Discover and read the best of Twitter Threads about #foamed

Most recents (24)

The Swan-Ganz Catheter 🦢🫀

AKA, the Pulmonary Artery Catheter or PA Catheter.

A thread discussing the basics of our PA Cath:
#MedTwitter #FOAMed #ICU
The PA Cath is a specialized venous catheter that can give us a whole host of values related to cardiac function, hemodynamics, and perfusion. 🧐
This cath is a long balloon tipped cath that enters the venous system. It is passed into the RA, through the tricuspid valve, into the RV, and then finally through the pulmonic valve with the tip resting in the pulmonary artery (PA). 🫀
Read 11 tweets
A young man in South Africa presented with acute onset of confusion, headache and vision impairment for the last two days after consuming alcohol. What is the likely diagnosis? #Medtwitter (Image @Radiopaedia, case by Hidayatullah Hamidi)
@Radiopaedia Imaging showed bilateral putaminal hemorrhagic necrosis, typically seen in methanol toxicity.

emdaily.cooperhealth.org/content/emconf…
Toxic alcohols (source unknown) #FOAMed
Read 3 tweets
From the 📦/📩 by a🫂series @PatSmitty1985
What is the dx
💻 using #PMcardioApp
Difficulty level:⭐️⭐️⭐

▪️16 yo
▪️ -sig ⚕️ hx
▪️p/w sz-like activity/spon recovery ~ 30 s (can't recall event)

What is the prob dx? Poll next

#FOAMed
#MedEd
#MedTwitter
#CardioTwitter
#EPeeps
What is the prob dx?
🐦 ur reply if none of the 4 choices

MI-myocardial infarction
SR-sinus rhythm
AJR-accelerated junctional rhythm
isoAVD-isorhythmic AV dissociation
WPW-Wolff-Parkinson-White

MI inferior wall
SR, AJR (isoAVD)
Pulmonary embolism
WPW pattern/syndrome
Tnx for the replies. I think this is the easiest so far & almost everyone got it. Pt was referred to cards coz of WPW. 📩@PatSmitty1985
Read 3 tweets
ICU stories (a boring one…): If you work in a general ICU of a community hospital in United States, one of the common admissions you will get is the unfortunate resident of a nursing home or rehabilitation center that lives there for several decades & at some point becomes
febrile/“altered” & is sent to the ED for “evaluation”. The course is so predictable that we usually consider these admissions “boring”. This is the case of a middle-aged pt w cerebral palsy/mental retardation/seizures (on valproic)/PEG-chronic Foley in place who was sent to
the ED for fever+hypotension+tachycadia. Labs: WBC 15k, lactate 4.0. UA -as usually- suggestive of UTI (WBC>50, +bacteria, +nitrite, +esterase). CXR “clear” & pt w sat 99% on room air. Received ivf, Abx (pip/tazo + vanco) but due to persistent ⬇️BP, norepinephrine gtt was ordered
Read 25 tweets
From the archives/sent by a friend series
What is the rhythm
Digitized using #PMcardioApp
Difficulty level:⭐️⭐️⭐️⭐️

▪️70 yo
▪️h/o DM HTN HF
▪️p/w palpitations

What do you think is the rhythm? Poll next

#FOAMed
#MedEd
#MedTwitter
#CardioTwitter
#EPeeps Image
What do you think is the rhythm?
🐦 ur reply if none of the 4 choices

AF-atrial fibrillation
ST-sinus tachycardia
VT-ventricular tachycardia
AFL/AT-atrial flutter/ atrial tachycardia
This is the ff-up ECG. This is not SR. The 🔑 to rhythm dx is in the PRI (long lead). You need a caliper to 👀 the PR difference. If you have 🦅👀 the extra P can be 👀. So, the ECG case can be explained with 1 reason.

Read 4 tweets
New to the ICU?

Osler's catalogue of modules is completely free, and you can even print off a certificate of completion for your records!

