Discover and read the best of Twitter Threads about #foamed

Most recents (24)

Medical visualizations (vizs; #visualAbstract, #infographic, or #graphicalAbstract) are ⬆︎popular. In this tweetorial I'm going to detail how I make vizs to help you in your #meded/#FOAMed endeavors. Here's my portfolio for background: twitter.com/i/moments/1057…
There are four large domains that I consider when making a viz: Design, Structure, Content, and Textual Context (mostly in the parent tweet).
Let's go through each of these and discuss various facets that one might want to consider when designing a medical viz
Design: Audience
Know your audience, particularly if your audience is one that *doesn't* have access to the article that inspired your viz. If they don't, then recognize that your viz may be the 1st and only exposure to the science that the reader will have.
Read 22 tweets
#PedsICU #FridayQuiz
2/12term👶♀
PrevF+W
24h⬆️WOB
🚑🔜🏥
O/E
HR200-220
RR↕️-gasps
Sats85%(L=R)FiO2 15L/min
CRT6
A♈️PU
BP34/14-L=R
AF↔️
⬇️AE Lbase
❌murmurs
pulses feeble-palpable
❌rash
A)ETT plan-drugs/preox?
B)Post ETT plan
C)Ddx
D)InterpretECG&identify intervention @Τ=5
/1
Acronyms
F+W Fit&Well
↕️Variable
♈️Responds to voice
↔️Soft
L=R Equal bilaterally
⬇️AE Decreased air entry
Ddx Differentials
Cases from published peer reviewed reports
Answers next week
Focus on management
Tomorrow is the 1 year anniversary of the #PedsICU #FridayQuiz/2
🎈 🎉 🍰
It has grown into this collaborative #FOAMed clinical storytelling platform that is fun, evidenced based & credible.
It wouldn’t have been a success without all the people that supported it from the very beginning and all of you playing along /3
Read 13 tweets
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

@UVM_EM

1/
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.

jamanetwork.com/journals/jama/…

2/
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.
3/
Read 16 tweets
Want to hear a joke?

What's bumpy & painful, & "read" all over?

A #tweetorial/#medthread on ERYTHEMA NODOSUM!

Now that I've lost a few hundred followers from that terrible opener😳, let's get started👇👇

#MedEd #FOAMEd #dermatology #dermtwitter #medtwitter pc: @dermnetnz
1/
Why talk about erythema nodosum (EN) in the first place? Well, most medical professional recognize it, will see it, but may need some help past that! If that's you, read on.
1st, exam: As the name implies- red nodules! It's usually on the legs, & they are often ill-defined.
2/
EN is commonly seen in young healthy pts, & women >> men. Of course, the patient's history is critical, as EN is a reactive process to something else! It's inflammation in the subQ fat (a panniculitis). The rash itself isn't dangerous, but should prompt looking for a trigger.
3/
Read 13 tweets
@813JAFERD @Orthofacts Sugartong or radial gutter

Something that is MOLDED to the arm especially dorsally (for dorsal fxs) to buttress the fx

NO MOLD NO HOLD

The point of the splint isn't just protect arm from exterior contact. If done well, can also maintain reduction (assuming that is done well)
@813JAFERD @Orthofacts Imagine the red is what the fracture WANTS to do. Muscle pull is trying to displace it backward RED=BAD

Geen is the force you apply to reduce it

GREEN=GOOD

ADEQUATE REDUCTION NEEDS LOTS OF GREEN

FOR IT TO STAY, SPLINT MUST CONTINUALLY APPLY GREEN FORCE
#medtwitter #FOAMed
@813JAFERD @Orthofacts GRAY in above diagram = PLASTER

Note it's NOT orthoglass

Also note how it doesn't help to extend the splint beyond the metacarpals SO DON'T

GREEN force is applied to the wrist

Splint doesn't work unless you hold splint material UNTIL it HARDENS obvi #MedTwitter
#NoMoldNoHold
Read 6 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

#theme?
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
1/
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.
2/
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
3/
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
Hello #MedTwitter! Inspired by @tony_breu, this is a tweetorial on feeding tube indications, a technique for placement, and how to read the post film. Credit goes to Dr. @AvoArtinyanMD who taught me this technique @BCM_Surgery! @RASACS #FOAMed #Tweetorial @BehindTheKnife
The above is an image from a patient who I placed a tube on, and is being shared with the consent of (and actually at the request of) that patient. She endured 4 unsuccessful placement attempts, but was gracious enough to let me try when I came on to cover overnight-
- a reminder of the incredible courage and resilience of our patients. Which is another tip- whenever you are feeling run down slogging through the endless 80+ hr weeks, just think of your patients. No matter how bad your day is, they are enduring far worse, and deserve your best
Read 23 tweets
1/
Many think that Van Gogh was "dig toxic" and that it impacted his vision and painting. Was that really true? This #tweetorial explores whether the great artist was actually toxic on digitalis.

