Discover and read the best of Twitter Threads about #emoryncctweetorials
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1/ Step 1 - Don’t
👉Shut anything off
👉Touch the vent
👉Remove restraints
👉Pause sedation
if you have not explicitly asked permission to do so.
[This is a survival thing! For the pt… (and you 😉)]
A #tweetorial @medtweetorial about critical care things for #neurologists
👉Shut anything off
👉Touch the vent
👉Remove restraints
👉Pause sedation
if you have not explicitly asked permission to do so.
[This is a survival thing! For the pt… (and you 😉)]
A #tweetorial @medtweetorial about critical care things for #neurologists
2/
Vibe check for the #neurologists out there. Do you like doing ICU consults?
#MedEd #NeuroTwitter #NeuroTwitterNetwork #EmoryNCCTweetorials
Vibe check for the #neurologists out there. Do you like doing ICU consults?
#MedEd #NeuroTwitter #NeuroTwitterNetwork #EmoryNCCTweetorials
3/
Tip 1⃣: Induction meds for intubation have different hemodynamic profiles.
In emergent situations, explicitly tell whoever is intubating the patient’s BP goals.
For ex: AIS = ⬆️ BP good; induction with propofol (frequently = hypotension) is suboptimal.
Reminders are 🔑
Tip 1⃣: Induction meds for intubation have different hemodynamic profiles.
In emergent situations, explicitly tell whoever is intubating the patient’s BP goals.
For ex: AIS = ⬆️ BP good; induction with propofol (frequently = hypotension) is suboptimal.
Reminders are 🔑
‼️ #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/🧵
1/ Get ready for the second installment of my ICU #Flextorials 💪🏻 This thread focuses on ICU intubation. These #MedEd #Tweetorials are designed to help you get in procedure shape for fellowship and residency. Enjoy! #EmoryNCCTweetorials
2/ Warm up: Push ups
3/ Rush to the head of the bed to claim the intubation!
1/
I posted this case last week as a mystery case.
Lots of votes for dissection, which I agree would seem totally plausible. But...
This was not a dissection!
I left out some key details to make it more interesting
So... what *was* going on here?
#EmoryNCCTweetorials
I posted this case last week as a mystery case.
Lots of votes for dissection, which I agree would seem totally plausible. But...
This was not a dissection!
I left out some key details to make it more interesting
So... what *was* going on here?
#EmoryNCCTweetorials
2/
Before diving in, major shout outs to fellows @maness_caroline & @stevefylypiw & @b3ta_lacTAM for their help investigating!!🤩
So... best guess, where is the stroke?
Reminder, the symptoms:
👁️ Unilateral (Left) Miosis
😵💫Vertigo
😴 Altered consciousness
Before diving in, major shout outs to fellows @maness_caroline & @stevefylypiw & @b3ta_lacTAM for their help investigating!!🤩
So... best guess, where is the stroke?
Reminder, the symptoms:
👁️ Unilateral (Left) Miosis
😵💫Vertigo
😴 Altered consciousness
3/
Of these, the best guess is the lateral medulla.
✨Descending sympathetic fibers = Horner’s syndrome (miosis. Hard to eval ptosis, anhidrosis in this acute situation)
✨Vestibular nuclei = vertigo
(Lateral pons can cause these as well, but that wasn’t an option)
Of these, the best guess is the lateral medulla.
✨Descending sympathetic fibers = Horner’s syndrome (miosis. Hard to eval ptosis, anhidrosis in this acute situation)
✨Vestibular nuclei = vertigo
(Lateral pons can cause these as well, but that wasn’t an option)
Ever wondered how MR Spectroscopy (MRS) is acquired & how to interpret it? Have you ever come across funky looking zigzag graph with MRI & scratched your head?
If interested in learning BASICS of MRS, follow this 🧵
MRS for non-radiologists
#EmoryNCCTweetorials @MedTweetorials
If interested in learning BASICS of MRS, follow this 🧵
MRS for non-radiologists
#EmoryNCCTweetorials @MedTweetorials
First available since 1980, 1H-MRS is noninvasive technique uses proton signals to determine relative concentrations of tissue metabolites & thereby acquiring data about chemical composition of a tissue.
13C MRS
23Na MRS(neurocognitive,brain tumor research)
31P MRS(🫀&💪🏻research)
13C MRS
23Na MRS(neurocognitive,brain tumor research)
31P MRS(🫀&💪🏻research)
1H-MRS:
-Most widely used
-Performed on 1.5, 3 & 7 T
-Only adds 5-10 min of exam⏰
So why not do it with every MRI?
