Discover and read the best of Twitter Threads about #foamed

Most recents (24)

THREAD: SGLT2 inhibitors for #diabetes

1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"

👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations

✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:

The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality

✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾‍💻

#T2DM #medsafety #FOAMed #MedEd #diabetes
Read 6 tweets
1/
Join me for a #dermtwitter #tweetorial on:

SCARS AND KELOIDS!

#MedEd #FOAMEd #medstudenttwitter #MedTwitter

Let's start ourselves off with a question: Which one of the following conditions will lead to scarring?
2/
The correct answer is Pyoderma Gangrenosum! This illustrates a quick first point - scarring only occurs if you damage the skin into dermis and beyond. Epidermal damage heals without scarring, which is why the first 3 don't lead to scarring!
3/
So what exactly is a scar?

Scarring is a normal part of healing that at its root, is extra collagen laid down to repair skin injury.

However, sometimes the process gets out of hand and exuberant which leads to hypertrophic scars (pic 1) keloids (pic 2)!
Read 12 tweets
ANSWER:
A patient is admitted hypotensive with E. Coli sepsis.

The consultant asks for gentamycin and adds:

"Please don't under-dose"

Why is the initial dose of gentamycin so important?
Gentamycin, like other aminoglycosides exhibit concentration dependent killing

The initial phase of rapid bacterial killing is induced
by passive ionic binding of the drug to bacterial lipopolysaccharide.

The killing rate is directly related to
initial drug concentration
A second phase of slower bacterial killing is associated with decreased energy-dependent uptake of the aminoglycoside

This rate is independent of the initial drug level
Read 5 tweets
Watch here TOMORROW for a new accredited, #tweetorial by neurointensivist @stephanamayer on optimizing DAPT and other interventions for secondary stroke prevention after #AIS or #TIA. Earn 0.5 CE/#CME credits: #physicians, #nurses, #pharmacists! #NoMercyOnStroke @svinsociety
1) Welcome to a #tweetorial on how to optimize therapy for secondary #stroke prevention. Accredited for 0.50 credits! I am your host @stephanamayer. Be sure to see prior tweetorials in the broader cardiometabolic space and earn more CE/#CME credit at cardiometabolic-ce.com Image
Read 54 tweets
Be sure to join us TOMORROW here on @ckd_ce for our first ORIGINAL accredited content . . . from none other than @edgarvlermamd . . . whom you #kidney-oriented clinicians will know as a comforting and familiar presence and as an AWESOME teacher. He'll be talking about ...
...IgA nephropathy (#IgAN) from the ... perspective of the 2021 @goKDIGO #guidelines. Lots to learn about this common cause of #CKD worldwide! Free CE/#CME for #physicians #nurses #PAsDoThat #nursepractitioner @ANNAnurses @neph_PAs @pharmacists @nephondemand @IgAN_JBarratt
Read 35 tweets
Amazing learning today on in-hospital cardiac arrest from an ACEM source. Will share.

(#FOAMed)
If your cardiac arrest patient is one of the 20% found in VT or VF (shockable rhythms): 40% survival.

If no pulse (PEA), or old, or COPD, or aortic stenosis, or metastatic cancer: 0-5% survival rate.)
'Out of hospital' arrests in NZ have a low survival rate: around 13% surviving to hospital discharge.
Meaning around 6 people in 7 die.
(Bystanders doing CPR helps greatly, along with AED use!)
Read 9 tweets
Don’t miss a new accredited #tweetorial launching TOMORROW here on @cardiomet_CE. #Cardiologist, #SoMe education advocate, and true #Renaissance man @CMichaelGibson will be discussing a novel #aspirin prep that has PK/PD like plain #ASA . . .
. . . but a different site of absorption--with greater predictability than ECASA. DON'T MISS IT!! @DLBHATTMD @cpcannon @AnnMarieNavar @DrM_ODonoghue @DrMarthaGulati @practicalcardio @GuyattGH @DrMauricioCohen @SVRaoMD @ASPCardio @PlateletDoc @stephanamayer #FOAMed #CardioTwitter
1) Welcome to a #tweetorial where we’ll explore how changing the formulation of #aspirin & where it's absorbed in the GI tract can ⬇️the risk of acute GI injury, but still maintain predictable absorption. This program is accredited for 0.50h CE/#CME. I am @CMichaelGibson. #FOAMed Image
Read 42 tweets
ICU scenarios: it's 5:40 am. After a rapid response is called, the team is bringing to the ICU a 60 yo male pt that has been managed in the COVID-19 ward for 12 ds with NIV/steroids/tocilizumab/empiric antibiotics and anticoag. Pt pulled his mask and desated to the mid-60s...
When he arrived to the ICU, sat was in mid-80s (NIV-Fio2 100%/PEEP10), not much ⬇️ than the last few ds (it was ~90%). He is breathing in the high 20s, in mild/mod resp distress (for whatever that means!). You realize that: i) there is nothing else to offer besides intubation/MV
...and ii) he can probably "go" for a few more hrs without being intubated. You already had a brutal night. You've been up 10.5 hrs. You have no "help" (no resident/fellow/NP/PA). The am crew (MD + PA) arrive at 7 am. Your resp therapists sign-out at 6 am. What would you do next:
Read 6 tweets
1/
Hi #dermtwitter/#medtwitter! Our last (for now!) #tweetorial/#medthread on nails! This time it’s...