Here's 10 great modules to get you started

#intensivecare #intensivist #ICU #FOAMed #FOAMcc #medtwitter @CICMANZ @anzics @ANZCA @acemonline
If your're going to do invasive procedures, you need to get the basics right

osler.app.link/CztXIRjyntb
If you're new to mechanical ventilation, this will give you the basics

osler.app.link/dnoTmYYRkvb

#mechanicalventilation
Read 12 tweets
Are you a #juniordoctor or #medstudent?

Here's 10 great FREE modules to help get you started on the wards!

#meded #medschool #tipsfornewdocs #juniordocs #FOAMed #medtwitter #medstudenttwitter #juniordoctors #medstudents
Occasionally you'll need to perform sterile procedures. Make sure you prepare the best you can

osler.app.link/CztXIRjyntb
Providing basic life support is a core skill for all healthcare staff

osler.app.link/u4fe8uqyntb

#basiclifesupport #bls #FOAMresus #resuscitation
Read 13 tweets
It's December, already. The time of the year when I am trying to spend every last cent of the annual allowance given to us for continuing medical education (CME) by our employer. In essence, this is money that we have worked for and, since it won't carry over to next year, I hate
leaving it on the table. The problem is that if you buy a conference or a study course now, you have to watch everything - and submit proof of attendance/completion - before the end of the year. So, it's a very busy month dedicated to studying/reviewing educational material!
For example, I just finished watching the last one of the 93 lectures from The Hospitalist & Resuscitationist 2022 conference #HR2022. If you are an intensivist/internist/family medicine/EM physician, I have no doubt that u will find several pearls to bring back to your practice
Read 5 tweets
TOP 🔟 ECHOCARDIOGRAPHY CASES ➡️ November 2022 (personal opinion) #medtwitter #pocus #echofirst #cardioed #cardiotwitter #medicaleducation #ENARM #FOAMed
⬇️🧵
10. Subaortic membrane in the outflow tract of LV @Irina67790690
9. Septal rupture complicating acute myocardial infarction @CyntiaMachain
Read 12 tweets
1/Asking “How old are you” can be dicey—both in real life & on MRI! Do you know how to tell the age of blood on MRI?

Here’s a #tweetorial on how to date blood on MRI
#medtwitter #neurorad #radtwitter #RSNA2022 #RSNA22 #radres #neurosurgery #neurology #meded #neurotwitter #FOAMed Image
2/If you ask someone how to date blood on MRI, they’ll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age

But mnemonics are crutch—they help you memorize, but not understand. If you understand, you don’t need to memorize Image
3/If you look at the mnemonic, you will notice one thing—the T1 signal is all you need to tell if blood is acute, subacute or chronic

T2 signal will tell if it is early or late in each of those time periods—but that type of detail isn’t needed in real life. So let’s look at T1 Image
Read 21 tweets
1) I am presently working on curating the best free resources for medical professionals.

I will focus on the medical subspecialties.

I will also post some of my own work.
2) Why am I doing this?

Because FOAMed is the future.

Because we have some amazing work on Twitter and other SM that does not get the visibility it deserves.
3) All creators will be credited.

If by any chance, it is not --> please bring it to my attention.
Read 4 tweets
1/Tonsillar or peritonsillar abscess? That is the question! When you look at a neck CT, do you know which one to say?
A #tweetorial on #tonsillitis complications
#medtwitter #radtwitter #neurorad #radres #meded #FOAMed #FOAMrad #HNrad #medstudenttwitter #RSNA2022
2/First some anatomy. Palatine tonsils (or faucial to the cool kids) sit in the oropharynx between the two palatine arches: the palatoglossus arch in front and the palatopharyngeus arch in back. These are easily visible on physical exam.
3/These archs are actually just mucosa draped over the palatoglossus and palatopharygeus musculature, like kids drape sheets over themselves to dress up for Halloween.
Read 13 tweets
Cinco pasos para interpretación de gasometria arterial 💨🩸

Abro hilo 🧵
1️⃣pH: ¿alcalosis o acidosis?

