Discover and read the best of Twitter Threads about #foamed

Most recents (24)

What is CORONAVIRUS? How might it affect ICU? Let's go back to basics and look at the emerging evidence bases, protocols and risks. #FOAMed #FOAMcc #WuhanCoronavirus #CoronavirusWho
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). #FOAMcc #FOAMed
A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.... which is what the virus that is widely reported on the media, and via the WHO and CDC etc are talking about. #FOAMed #FOAMcc
Read 52 tweets
What is going on with VITAMIN C in Critical Care? From basics to current day conundrums. #FOAMed #FOAMcc #VitaminC You can use the @threadreaderapp to read this Tweetorial!
First - let's look at what Vitamin C is. Unlike most mammals, we can't actually synthesise it! It's a water-soluble vitamin:…
Which is why it needs ingested, or... supplemented.
It's most important function (from a critical care perspective) likely comes from its function as an anti-oxidant. #FOAMed #FOAMcc…
Read 34 tweets
Thematic talk today about the ROLE of RCTs in Intensive Care Medicine. **TWEETORIAL** #ESICMphysio #FOAMed #FOAMcc
Randomised controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and are an integral component in the hierarchy of evidence which guide current clinical practice. #ESICMphysio ... but...
There are some problems...
Read 14 tweets
Today we're going to take a look at BIOENERGETICS in ICU in this quick Tweetorial :-) #ESICMphysio #FOAMed #FOAMcc
Bioenergetics = biochemistry concerned with the energy involved in making and breaking of chemical bonds in the molecules found in biological organisms. It can also be defined as the study of energy relationships and energy transformations and transductions. #ESICMphysio
Mitochondrial functions incl production of energy, activation of programmed cell death, and a number of cell specific tasks, e.g., cell signaling, control of Ca2+ metabolism, and synthesis of a number of important biomolecules.…
Read 37 tweets
So - the candidates from #ESICMphysio are off to engage in their workshops - so I thought... let's hold a virtual workshop here on MECHANICAL VENTILATION! #FOAMed @ESICM
Let's start off at the very beginning. This is a HUGE topic... obviously not going to cover everything. But let's start off at the very beginning and look at my Tweetorial from yday from Prof Barnes talk on the physics of ventilation... #ESICMphysio
@MedCramVideos do a REALLY good series for beginners - for free - on YouTube - 5+ videos on Ventilators and how they work:…
Read 30 tweets
The amazing @icu_nivare gives a talk on HOMEOSTASIS in ICM! Here is my Tweetorial on his brilliant talk. #FOAMed #ESICMphysio IT'S ALL ABOUT BALANCE.
Three main topics of this Tweetorial and @icu_nivare's lecture. All about the salt! #ESICMphysio
A brilliant overview of OSMOREGULATION and VOLUME REGULATION. #ESICMphysio
Read 20 tweets
@susannaprice gives us a whirlwind tour of VENOUS RETURN. Going back to basics is vitally important. This is her talk in the form of a Tweetorial at #ESICMphysio #FOAMed - don't forget to get involved in the conversation! #POCUS
"When asking about the RIGHT heart... Which RIGHT heart do you mean?" Normal? Pathological? It's complicated... #FOAMed #ESICMphysio
Starling = what goes in 'must' (hopefully) come out. Although venous return leads to COutput; COutput must dictate venous return! BOTH must be equal.... or it can't quite 'flow'.... #ESICMphysio
Read 15 tweets
The fantastic Prof Tom Barnes gave us a talk today on the PHYSICS of mechanical ventilation. This is his material via @ESICM #ESICMphysio in the form of a Tweetorial :) #FOAMed THREAD BELOW --> (continued...)
and so we start... Physics can tell us an awful lot about the way our bodies work - but it's SO different from clean 'physics' - this is applied physics. All patients lungs are different. These concepts however are vital to understanding key issues in ventilation.
Lung damage can amplify from the smallest of initial injuries. Positive feedback ++. Damage begets damage. This is why we try to mitigate pressures in our vent settings. #ESICMphysio Question is tho... how can we do it better?
Read 18 tweets
Before our LUNG sessions today... a quick look at what we already know about PPV and PEEP in ICU... #ESICMphysio #FOAMed
We've been looking at MV for decades. In 1986 - a good summary was published about its deleterious effects... Life saving yes, but nurses and doctors agreed it came with profound sequelae... #FOAMed #ESICMphysio and
In 2008 a great reflection was published in BJA - which did summarise that "Ventilation with PEEP is a proven, effective modality in both anaesthesia and ICU, despite the immense physiological derangement it causes" #ESICMphysio…
Read 10 tweets
1/ Time Management is today's #MedEdMethodsMonday #MedThread

As junior faculty & a #GIM fellow working on a #MedEd Masters, life is often a precarious juggling act. How do you stay on track in #academics?