-Limited value &⬇️specificity
-Most of the time,history & MRI is just enough
-Adding 5-10 mins for every MRI⬇️productivity w/o significant gain in diagnostic yield
-Most widely used
-Performed on 1.5, 3 & 7 T
-Only adds 5-10 min of exam⏰
So why not do it with every MRI?
-Limited value &⬇️specificity
-Most of the time,history & MRI is just enough
-Adding 5-10 mins for every MRI⬇️productivity w/o significant gain in diagnostic yield
1/
There have been a lot of “❓cerebritis” on the neuroICU signouts this year.
I, too, have some questions re: cerebritis… mainly, like what the heck is cerebritis and how are these “cerebritis” pictures related?
A #tweetorial #EmoryNCCTweetorials @MedTweetorials
There have been a lot of “❓cerebritis” on the neuroICU signouts this year.
I, too, have some questions re: cerebritis… mainly, like what the heck is cerebritis and how are these “cerebritis” pictures related?
A #tweetorial #EmoryNCCTweetorials @MedTweetorials
2/
When you hear 'cerebritis' you think ...
When you hear 'cerebritis' you think ...
3/
We'll get there.
But 1⃣st, it's important to realize there are many different forms of neurologic "-itis" 🔥
⭐️Meningitis=inflammation of the meninges
This comes in two flavors🍦 :
👉pachymengitis
👉leptomeningitis
⭐️Pachy-meningitis =🔥 of the “thick membrane” (dura)
We'll get there.
But 1⃣st, it's important to realize there are many different forms of neurologic "-itis" 🔥
⭐️Meningitis=inflammation of the meninges
This comes in two flavors🍦 :
👉pachymengitis
👉leptomeningitis
⭐️Pachy-meningitis =🔥 of the “thick membrane” (dura)
Another #CriticalCare #Tweetorial!
🫀Left Ventricular Assist Device for the non-cardiologist🫀
Join me on a journey through LVADs with some #FOAMcc highlights useful for #CritCare #EmergencyMedicine #HospitalMedicine #Meded
#EmoryNCCTweetorials
@CardioNerds @emoryheart
1/🧵
🫀Left Ventricular Assist Device for the non-cardiologist🫀
Join me on a journey through LVADs with some #FOAMcc highlights useful for #CritCare #EmergencyMedicine #HospitalMedicine #Meded
#EmoryNCCTweetorials
@CardioNerds @emoryheart
1/🧵
Goals for this #Tweetorial
1-Review the basics of what an LVAD is and does
2-Discuss indications for an LVAD
3-Review some common complications of the device itself
4-Review systemic complications of an LVAD
2/🧵
1-Review the basics of what an LVAD is and does
2-Discuss indications for an LVAD
3-Review some common complications of the device itself
4-Review systemic complications of an LVAD
2/🧵
Lets start with some basics of the LVAD. Historically the two most commonly encountered are the Heartmate 3 and the Heartware.
We will focus on the Heartmate 3 (Shown below)
3/🧵
We will focus on the Heartmate 3 (Shown below)
3/🧵
1/ There’s a lot of AEDs that work great together to tx szs! Unfortunately, Valproic acid (VPA) and Phenytoin (PHT) are two that didn’t get that memo.
Get ready for a fun and educational two-part #tweetorial on the do not miss VPA and PHT interactions w/ @theABofPharmaC
Get ready for a fun and educational two-part #tweetorial on the do not miss VPA and PHT interactions w/ @theABofPharmaC
2/ Let’s go back in time.
Valproic acid was first synthesized in 1882 by Burton. It wasn’t until 1963 when its anticonvulsant properties were discovered by Eymard.
Phenytoin was first synthesized in 1908 by Biltz and discovered to have anticonvulsant properties in 1936
Valproic acid was first synthesized in 1882 by Burton. It wasn’t until 1963 when its anticonvulsant properties were discovered by Eymard.
Phenytoin was first synthesized in 1908 by Biltz and discovered to have anticonvulsant properties in 1936
3/ VPA works by ⬆️ GABA lvls and blocking Na and Ca channels. It’s broad-spectrum permits its use for various szs types: partial, tonic clonic, myoclonic, and absence.
PHT works solely by inhibiting Na channels and has a narrower spectrum of use: partial and tonic clonic szs
PHT works solely by inhibiting Na channels and has a narrower spectrum of use: partial and tonic clonic szs
1/ 🧵Ready to play a game #EmoryNCCTweetorials #Neurotwitter #FOAMncc ?