PEDIATRIC NAIL CONDITIONS!

Education from @naildisorders and the @jmervak team!

@societypedsderm @PeDRAResearch #medstudenttwitter #medtwitter #meded #FOAMed
2/
Beau’s lines (transverse ridge) and onychomadesis (nail shedding) common in kids! Often seen in a post-viral setting.

Common culprit = hand foot mouth disease!
3/
Congenital malalignment of the great toenails – lateral deviation of the first toenails. More common than you think. Start looking at more toes and you’ll see it! Can improve with time or persist. Risk for nail thickening or ingrown nails.

pc: sciencedirect.com/science/articl…
Read 12 tweets
Analogy: The humble coffee cup #KidneyWk

This is going to be good!
Challenges

Busy clinical services, balance, sub-specialization, research demands, business getting complex. #KidneyWk
Getting to the goal! #KidneyWk
Read 18 tweets
OMI/NOMI vs STEMI/NSTEMI by @srrezaie at #ResusX21

Is it time to change how we think about acute coronary occlusion (ACO)?

❗️OMI/NOMI isn’t just dependent on millimeter EKG criteria

✅ Need to switched the paradigm, STEMI/NSTEMI model can miss up to 1/3rd of ACO!!
DIFOCCULT Trial (2020)

❗️In NSTEMI group: 28.2% re-classified as having ACO. EKG findings in this group: subtle ST changes, hyperacute T wave, subtle anterior STEMI

‼️OMI/NOMI approach is more sensitive & had improved long term mortality
In another study, STEMI/NSTEMI paradigm missed significant number of ACO & led to ⬆️time to cath

✅OMI/NOMI allows to identify more Pts with ACO & salvageable myocardium that SHOULD get cath. It allows us to also move away from relying only on millimeter change on EKG

#FOAMed
Read 3 tweets
@HedayatiMD breaking down wide complex tachycardias at #ResusX21

❗️Know how to differentiate WCTs
‼️If unstable ➡️ treat as VT until proven otherwise

❓What is fascicular VT❓More below👇🏼

#FOAMed #FOAMcc #CardioTwitter
⚡️Ventricular Tachycardia⚡️

🔺Very wide & regular
🔺Lead I & avF: both downward ➡️ extreme axis
🔺V1-V6: look for polarity ➡️all QRS the same (upward or downward)
🔺Fusion beat: wide complex QRS followed by narrow QRS
🔺Capture beat: run VT w/ 1 random narrow QRS then back to VT
SVT w/ bundle branch block (BBB)
🔺Different polarity in V1-V6 as opposed to VT
🔺Look at previous EKG for known BBB

If too too fast ➡️ consider accessory pathway ➡️ SVT with WPW

#FOAMed #cardiotwitter
Read 4 tweets
Dr @sergio_zanotti on Antibiotic Rationale at #ResusX21

⏱When to start antibiotics

💊Optimizing antibiotics

❌When to stop antibiotics

#FOAMed #FOAMcc
⏱Timing of Abx Initiation⏱

✅In Septic Shock, goal is to administer Abx ASAP (within 1hr)

🔺For every hour of delay of antibiotics in septic shock ⬆️ 6.1% odds ratio of death

🔺Less severe infection/sepsis > you have more time to decide what/if patient needs antibiotics
💊Which Antibiotic To Start?🦠

❗️Adequate choice affects mortality

Three factors to consider when making choice:

1️⃣Anatomic source of infection
2️⃣Pt characteristics (i.e. indwelling line > need MRSA coverage)
3️⃣Local antibiogram!

❌No role for empiric double coverage

#FOAMcc
Read 5 tweets
1/12 The cognitive load on rounds can be high, so I like using daily e-mails as an adjunct to teaching on rounds. Here is a 🧵 on my approach! #MedTwitter #MedEd #FOAMEd
2/ I am of the opinion that you can form an outline of a lesson plan BEFORE you even start on service! My group attends for 14 days at a time, so this tells me how much “time” I have allotted to teach (more on this later).
3/ Make sure to include every learner who will rotate with you while you are on (I use amion to figure out which trainees are on with me). They might appreciate getting learning when they are off service and if there is an ongoing thread of teaching, they won’t miss out!
Read 12 tweets
1/
Join me for a quick #tweetorial/#medthread on:

Pearls for the #Dermatology Exam!

#MedEd #dermtwitter #medtwitter #medstudenttwitter #FOAMed

First a question - What do you think when someone asks for your help with a rash?
2/
Regardless how you answered, I hope to teach you something today! Let's start!

"In #dermatology, we don't do an H+P, we do a P+H."

The exam is perhaps most important. You can use it to narrow down your ddx! Then, you use your history to further work toward the right dx.
3/
"If there's scale, there probably is epidermal involvement."

Scale usually implies action in the epidermis. This doesn't rule out anything in the dermis or subcutis, but just that the pathology includes action up top.