#Medtwitter #MedEdPearl #FOAMed
2/ Components of Time Management
Gordon & Borkan’s lit review highlights 4 principles of time management

1. Set goals
2. Prioritize competing responsibilities
3. Plan & organize activities
4. Minimize wasted time
3/ Set Goals
- Set short- (1-3yr) & long-term (5-10yr) goals for your career
- Break long-term ends goals into bite-sized means goals
- Monitor past & current activities for goal compatibility
Read 11 tweets
Hi #medtwitter. Another awesome day deconstructing electrolytes. Join us as we diagnose and manage severe hypernatremia! #tweetorial #FOAMED #nephtwitter @TheSkeletonKG
What’s the highest level of sodium you have seen with patient walking in your office.…
You are on consult service and get a page from ER for a stat consult. Patients sodium is 183 !!! You rush to the ER to evaluate the patient. If you are allowed to ask one question, then what would it be?
Read 18 tweets
STAPHYLOCOCCAL SCALDED SKIN SYNDROME - A #dermatology/#dermtwitter #tweetorial!

Let's start with a question: You are seeing a new patient with a rash you suspect of being SSSS, but aren't sure if it might be bullous impetigo.

What test will help you differentiate the two?
The correct answer is wound culture! SSSS should be sterile or skin flora; bullous impetigo will have lots of staph grow out. Keep reading to find out why! 👇

But before we get there, let's talk about the SSSS exam. The pic is a good example of "sad facies." pc:@dermnetnz
The other great clue you are dealing with SSSS is the predilection for skin folds. This eruption can cause a high BSA of erythema --> desquamation.

SSSS is more common in the #pediatrics population, especially in kids <5 years of age (for all the #tweetiatricians out there!)
Read 14 tweets
Bcp d'externes ont du mal avec les ECGs. Je vous vois transpirer quand je vous demande ce que vous pensez de l'ECG qu'on m'apporte.

Je vais essayer de vous montrer comment je m'y prends, et quels sont mes moyens mémotechniques.
Un thread ECG, c'est par ici 💟
DISCLAIMER : Je ne suis qu'un interne de MG, loin de moi l'idée de me faire passer pour un cardiologue rythmologue aguerri. D'ailleurs, si je dis des conneries, n'hésitez pas à me reprendre.
L'idée est de vous transmettre une trame qui m'a permis jusqu'ici de me débrouiller.
Quand vous interpretez un ECG, soyez S.Y.S.T.E.M.A.T.I.Q.U.E
On ne le dira jamais assez.
J'utilise le "FRACHIQ". Chaque lettre correspond à quelque chose à regarder.
Si des étudiants me lisent, chaque fois que vous entendez le mot ECG, le mot "FRACHIQ" doit résonner en vous.
Read 42 tweets
Does Vitamin C, Thiamine, and Hydrocortisone cure sepsis?

Is this "cocktail" the wonder drug that the media hype implied in 2017 based on ONE before-after retrospective study?

Answers from the 1st major international randomized control trial ARE HERE! @JAMA_current.

Let’s not bury the lede here.

*This trial is PROFOUNDLY negative*

The authors (Fujii et al) found the vitamin C cocktail to have NO effect on the primary outcome: time alive and vasopressor free days.
The authors also found no effect in 9 of 10 secondary outcomes including 28 day mortality, 90 day mortality, need for mechanical ventilation, renal replacement therapy (dialysis) and others (see below).
Read 25 tweets
Here’s a great #ECG of a man who presented to the ER with crushing chest pain.

Here’s the ECG Computer Read:

"Non-specific ST abnormality, consider anterior subendocardial ischemia."

Take a good look at Leads V1-V3 and burn this morphology and pattern into your mind.

THIS is what Posterior #STEMI looks like on a Standard 12-Lead ECG!

Read 12 tweets
Reading more about venous air embolism after putting in/removing ~10 CVCs in last 2 weeks is kind of freaking me out so I decided to do a deeper dive

#FOAMed #FOAMcc #EmergencyMedicine
🔺Symptoms: acute onset dyspnea, cough, syncope, AMS, “mill wheel murmur" (specific but not sensitive)

🔺Clinical manifestation: acute R-heart failure, cardiogenic shock (hypotension, oliguria, JVD), acute embolic stroke (air bubbles pass thru patent foramen ovale)
🔺Clinical Dx but can use:
🔹EtCO2: decreased due to increase physio dead space & worsening V/Q mismatch
🔹EKG: signs of R-heart strain (R axis deviation, RBBB, peaked P waves), non-specific ST changes
🔹TTE/TEE: Air in cardiac chambers, RV dilation
🔹CXR: pulmonary edema
Read 7 tweets
Recently our team had to manage a patient who presented critically unwell from post-tonsillectomy hemorrhage - something you may not see that often but can be a true life-threat!

(pictured is only one of several buckets)

My tips here:


Tip 1: Call for help early!

