Discover and read the best of Twitter Threads about #im2023
Most recents (5)
Day 3/Lecture 1: CKD
1. Cr and cystatin C: Cr has a diet source, cystat C does not (nor muscular influence). Musc young pt w/o RF and neg UA with an inc Cr has just that, not AKI!
2. Indications for Nephrology Referral in patient's with CKD (see photo). #IM2023 @ACPIMPhysicians
1. Cr and cystatin C: Cr has a diet source, cystat C does not (nor muscular influence). Musc young pt w/o RF and neg UA with an inc Cr has just that, not AKI!
2. Indications for Nephrology Referral in patient's with CKD (see photo). #IM2023 @ACPIMPhysicians
4. SGLT2i + Finerinone (non-steroid MRA) attenuates CKD progress and HF hospitalization (not Semaglutide except w/CAD pts) even w/o hx of DM. + effect after max RASi on board.
5. Tx pts w/ DM+CKD with GFR > or = 30 cc/min w/ SGLT2i (Empa, Dapa, Canag).
#IM2023 @ACPIMPhysicians
5. Tx pts w/ DM+CKD with GFR > or = 30 cc/min w/ SGLT2i (Empa, Dapa, Canag).
#IM2023 @ACPIMPhysicians
6. SGLT2i not rec in DM1 pts (risk of DKA) and ADPCKD
7. Spiro/eplerenone with more data in HFrEF, Finerenone with more data in CKD.
8. Q of which to start first - SGLT2i or MRA, still remains.
9. Per KDIGO, sCr increase of 0.3 mg/dL in 48h = AKI.
#IM2023 @ACPIMPhysicians
7. Spiro/eplerenone with more data in HFrEF, Finerenone with more data in CKD.
8. Q of which to start first - SGLT2i or MRA, still remains.
9. Per KDIGO, sCr increase of 0.3 mg/dL in 48h = AKI.
#IM2023 @ACPIMPhysicians
Day 2/Lecture 5: For my fellow CVD Hospitalists - ACS updates in 2023!
1. Chest pain should not be described as atypical.
2. hsTNT: approved in 2017, more testing will result in more positive results (28% T1MI, 225% in T2MI)
#IM2023 @ACPIMPhysicians
1. Chest pain should not be described as atypical.
2. hsTNT: approved in 2017, more testing will result in more positive results (28% T1MI, 225% in T2MI)
#IM2023 @ACPIMPhysicians
3. In women with CP, focus on history that emphasizes accompanying symptoms more common in women with ACS.
4. ACC guidelines don’t specify when you should load with P2Y12 inhibitors. ESC guidelines clearly DO NOT rec them in patients w/ unknown coronary anatomy and….
#IM2023
4. ACC guidelines don’t specify when you should load with P2Y12 inhibitors. ESC guidelines clearly DO NOT rec them in patients w/ unknown coronary anatomy and….
#IM2023
…being considered for early revascularization strategy (high GRACE). Load ASA/statin and consult cards.
5. More stat sig bleed with prasug d/t higher degree or nonfatal MI.
6. Ticag>prasug in ACS patients based on PLATO trial results. Clopid is falling out of favor.
#IM2023
5. More stat sig bleed with prasug d/t higher degree or nonfatal MI.
6. Ticag>prasug in ACS patients based on PLATO trial results. Clopid is falling out of favor.
#IM2023
Day 2/Lecture 4: analyzing thought processes behind clinical reasoning with cases! Premature closure, framing and anchoring biases ARE a thing in the diagnostic process.
#IM2023 @ACPIMPhysicians
#IM2023 @ACPIMPhysicians
Think about your PR and schema based on the patient’s presenting complaint, trust your H+P, and resultant medical decision making! Practice holding off clinching Dx in PR. Can elaborate in A/P of note. Compare typical and atypical PRs. #IM2023 @ACPIMPhysicians
Keys to Clinical Reasoning:
1. Be skeptical - Trust but verify.
2. Deliberately engage in clinical reasoning
3. Foster a non-punitive culture for errors
4. Craft avenues for feedback
5. Identify the hard stops to prompt reflection and reassessment.
#IM2023 @ACPIMPhysicians
1. Be skeptical - Trust but verify.
2. Deliberately engage in clinical reasoning
3. Foster a non-punitive culture for errors
4. Craft avenues for feedback
5. Identify the hard stops to prompt reflection and reassessment.
#IM2023 @ACPIMPhysicians
Day 2/Lecture 2: full house for the one and only Brad Sharpe with Updates in Hospital Medicine! @UCSFDHM @ACPIMPhysicians #IM2023
1. Fluid resusc in pancreatitis: aggress (vs mod) fluids lead to more VOL in mild to mod disease
1. Fluid resusc in pancreatitis: aggress (vs mod) fluids lead to more VOL in mild to mod disease
2. Intermediate LMWH for VTE PPX form highest degree of efficacy and lowest bleeding risk
3. Beta-lactam or Vanco first - B-lactam first decreased mortality by 50% per 48h and 7d mortality rate (GN sepsis…)
@ACPIMPhysicians #IM2023
3. Beta-lactam or Vanco first - B-lactam first decreased mortality by 50% per 48h and 7d mortality rate (GN sepsis…)
@ACPIMPhysicians #IM2023
4. Cellulitis Over-Dx 40% of the time…alt <18%: venous stasis, stasis dermatitis, abscess; shorter LOS, less Abx; consider consult in atypical cases
5. ID Consult on outcomes for Pseudomonal bacteremia: 50% drop in-hosp and 30d mortality
#IM2023 @ACPIMPhysicians
5. ID Consult on outcomes for Pseudomonal bacteremia: 50% drop in-hosp and 30d mortality
#IM2023 @ACPIMPhysicians
1/
Super pumped to be at #IM2023 - would love to connect with so many of you while here!
Starting the day listening to early career promotion via non-traditional methods with @DoctorWatto @aoglasser @docwithapurpose
Super pumped to be at #IM2023 - would love to connect with so many of you while here!
Starting the day listening to early career promotion via non-traditional methods with @DoctorWatto @aoglasser @docwithapurpose
2/
Some takeaways from discussion:
✳️think about the next steps/long term vision and how work you do every day can become scholarly
✳️have a social media promotional buddy (who can amplify your big wins)
✳️make social media work tangible (outcomes) to support FTE, promotion
Some takeaways from discussion:
✳️think about the next steps/long term vision and how work you do every day can become scholarly
✳️have a social media promotional buddy (who can amplify your big wins)
✳️make social media work tangible (outcomes) to support FTE, promotion
3/
✳️from @aoglasser: find a mentor a few steps ahead of you who is doing this work to guide you
✳️create a portfolio and state your cases - use metrics & make it obvious
✳️guidelines: pubmed.ncbi.nlm.nih.gov/33263554/
✳️from @aoglasser: find a mentor a few steps ahead of you who is doing this work to guide you
✳️create a portfolio and state your cases - use metrics & make it obvious
✳️guidelines: pubmed.ncbi.nlm.nih.gov/33263554/