👉🏻 Menor a 7.35 ACIDOSIS
👉🏻 Mayor a 7.45 ALCALOSIS
2️⃣PAO2
👉🏻 menor a 80 mmhg HIPOXEMIA
Read 7 tweets
Abdominal Vein Milking demonstrating rostral blood flow of Caput Medusae via @bobvarkey

grepmed.com/?q=milking

#foamed #meded

Compare to this example of caudal blood flow in SVC Stenosis

grepmed.com/?q=svc+physica…

See this great thread by @DrArunKValsan on abdominal vein physical exam pearls Image
Read 3 tweets
1/They say form follows function! Brain #MRI anatomy is best understood in terms of both form & function

A #tweetorial on how to remember important functional #brain #anatomy

#meded #medtwitter #neurosurgery #neurology #neurorad #FOAMed #FOAMrad #radiology #medstudent #radres
2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.
3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)
Read 12 tweets
Neuroendocrine tumours

Arise from neuroendocrine cells that can exist all over the body & have special traits ie hormone producing

Risk is ⏫ in 👥 with a family Hx of 🧬 syndromes ie MEN1

Common 🗺
👉🏼 lungs 30%
👉🏼 GIT 34%
👉🏼 pancreas 7%
👉🏼 unknown 15%

🧵 1/4
Can also be classified as functional vs non functional (60%)

Symptoms result from
👉🏼 tumour growth - obstruction
👉🏼 excess hormone
👉🏼 B symptoms

2/4
Common tumours ➡️ 🫁 💩 🧪

Lung ⤵️

🫁 well differentiated - 5HT, ACTH, GHRH

🫁 Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)

GIT ⤵️

💩 5HT, gastrin, insulin, glucagon, vasoactive intestinal polypeptide (VIP). Less common PTH, ACTH

3/4
Read 4 tweets
@girardDev presents on managing the obese parturient at #OAA3dc2022. He sets the bar high for the future of presentations at #SOAPAM2023, #OAA23, #ASM23SYD: a QR code that links to all his references as well as a pdf of his slide deck - perfect for #OBAnes #SoMe & #FOAMed.
The value of PERI-oxygenation in obesity is not to be ignored. All patients will go blue, perioxygenated ones take 52 seconds longer (how long it feels depends on the sats?). We all remember the troop pillow, but do we remember the stool? Ergonomics of intubation #OAA3dc2022
@mbrrace meeting 10 November. Hope to see some live tweets of key messages @SusannaStanford. “We are ALL part of the solution” #OBAnes and obesity is definitely part of the puzzle, preventing it part of the solution. #OAA3dc2022
Read 11 tweets
MAPSE in #IntensiveCare (with examples)🧵#FOAMcc #FOAMed #MedTwitter #Hemodynamic #POCUS #EchoFirst #CriticalCare
Take homes:
1⃣ Redefining "the hyperdynamic heart" with #MAPSE
2⃣ MAPSE is better than EF in the #ICU
3⃣ Linking MAPSE with supply/demand-ischemia
1/n
1⃣ Can MAPSE redefine "the hyperdynamic heart?
The term "hyperdynamic LV" - EF > 55% - is misleading. It has no relation to a hyperdyanmic circulation; SV/CO. Someone bleeding to death has a hyperdynamic heart, but the circulation is life-threatening hypodynamic.
2/n
MAPSE is cardiac motion, and defining the hyperDYNAMIC heart as good cardiac motion makes perfect sense. Recent geometrical analysis of cardiac pumping shows that MAPSE is the main determinant of SV. Fig from @mugander: tinyurl.com/mxbfmcyk
Why?
3/n
Read 17 tweets
A case of low ScvO2 (60%), high PvaCO2 (8.2 mmHg), fluid intolerance (CVP 11) and fluid responsiveness (PPV 17). What's the physiology and what to do?
#FOAMcc #Hemodynamics #ThePeoplesVentricle #FOAMed #Fluidtolerance #Cardiotwitter #CriticalCare
Post-cardiac surgery. MAP 70, HR 95, low dose pressor. High CVP (11 mmHg) with pathologic waveform of x < y-descent. PPV > 17 despite low Vt (< 6 mL/kg). Normal blood gasses, normal lactate.
#EchoFirst #POCUS #TEE: Mildly reduced LV function; #MAPSE 5.75 mm. EF visually 45-50%. Small EDV.
Read 11 tweets
Alcohol withdrawal syndrome: I don’t know if u have a similar experience in other countries (or other places in the States) but I've recently seen a big spike in alcohol abuse-related disorders, especially alcohol withdrawal syndrome (AWS). I'm obviously referring to severe AWS
that eventually will need to come to the ICU (if we have a bed available!). There are many fantastic, well-searched reviews on this topic but it may be hopefully interesting for some if I put “my way” out there & also for me to learn from your experience. Even though the focus
will be on the neuropsychiatric component, I believe it is quite important to highlight other parts of AWS management. To this end, I will use the assessment/plan “per organ” approach which is commonly used when we write progress notes here in US. Here it goes:
Read 26 tweets
1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!