Review these images carefully. Poll in next tweet.
Review these images carefully. Poll in next tweet.
2/ What do all of these diverse #braininjury cases have in common?
3/ All of these patients developed paroxysmal sympathetic hyperactivity (PSH) or #neurostorming
Here you will find PSH resources to
✅Understand the pathophys of #PSH
✅Rule out mimics
✅Diagnose PSH
✅Treat PSH
Here you will find PSH resources to
✅Understand the pathophys of #PSH
✅Rule out mimics
✅Diagnose PSH
✅Treat PSH
1/
A pt w/ ESRD on HD, a fib on coumadin is transferred after a 2 wk hosp for SDH/contusions + ESBL PNA w/ status epilepticus
Scan ⬇️
AEDs: fPHT 100mg Q8H, LEV 1g BID, LAC 100mg BID, VPA 750mg BID + propofol 30, midaz 5.
Admission VPA level 13 (tx range 50-~100)
🤔🤔🤔
A pt w/ ESRD on HD, a fib on coumadin is transferred after a 2 wk hosp for SDH/contusions + ESBL PNA w/ status epilepticus
Scan ⬇️
AEDs: fPHT 100mg Q8H, LEV 1g BID, LAC 100mg BID, VPA 750mg BID + propofol 30, midaz 5.
Admission VPA level 13 (tx range 50-~100)
🤔🤔🤔
2/
Whats going on… That’s a 15mg/kg/day dose… why is the VPA level so low?
Whats going on… That’s a 15mg/kg/day dose… why is the VPA level so low?
3/
VPA is a great AED.
But a @medtweetorial #tweetorial, on how in the critically ill, this drug often becomes problematic and complicated.
#EmoryNCCTweetorials.
VPA is a great AED.
But a @medtweetorial #tweetorial, on how in the critically ill, this drug often becomes problematic and complicated.
#EmoryNCCTweetorials.
1/ #EmoryNCCTweetorials 🚨
The setup: Neuro ICU at @EmoryNeuroCrit
The pt: John Doe transferred for status epilepticus
You’re told about the pt’s ammonia lvl ➡️ 181 (where's @Capt_Ammonia?!). He’s also on 5 different AED’s...
@MedTweetorials
#MedEd #tweetorial #neurotwitter
The setup: Neuro ICU at @EmoryNeuroCrit
The pt: John Doe transferred for status epilepticus
You’re told about the pt’s ammonia lvl ➡️ 181 (where's @Capt_Ammonia?!). He’s also on 5 different AED’s...
@MedTweetorials
#MedEd #tweetorial #neurotwitter
2/ On quick review, patient was admitted 5 days earlier at the OSH. Initially admitted for encephalopathy that was then c/b seizures the following day. Initial ammonia was normal. CT/CTA unremarkable. MRI brain w/ contrast shows the following abnormality over the R frontal area
3/ Further hx significant for excessive EtOH (~2-3 glasses of wine/day). Recently in the mountains drinking homemade moon shine. He had nausea and vomited ~24-48 hrs later before becoming encephalopathic. Eventually admitted ~4 days later.
1/
It’s no secret what’s growing in blood.
But, the cultures won’t clear,
On valves it adheres!
Patient aphasic,
What’s with the agitation?
ESR & CRP rising!
An #Tweetorial advising:
Never overlook the spinal epidural abscess!!
#EmoryNCCTweetorials
It’s no secret what’s growing in blood.
But, the cultures won’t clear,
On valves it adheres!
Patient aphasic,
What’s with the agitation?
ESR & CRP rising!
An #Tweetorial advising:
Never overlook the spinal epidural abscess!!
#EmoryNCCTweetorials
2/
All poetry aside (pretty good tho, right?!)
Goals for the scroll (⬅️credit @sigman_md 😂):
1⃣ How difficult it can be to diagnose spiral epidural abscesses (SEA)
2⃣ What exactly is the spinal epidural space
3⃣ How these should be treated
4⃣ And why decompress?
All poetry aside (pretty good tho, right?!)
Goals for the scroll (⬅️credit @sigman_md 😂):
1⃣ How difficult it can be to diagnose spiral epidural abscesses (SEA)
2⃣ What exactly is the spinal epidural space
3⃣ How these should be treated
4⃣ And why decompress?
3/
Diagnosing SEA = super tricky. The symptoms & labs are so non-specific!
✅Back pain ⏫(but back pain--who doesn't?)
✅Fever is often present, but not always.
✅WBC may be elevated, but sometimes just mildly. ✅Blood cultures are only positive about 60% of the time.