Check out my #tweetorial on scale
Read 10 tweets
1/
Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:

ONYCHOMYCOSIS- nail fungus!
 
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
2/
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors

Pro tip- check the feet for tinea pedis if you suspect onychomycosis!

@podiatrytoday
3/
Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.

The big toenail is most frequently affected.

Fingernail involvement without also have toenail involvement is uncommon.
Read 14 tweets
*Hyperdynamic LV: Harbinger of Doom*

This clincial scenario has played out before my eyes on multiple occasions

Echo performed on a pt with undifferentiated shock

"EF > 70%...hyperdynamic.. all good."

A hyperdynamic LV is more sinister than you may think. Lets find out why..
Consider why the LV would be hypercontractile and avoid the knee jerk reflex to assume that it is ONLY due to hypovolemia/hemorrhage i.e decreased RV preload/low mean systemic filling pressure .
Start thinking in terms of LV preload.
1. RV failure
2. Mitral regurgitation
3. VSD
4. Vasodilated state

You need to actively rule out these conditions in the right clinical context.
Read 8 tweets
Der Freitagsfall:
38-jähriger Patient ohne bekannte Vorerkrankungen. Stellt sich vor wegen vor 30min erstmals, in
Ruhe vor dem Fernseher aufgetretenen Brustschmerzen, die er noch nie so hatte.
Das sofort geschriebene EKG:
#Notfallpflege #ZNA #INZ #FOAMed #Rettungsdienst #INA Image
Frage 1: Was für ein Herzproblem haben wir hier?
Frage 2, etwas schwieriger:
Welches Gefäss ist wohl verschlossen?
Read 12 tweets
Welcome to our final Goggledocs tweetorial from this #EASD2021 takeover!
Over the last few days we have discussed all things cardio-reno-metabolic including SGLT2s, GLP1s, dual agonists, triple agonists….but not mentioned much about type 1 diabetes…
So today we are going to end on a cardiometabolic focused look at Type 1 Diabetes with data from #EASD2021 interwoven in... stay tuned!
One of the key sessions and guidance from @EASDnews #EASD2021 was the formalized joint ADA-EASD consesnsus report for management of type 1 diabetes… care.diabetesjournals.org/content/early/…
Read 61 tweets
So it’s our first HOT TOPIC

The convalescent plasma arm of @remap_cap

Currently on channel 1 at #lives2021
@remap_cap Inclusion criteria below

Intervention: 2u convalescent plasma vs standard care
Read 6 tweets
1/
Hi #dermtwitter! I'm working with @jmervak et al, who put together this amazing #tweetorial on

NAILS!

Specifically, findings in the setting of systemic diseases: let nails help your diagnosis!

Coordinated with @naildisorders

#medstudenttwitter #medtwitter #meded #FOAMed
2/
First things first, do you mind telling us who you are?
3/Let's begin: Beau’s lines! Transverse depression across the nail. Means the nail briefly stopped growing and started again.

Seen weeks after nail injury! Or, if it's seen on multiple nails, ask about febrile illness (like post #covid19) or stressors like SJS or chemotherapy.
Read 16 tweets
Be sure to join us RIGHT HERE on Monday for the launch of a new accredited #tweetorial on continuity of care in the mgt of #migraine, by expert author Annika Ehrlich, MS, FNP-C, AQH, CNRN (@EhrlichNP). Follow us so you don't miss a tweet on your way to 0.75h CE/#CME credit! Image
1) Welcome to an accredited #tweetorial on #migraine, focusing on continuity of care, education, communication & resources for you & your patients. I am Annika Ehrlich, MS, FNP-C, AQH, CNRN (@EhrlichNP). Follow this thread & earn 0.75h CE/#CME credit! @academiccme @UCSFHospitals Image
2) This series is supported by an educational grant from AbbVie and is intended for healthcare providers. Faculty disclosures are listed at academiccme.com//migrainetweet…. Program chair Dr. Tesha Monteith (@headacheMD) and I welcome your participation! #FOAMed #neurotwitter
Read 28 tweets
Bone marrow biopsy (BMB) FAQs! Ever wondered what it's all about? Keep reading... 👀
What makes up a BMB? Usually it includes 2 samples - the aspirate (liquid marrow 🩸) and the trephine (bone core 🦴)
Why do we need 2 samples? The aspirate allows us to individually look at each BM cell under the microscope 🔬 (e.g. WBCs, RBCs) and classify them via flow cytometry (a method of identifying and measuring pathological cells using their surface markers e.g. CD19 for B-cells)
Read 11 tweets
Demystifying APRV-TCAV yesterday at #TCAV course. Thank you for the invite @ThinkingCC #FOAMed #ventilation #COVID19 #ARDS
Initial settings - important to distinguish between rescue and post op atalectasis.

Set :
P high to 2mmHg less than patient's peak pressure on current settings.

P low to 0mmHg.
To set your resp rate:

60/current resp rate is your Time at high pressure (T high) + Time at low pressure (T low)

Eg: Resp rate of 25
60/25 = Thigh + Tlo = 2.4 secs
Read 11 tweets

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