This patient did well because of excellent #teamwork from scene to OR. We received an alert from the EMS team, and informed ENT early (not in house) to the situation and need for OR. Anesthesia and OR team were also informed to prepare for this

Tip 2: Keep the patient sitting upright

Position is key. This patient was awake & alert, and keeping them upright allowed them to spit out the blood. Give them the suction to use also.

Read 9 tweets
1/15 #Fever #tweetorial

Parents and paediatricians alike are obsessed with fever

We've all got fever fever 🔥 But it is SO misunderstood

Let's take a look at what fever actually is, and finish off with some myth busting!

#FOAMPed #FOAMed #IDTwitter #PedsICU #PedsID
Fever (pyrexia) is an elevated core body temperature as part of a physiological response to infection controlled by the hypothalamus

This is opposed to hyperthermia, a pathological elevated temperature

This is important, as your body is IN CONTROL. Fever happens on purpose
What temperature counts as a fever?

There's no strict definition (there's no really good data on what a "normal" temperature is...), but an arbitrary cut of off 38C is often used.

Its better taken in context; 37.8C following temps >38.5C is probably still a fever.
Read 15 tweets
#tweetorial time for SUPER FAST, no WINTER or (difficult) MATH evaluation of Anion-Gap Metabolic Acidosis:


The metabolic seesaw:

(more BC)

dAG = delta Anion Gap
dBC = delta Bicarbonate.
Toward the Center = more bicarbonate

This will all make sense in a moment.

Scene: patient w/ anion-gap metabolic acidosis

Your ?: is their compensation appropriate? Do I need more labs? Who and what is a winter and why do they have a formula?!?!

Answers: seesaw only, a chemistry is all you need!

Read 12 tweets

AKA "jams" (XR neg)

Often worse than they seem

EXAMINE the patient
Check FDP & FDS, EDC, and CENTRAL SLIP (Elson test) as well as jt stability

"XR neg, go home" = WRONG ANSWER

Acute tx much easier & more reliable than chronic
#medtwitter #foamed
If missed, central slip tears progress to BOUTONNIERE deformity

Perform Elson test to check CS integrity for all "jammed fingers"

Flex PIP over a table edge and hold down P2. Ask them to extend DIP. If they CAN, it's ABNORMAL & sign of tear (2/3) #medtwitter #foamed
Or, "Modified Elson test"

Align P2s back to back

Ask pt to extend DIP

Normally unable to, but if central slip torn, they can extend the DIP through the lateral bands

Either learn this or send all to hand for eval

Acute treatment = easy
Chronic = not (3/3)
#medtwitter #foamed
Read 4 tweets
“The Erythemas” – A #dermatology #meded #FOAMEd #tweetorial. pc:@dermnetnz

Ever get all the different #dermatologic terms jumbled up? Was it erythema nodosum, erythema migrans, or erythema multiforme?

Honest poll – Ever write “rash” b/c you couldn’t remember the diagnosis?
All kidding aside, these terms can get confusing. Remember though, derm terms are usually just descriptors of what you see. The name tells you all you need to know.

For example: Acute Generalized Exanthematous Pustulosis (AGEP) = pustules suddenly appeared everywhere!
So, the “erythemas.” First off, what does “erythema” actually mean? Well, according to my Google machine, it's from the Greek root “eruthros” meaning “red.” So "erythema" doesn’t add much to our knowledge of what the rash looks like other than it’s red, and so, likely inflamed
Read 15 tweets
@BenTritle presenting an Update on IR-guided central line access! #meded #foamed @CleClinicMD
Different central line access:
Dialysis catheters and Port catheters:
Read 10 tweets
"What is the best Venous Access Device for my patient?"

An #InterventionalRadiology (#Irad) #Tweetorial to address a frequent clinical dilemmas for #Medtwitter and #NurseTwitter


Type of VAD:

PIV: 3-6 cm, enter and terminate in peripheral veins.

US-PIV: US to reach deep veins when superficial veins difficult to palpate, ≥8 cm

Midline catheter: 7.5-25 cm, inserted basilic/cephalic vein), terminating short of subclavian. 🚫 vesicant infusions

CVC: duration 7-14 d, direct puncture of internal jugular, subclavian, or femoral veins.

TC : diff from CVC, seperate insertion site in upper chest and venipunture in neck
⬇️ risk of infection due to cuff
👍 location for catheter care
Read 15 tweets
Another day on service and you are starting with answering a page from PACU. "Hi this is nephrology fellow returning your page". "Great! This is Ortho, and our patient post op has low potassium here; I believe you call it HYPOkalemia" #Loveourorthopods #Tweetorial #medthread
Join us for our electrolyte abnormality du jour and learn how to break it down! #nephtwitter #medtwitter #FOAMED See our full post @RenalFellowNtwk >…
59 yo F with a hx of HTN, and HLP admitted for a left femur fracture; she was found down by her neighbor 3 days after her fall; awake and in pain. Now, patient is post op; and on labs: (baseline cr: 0.51). UA unremarkable.
Read 19 tweets

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