challenge. Automatically measured by some bedside monitors. No good in arrhythmias, spontaneous breathing, low lung compliance or tidal volumes (eg ARDS), so only works out in about 20% of ICU patients.
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