Diagnosing SEA = super tricky. The symptoms & labs are so non-specific!
✅Back pain ⏫(but back pain--who doesn't?)
✅Fever is often present, but not always.
✅WBC may be elevated, but sometimes just mildly. ✅Blood cultures are only positive about 60% of the time.
Time for a #CriticalCare #Tweetorial!
‼️Basics of CRRT for the non-nephrologist‼️
Exiting my typical #Neurology wheelhouse as I tackle some #FOAMcc topics for my own learning. Please join in on teaching and address any mistakes!
#EmoryNCCTweetorials
@EmoryNephrology
1/🧵
‼️Basics of CRRT for the non-nephrologist‼️
Exiting my typical #Neurology wheelhouse as I tackle some #FOAMcc topics for my own learning. Please join in on teaching and address any mistakes!
#EmoryNCCTweetorials
@EmoryNephrology
1/🧵
CRRT- What does it stand for?!
Continuous- Runs around the clock (sort of)
Renal- The beans!
Replacement- More of a rinse than a true replacement
Therapy- It helps!
@criticalbeansmd @EmoryNeuroCrit @caseyalbin @KrafteKraft4 @mallyaa @VijayanMD
2/🧵
Continuous- Runs around the clock (sort of)
Renal- The beans!
Replacement- More of a rinse than a true replacement
Therapy- It helps!
@criticalbeansmd @EmoryNeuroCrit @caseyalbin @KrafteKraft4 @mallyaa @VijayanMD
2/🧵
Why do we use CRRT instead of HD?
Patient’s with hemodynamic instability (ie blood pressure is so low they can’t tolerate HD)
Conditions where you need to avoid large fluid shifts (like cerebral edema)
3/🧵
Patient’s with hemodynamic instability (ie blood pressure is so low they can’t tolerate HD)
Conditions where you need to avoid large fluid shifts (like cerebral edema)
3/🧵
1/ 42 yo patient presents with 3 hours of left hemiparesis found to have right M1 thrombus. Platelets are 24,000/uL!
Welcome to a CANNOT MISS #EmoryNCCTweetorials @EmoryNeuroCrit on a rare etiology of #acuteischemicstroke
#Neurotwitter #FOAMncc #stroketwitter
Welcome to a CANNOT MISS #EmoryNCCTweetorials @EmoryNeuroCrit on a rare etiology of #acuteischemicstroke
#Neurotwitter #FOAMncc #stroketwitter
2/ 🚨Goals for the scroll:
✅Discuss a rare cause of acute ischemic stroke
✅ Review thrombectomy safety w thrombocytopenia (tcp)
✅Review dx and pathophys of thrombotic thrombocytopenic purpura (TTP)
✅Review the treatment of TTP
✅Discuss a rare cause of acute ischemic stroke
✅ Review thrombectomy safety w thrombocytopenia (tcp)
✅Review dx and pathophys of thrombotic thrombocytopenic purpura (TTP)
✅Review the treatment of TTP
3/ Our patient with plt of 24,000 /uL is taken for #thrombectomy. Would you send your pt w/ severe thrombocytopenia for thrombectomy?
1/ Alright, time to give this #EmoryNCCTweetorials a swirl!
The setup: Neuro ICU at @EmoryNeuroCrit
The pt: Basilar stroke s/p tPA & MT. Now intubated & undergoing stroke workup
You’re called to the bedside for sats in the 80s!
@MedTweetorials #MedEd #tweetorial #neurotwitter
The setup: Neuro ICU at @EmoryNeuroCrit
The pt: Basilar stroke s/p tPA & MT. Now intubated & undergoing stroke workup
You’re called to the bedside for sats in the 80s!
@MedTweetorials #MedEd #tweetorial #neurotwitter
2/ RN lets you know that the patient just completed their TEE....
O2 is beeping, 88% ➡️87%➡️ 86%
O2 is beeping, 88% ➡️87%➡️ 86%
3/ Time to quickly go over your checklist
✅Auscultate breath sounds?
Normal.
✅Change sensor on O2 sat probe?
Still 86%.
✅Check ETT placement?
Unchanged from the day prior.
✅Compliance/Plugging issue?
Normal Peak and Plateau pressure. Nothing clogged.
✅Auscultate breath sounds?
Normal.
✅Change sensor on O2 sat probe?
Still 86%.
✅Check ETT placement?
Unchanged from the day prior.
✅Compliance/Plugging issue?
Normal Peak and Plateau pressure. Nothing clogged.