#medtwitter #FOAMed #meded #medicalhumanities
2/
First, we need to understand a couple of things:
▪️What ailed Van Gogh?
▪️How can digitalis affect vision?
3/
Many diagnoses have been applied to Van Gogh, from lead poisoning to porphyria.

Most historians believe his depression, mania, and convulsive episodes indicate:
⭐️Schizoaffective disorder
⭐️Epilepsy
Both of which were made worse by absinthe.

ajp.psychiatryonline.org/doi/full/10.11…
Read 13 tweets
Traumatismo Craneoencefálico
#TCE #TBI

Abro hilo, iniciamos, y abierto a tus comentarios
👨‍💻👩‍💻

Iniciamos con Abordaje Prehospitalario e Inicial en el TCE (parte 1/2)

Ayúdame a difundir @eduk_salud @aline_zarate @dralexgiles @Afedokmate1 @GMonraz @GabiOrtz
Todos los órganos son importantes, pero uno de ellos está procesando esta información, abrió la 👩‍💻 , desbloqueó el 📱, se despidió de sus seres queridos en la mañana.
Si nos falla un órgano, podemos suplantarlo, y seguimos siendo nosotros mismos. Pero si falla el 🧠, eso cambia.
El TCE lo definimos como una lesión estructural cerebral resultado de una fuerza física externa transmitida a la cabeza que interrumpe la arquitectura y función normal del cerebro.
Este hilo, nos vamos a enfocar al TCE severo.
Read 38 tweets
1/#Medtwitter friends, we are thrilled to share a #tweetorial courtesy of @StephenieLe11 and inspired by @DrDanRestrepo's episode on intrarenal AKI #FOAMed
clinicalproblemsolving.com/2019/03/21/epi…
2/30M presented with MSSA native tricuspid valve endocarditis and lower extremity edema was found to have AKI. What are the renal manifestations of endocarditis?
3/There are numerous causes of AKI in patients with endocarditis. Let us know if you think of others!
Read 11 tweets
Dear pharmacists,

Heparin SC x1 pre-op with a VERY HIGH 🛑warning due to severe thrombocytopenia! 😱That happened 6 months ago! Last platelets were 547K 1 week ago.🙄

What meaningless warning override button do you click when verifying?

Benefits outweigh risk
Dose appropriate
Insignificant
Low risk
Previously tolerated
Pt to be monitored
Not true allergy
See comments

If you say see comments, you better be writing something good.

I always go for, "benefits outweigh risk." Fastest one to reach with the mouse.
Open to suggestions for improving my alert overriding! Always trying to click through them faster lol. What tips do you have?

@KAckerB_PharmD @JasonMordino @m_feen @theABofPharmaC @ThePeoplesRuben @laxswamy #TwitteRx #FOAMed #MedEd
Read 3 tweets
Time for a #tweetorial/#medthread on:

#CALCIPHYLAXIS!

This is a devastating diagnosis often seen in inpatients, so this goes to all the @DermHospitalist & #hospitalists out there!

#FOAMed #MedEd #dermatology #dermatologia #dermtwitter #medtwitter @SHMlive @DermHospitalist
1/
First of all, what is it? The exact mechanism is unknown. What we do know is that there is calcium in the arterioles of the skin, with arterial thrombosis. This interruption of blood flow causes painful ulcers and retiform purpura. Remember this?



2/
That interruption of blood flow causes the clinical picture of calciphylaxis - retiform purpura with a predilection for fatty areas, violaceous borders, necrosis with ulceration, and TERRIBLE PAIN. Without the pain, I really think one needs to reconsider the diagnosis!

3/
Read 17 tweets
UTI-Club #3: lesión pulmonar inducida por la ventilación mecánica: VILI #tweetorial

interconsulta.online/uti-club-3-les…

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

1/
👩‍🦱 55a
⌨️POP hemicolectomía (CA Colon). 3 hs de cirugía, sin complicaciones
2/
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 ❎
3/
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 did Beethoven, possibly the greatest composer of all time, go deaf at the age of 28? Read on in this short Tweetorial to learn about a theory...

#medtwitter #FOAMed #MedEd #medicalhumanities
(theory co-described with Sunil Nair and Joseph Tremaglio)
2/
First, let's get Beethoven's review of symptoms, as documented in his letters and conversations 🤔:

+ Progressive hearing loss/tinnitus ➡️ total deafness
+ Chronic unilateral eye pain
+ Polyarthritis
+ Fatigue
+ Chronic abdominal pain and diarrhea
3/
Many theories try to explain Beethoven's deafness. Perhaps most popularly:

▪️Lead poisoning (supported by high lead levels found in the composer's hair)
▪️Paget's disease (auditory nerve compression from skull changes)
▪️Lupus
▪️Sarcoidosis
▪️Typhus

sciencedirect.com/science/articl…
Read 10 tweets
ALERT: Based on popular demand, #NAFLD #tweetorial for primary care starts here. I guess it's a risk of calling yourself the "hepatoMD".