Here’s a #tweetorial of a lumbar grading system that’s easy, reproducible & evidence-based

#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad
2/Lumbar stenosis has always been controversial. In 2012, they tried to survey spine experts to come to a consensus as to what are the most important criteria for canal & foraminal stenosis. And the consensus was…that there was no consensus. So what should you use to call it?
3/Well, you don’t want just gestalt it—that is a recipe for inconsistency & disagreement. But you don’t want to measure everything either—measurements are not only cumbersome, they introduce reader variability & absolute measurements don’t mean the same thing in every patient.
Read 15 tweets
1/One important aspect to stroke care is well... ASPECTS.😂

Here’s a #tweetorial to help you remember this basic #STROKE scoring system

#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radiology #radres #neurology #Neurosurgery #CT #meded #neurotwitter
2/ASPECTS stands for “Alberta Stroke Program Early CT Score.” It is meant to replace gestalt-ing what percent of the MCA territory is infarcted. Instead, it uses a 10-pt score to semi-quantitate the amount of infarcted tissue in the MCA territory on non-contrast head CT
3/You can think of it as a scorecard for the MCA.

For each region of MCA territory NOT infarcted, the pt gets one point

So the highest score possible is 10, and lowest score possible is 0
Read 18 tweets
☑️HALLOWEEN 2022 @AirwayMxAcademy and @dasairway airway nightmare case🎃You are a critical care doc and decorating your ultimate Halloween party👻underwater cave with a healthy friend. The room is now flooding with water and your friend falls down on the rocks…oops😳1/13 #meded Image
2/13 “Are you okay?”Yes but I have difficulty breathing and it hurts. There is 1 scuba🤿unit, and you see a HFNO device & oxygen cylinder. You know that underwater breathing is possible with HFNO. How much flow is needed to swim 0,5 m below surface & b able 2breath underwater?
3/13 First you check the oxygen tubing which is long enough, than you check the class E oxygen cylinder: 1000 PSI. Save PSI 200. How much time/oxygen do you have at 40 l/min to swim underwater? #halloweenairway #foamed #foamcc #airway
Read 13 tweets
Cystic supratentorial brain tumors in adults, the usual and the unusual. Non-exhaustive list of differential diagnostic considerations. The PA had a nice mural nodule, not shown on this figure. #radres #neurorad #FOAMrad #FOAMed #MedEd #RadEd
impossible to tell which is which on only T1-images with GD. Whenever I see an intra-axial tumor in an adult, I automatically consider GBM and metastases as they are the most frequent brain tumors in adults, so even when the tumor looks strange or atypical, they are a good bet.
Brain abcess and epidermoid cyst are pretty straightforward on diffusion-weighted images as their content is very diffusion restrictive. Brain abscess has a thick enhancing capsule, epidermoidcyst doesn't.
Read 8 tweets

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