Discover and read the best of Twitter Threads about #foamcc

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Tips on the mechanically ventilated ARDS and sick hypoxemic patient.

Protect the lungs from the start! See the basics below.

#Tweetorial #foamcc #foamed

Based on prior work with @mattroginski @roo_atchinson


What is the definition of ARDS?

The Berlin criteria: Acute onset within one-week, bilateral opacities on CXR not explained by cardiogenic pulmonary edema, pleural effusion etc. and a PaO2/FiO2 ratio of <300 mm Hg with PEEP 5 cm H2O.…

More simply in the ED or acute setting I consider anyone with bilateral infiltrates + inflammation (sepsis, pneumonia, trauma etc) + hypoxemia to be at risk for ARDS and if intubated manage them with lung protective ventilation.
Read 16 tweets
#Tweetorial vs. #UnsolicitedAdviceThread
🤔"What I wish I knew"🤔
#tipsfornewdocs #2wk

I was asked to do a wonderful Q&A during @umnmedresidency's first intern academic 1/2 day

Complied all tips👇

(💪work @Kay_L_Ingraham, @VigneshWP, @PendlKM) with co-panel (@jenwong101)
Before we begin.

Aside from trying to coax you to try twitter for #FOAMed #MedEd ...

Please know👉🏽not every tip will work for every person. Find what works for you!

Don't be overwhelmed
👉 Focus on something new each week or month!
** Audience ?s **

🗝️ Step 3 😱?👉focus on patient care unless you are taking w/in 3 months, just get signed up (it'll be OK)

🗝️ Research?👉focus on patient care and being a wonderful doctor (till spring @ earliest)

🗝️ Reading?👉read to care for your patient's illness

Read 18 tweets
You intubated the asthmatic! What to look for on the vent and what to do about it.

It gets complicated, but the basics are in the thread below

#foamcc #foamed #tweetorial mini
The problem is bronchospasm and secretions narrow the airways and lead to obstruction, limitations in exhalation and high airway resistance.

On the vent, this is seen as a high peak pressure (high resistance) and a prolonged expiratory flow or incomplete exhalation.
The high peak pressure isn’t really a problem unless the plateau (obtained by an end insp hold) is also high. The delicate alveoli only feel the plateau pressure. Best to keep the plateau pressure < 30 cm H20 by minimizing auto-PEEP as the auto-PEEP contributes to plat press
Read 11 tweets
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,

- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
Read 88 tweets
UTI-Club #3: lesión pulmonar inducida por la ventilación mecánica: VILI #tweetorial…

#TuitMédico #MedTwitter #FOAMed #FOAMcc #MedEd #UTI #ICU #MechanicalVentilation #VIL

👩‍🦱 55a
⌨️POP hemicolectomía (CA Colon). 3 hs de cirugía, sin complicaciones
Ingresa a UTI extubada, sin requerimientos de vasopresores.

Al poco tiempo desarrolla hipoxemia e infiltrados pulmonares 🖥️

EAB: (con máscara de O2 al 50%): 7,42/50,4/36,5/-1/23/85,9% 💉

Ecocardiograma normal ❤️

AngioTC negativa para TEP ❎
Requiere intubación orotraqueal y conexión a asistencia respiratoria mecánica.

Cuando se procede a setear al respirador, llama la atención que la paciente tiene baja estatura (1,55 m) y sobrepeso (en la historia clínica de ingreso figura peso previo a la cirugía de 68 kg) ⚖️
Read 16 tweets
1/ Why is lactate elevated in sepsis or septic shock?

@dolan_russell & I explore this common #ICU pimp question via #tweetorial.

We're taught that ↓O2 revs up anaerobic metabolism causing ↑ lactate. But wait, there's more...

#medtwitter #FOAMed #meded #FOAMcc #criticalcare
2/ In homeostasis, lactate is continually produced and metabolized; serum concentration is at steady state.

Which of the following organs is responsible for the majority lactate consumption and metabolism?
3/ The liver is responsible for ~70% of lactate metabolism.

Patients with hepatic dysfunction can have ↑ lactate 2/2 ↓ clearance or ↑ production. Also, cirrhotics are more prone to hyperlactatemia in setting of sepsis.

Diving deeper, how does the liver metabolize lactate?
Read 13 tweets
There are many advantages of continuous IAP measurement as listed in infographic #ISICEM19
Start measuring IAP (abdominal pressure) in ICU patients when there are 2 or more risk factors related to
-increased intra-luminal contents
-increased intra-abdominal contents
-decreased compliance
-fluid overload and capillary leak

Some causes of increased intra-luminal contents resulting in abdominal hypertension #ISICEM19
Read 11 tweets
[THREAD] Our tips on small bore chest tube placement for pleural effusion! Performed by a resident @BostonCityEM supervised by fellows @BUPulmonary. We'd love your input! Not a comprehensive guide. Made with written patient authorization. #meded #FOAMcc #pulmcc
For new large unilateral effusions such as this, we place a chest tube if fluid pH <7.2, glucose <60. Without fluid studies, we place a tube empirically if effusion is large, loculated, infected, or likely to reaccumulate- except CHF/fluid overload.
First step: ultrasound. We position the probe with marker to the head, as lateral as possible. Intercostals tend to sag as you move towards the midline, so you could hit them when going above the rib. Lateral access is safest.
Read 24 tweets
Assessing the whole body with #ultrasound #WBU impacts the outcome? a look at the literature part 1 Van Der Horst I at #LIVES2018 #FOAMus #FOAMcc #FOAMed @ESICM #echofirst #FOAMcc
Assessing the whole body with #ultrasound #WBU impacts the outcome? a look at the literature part 2 Van Der Horst I at #LIVES2018 #FOAMus #FOAMcc #FOAMed @ESICM #echofirst #FOAMcc
Assessing the whole body with #ultrasound #WBU impacts the outcome? a look at the literature part 3 Van Der Horst I at #LIVES2018 #FOAMus #FOAMcc #FOAMed @ESICM #echofirst #FOAMcc
Read 3 tweets
Good morning everyone! For my first session of day 2, I’ve decided to come and learn all about vasculitis in the ICU - being presented by Marlies Ostermann from @GSTT_ICU #lives2018
Marlies starts with a couple of case histories:

Middle aged women, presenting with undifferentiated pulmonary and renal failure, raised inflammatory markers, Nonspecific chest X-ray changes...

But which one has vasculitis? #lives2018
The answers are surprising...

(And it looks like you should #POCUS everyone with suspected vasculitis 😁😜) #lives2018
Read 22 tweets
Now listening- Sheldon Magder: How does the venous system respond to changes in arterial pressure? #lives2018
“a compliant system is necessary for pulsation flow”- S Magder

#lives2018 #foamed #foamcc
The time constant of venous emptying is a new concept I’m not very familiar with #lives2018
Read 6 tweets

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