Topics: What is #NAFLD? How to diagnose it? Who to worry about? Who to refer? How to monitor?

#medtwitter #FOAMed
#NAFLD is an umbrella term. On one end of the spectrum there is 'simple steatosis', and on the other end there is 'NASH'. NASH is the clinical entity liver folks worry about because it causes liver disease.
So what causes NAFLD?
Best way to think of it is as a metabolic disease caused by insulin resistance, that is caused by genetic/environmental/lifestyle factors leading to adiposity.
Read 22 tweets
Get your #dermatology jokes out now, because this is a #tweetorial/#medthread on....

TOPICAL STEROIDS!

Read on for tips on how to prescribe them, which one to choose, when does it matter, etc.

#MedEd #FOAMed #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
1/
Truly the workhorse of the #dermatologist's medicine chest, topical steroids are great for a multitude of reasons:
- Delivery straight to the organ of interest
- Systemic absorption is usually minimal
- Can be cheap (usually)

What on skin exam best suggests steroids may work?
2/
Erythema is a great indicator that there is inflammation. As such, topical steroids may be a good treatment option. However, there are some reasons NOT to use topical steroids. For example, if the rash is infectious (eg: tinea in photo1, herpes in photo2), steroids = no bueno.
3/
Read 18 tweets
(1/18) A Brief History of Coronary Angioplasty and the Roots of the Interventional Cardiology Field -- a #Tweetorial

#Cardiotwitter #FOAMed #ACCFIT #histmed @ACCCardioEd

Courtesy of @PopmaJeffrey & @ACCinTouch
(2/18) Dr. Werner Forssman (🇩🇪) performs 1st human #RHC (1929) by inserting a 65cm urologic catheter into his own antecubital vein and walking up to the X-ray department for imaging. Reportedly, he did this repeatedly! He left urology for primary care & shared @NobelPrize (1956).
(3/18) Dr. Fariñas (🇨🇺) performs aortography via femoral🔪 cut down (1941). Dr. Euler (🇩🇪) performs thoracic angiography by direct aorta puncture via esophagus (1949). Drs. Cournand & Dickinson (🇺🇸) open 1st US #cath lab (1945), publish extensively, and shared @NobelPrize (1956).
Read 26 tweets
Thanks, @MelBreggs for the mention, and thank you to @gopiastik for a great #tweetorial on #AGEP (acute generalized exanthematous pustulosis). I would add a couple thoughts here. Please read on!

#MedEd #FOAMEd #derm #dermatology #dermatologia #medthread PC: @dermnetnz
1/
First of all, the name AGEP can be confusing, but really all it is a description (we dermatologists just like to sound #fancy). If you break it down, Acute (really quick onset) generalized (everywhere), exanthematous (rash-y), pustulosis (pustules)!
2/
The exam is red plaques studded with pustules (see photo). These pustules can coalesce and become "lakes of pus!" The 2nd picture doesn't have pustules b/c all of them came together, lifted off, and left the "collarette" of scale (which means there's a footprint leftover!
3/
Read 12 tweets
Inspired by a question from @Econdoor , a #tweetorial about instrumental variables and the exclusion restriction.

#econtwitter #epitwitter #FOAMed
First, instrumental variables and causal graphs:

An instrument is a special type of variable that is associated (causally or otherwise) with the exposure you’re interested in.

The directed acyclic graph (DAG) below shows the basic required structure.
There are three key requirements for a variable to be an instrument:
•it is associated with the exposure
•it is not associated with the outcome EXCEPT through exposure
•it does not share any causes with the outcome (ie unconfounded).

We have these 3 properties in our DAG👇🏼
Read 26 tweets
I’m LJ, a UK Respiratory doctor & medical education enthusiast. I’m here to share my experience of creating respnetlondon.com #RespEd #RespisBest #MedEd #FOAMed #PressEdConf19 /1
UK medical doctors in training must navigate a complex landscape of changing accreditation requirements. Vital information is often dispersed across multiple emails & websites e.g. JRCPTB & PGMDE #RespEd #MedEd #PressEdConf19 /2
I built Respnet as a practical way to centralise information, but also to inspire #trainees & create a sense of belonging. Belonging, connection & community are important for motivation, fulfilment & #wellness, & help prevent #burnout. #RespEd #MedEd #PressEdConf19 /3
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
A short #tweetorial about how to quantify harms (or benefits) to help make decisions, inspired by that @BillGates tweet...

#epitwitter #FOAMed
If we want to use evidence to make decisions, the first step is to describe the problem. And the first step in describing the problem is to count how often it happens.
If we want to decide how to spend money to prevent the most death, counting deaths from shark bites & mosquito bites is a good place to start.

As Bill Gates did, we’ll find the number of mosquito bite deaths is much higher! Mosquitos are probably a good place to spend our money!
Read 10 tweets

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