Discover and read the best of Twitter Threads about #meded

Most recents (24)

1/ @umichmedicine we're quickly developing more and more ICU experience with #COVID19 patients and have open sourced all our pathways, protocols and lessons learned here: med.umich.edu/surgery/mcccn/ #MedEd #FOAMED
2 / #COVID19 Airway response Guidelines for Outside of OR Airways med.umich.edu/surgery/mcccn/ #MedED #FOAMED
3 / #COVID19 Emergency Department Airway Management Algorithm med.umich.edu/surgery/mcccn/ #MedED #FOAMed
Read 7 tweets
Hello guys!

Here's another hopefully helpful/educational thread on #COVID19 transmission & quarantining! 

Few important points to be noted on the above topics to understand the situation better. 

#SciComm #MedEd #PatientEd #lka
1) A-SYMPTOMATIC vs PRE -SYMPTOMATIC transmission 

¤Asymptomatic transmission is when a laboratory confirmed patient with #COVID19 who DOES NOT develop the typical symptoms during the course of the infection transmits the virus to another person. 

#AsymptomaticTransmission
¤ Even though the occurence of this phenomenon is currently found to be rare, Asymptomatic carriers will pose a significant challenge for the public health officials in tracing and curbing the spread of the virus. 
This term can often be confused with Presymptomatic transmission.
Read 10 tweets
1/
⭐️Respiratory virus shedding in exhaled breath & EFFICACY OF FACE MASKS?

This #Tweetorial, @BUMedicine classmates/future @BIDMC_IM coresidents @RahulAggarwalMD and I review:

🔷@NatureMedicine (hot-off-press 🔥04/03)
@bencowling88

#MedTwitter #MedEd #COVID19 @MedTweetorials
2/
First off: a question to test understanding of the size difference between RESPIRATORY DROPLETS and FINE-PARTICLE AEROSOLS:

What is the diameter cutoff for a droplet to be considered a FINE-PARTICLE AEROSOL?
3/
5 micrometers is the traditional cutoff for defining FINE-PARTICLE AEROSOLS.

So, when public health officials refer to a virus as airborne, they mean transported in virus-laden aerosols smaller than 5 micrometres in diameter.

Back to the objective of this study…
Read 17 tweets
[THREAD] Resident story #2:
The @Royal_College of Physicians of Surgeons of Canada has postponed its Spring exams and this has a direct impact on physicians providing care to patients with #COVID19. /1
#PGY5Stories #examfail #battlefieldpromotion #meded
We're starting to learn that #COVID19 can be a multi-system disease that impacts a number of patients' vital organs, and most critically it impacts patients' lungs. This leaves patients requiring care from highly-skilled critical care doctors. /2
#PGY5Stories
Less often do we consider the roles of resident doctors with advanced training for these extremely sick, highly contagious patients. I'd like to share the story of one of those doctors. /3
#PGY5Stories
Read 9 tweets
1/
Day 3 of #DistanceMedEd for #dermtwitter and #medtwitter! We've done 2 of the 5 reaction patterns so far, so let's focus in on the....

DERMAL reaction pattern!

#MedEd #FOAMEd #tweetorial #medthread PC: @dermnetnz
2/
As opposed to the papulosquamous reaction pattern, the dermal pattern implies the action is DEEP in the DERMIS. This means that without epidermal alteration, you shouldn't see scale!

There is of course an exception with overlying xerosis or if you have another process on top!
3/
When you see something dermal, you have to think about what is infiltrating the skin. A few possibilities/examples:

Edema/fluid 👉 urticaria (1)
Inflammatory cells (reactive) 👉 granuloma annulare (2)
Inflammatory cells (cancer) 👉 CBCL (3)
Collagen 👉 Morphea (4)
Read 8 tweets
1/6 #Cardiotwitter - check out this #Tweetorial

"CV considerations & #COVID19"

💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit

#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether
2/6

💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity
3/6

💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS

#COVID19
Read 6 tweets
A physician draft: wow. We are comparing doctors to soldiers now? Here’s the deal... a thread

1/ #covid19 #physiciandraft #meded
Soldiers don’t work for free. Even drafted soldiers. Don’t expect doctors to leave our families to work for free.

2/ #covid19 #physiciandraft #meded #RadCX
Soldiers are sent into battle with adequate personal protection equipment. This country is running out of medical PPE. Address this super stat.

3/ #covid19 #physiciandraft #meded #RadCX
Read 11 tweets
1/
2nd installment of #dermtwitter #DistanceMedEd. Today's #tweetorial will be a brief one on...

VESICOBULLOUS REACTION PATTERN!

#MedEd #FOAMEd #dermatology #medtwitter

PC: @dermnetnz
2/
First things first - some definitions:
Vesicle: fluid filled <1 cm
Bulla: fluid filled >1 cm
Pustule - Filled with pus
- Ahem, the word you're looking for describe something with a lot of pus is "purulent," not what you're thinking....🤨
3/
Next, the name is self explanatory. The vesicobullous pattern implies you're seeing vesicles or bullae. There is one very important exception:

If you see COLLARETTES of scale (round pattern of scale remnant), these can indicate a prior vesicle or bulla (like an old footprint)
Read 10 tweets
1/
Motivated by @TedWJamesMD to put together a #dermtwitter/#medtwitter #tweetorial for #DistanceMedEd today.

Let's do one about PAPULOSQUAMOUS DISORDERS of the skin.

What would be a good example of a papulosquamous rash you might see on #skinexam?

PC: @dermnetnz
2/
Psoriasis is the perfect example of a papulosquamous disorder. Before we break down what this means, let's start with the basics. I was taught that skin rashes & lesions fall in one of 5 reaction patterns:
- papulosquamous
- eczematous
- vesicobullous
- dermal
- red (vascular)
3/
By knowing which category each rash/lesion is, you can limit your Ddx.

For example:
If something is both vesicobullous and eczematous, you're probably dealing with some type of eczema.
If you're dealing with something dermal, you can probably take psoriasis off your ddx!
Read 9 tweets
One of the key advantages of doing #POCUS is we know when to avoid unnecessary/ 'empiric' iv fluid administration. Almost every organ suffers from the pathologic sequelae of fluid overload. Take a look here in this thread 👇 #IMPOCUS #MedEd
Lung
*Note B-lines on #POCUS can detect asymptomatic lung congestion
Heart
Read 10 tweets
THREAD
#MEDED and #PCCM ADVOCACY HELP NEEDED:
The U.S. Citizenship and Immigration Services announced on March 20 the suspension of premium processing for H1B visas.
@ATS_BSHSR
@accpchest
@acpinternist
@APCCMPD
@AmerMedicalAssn
THIS IS A MAJOR PROBLEM.
1/
Premium processing is THE WAY that these trainees are able to have visas processed in a timeline that best prepares them to practice at their place of employment starting in July. Disallowing premium processing means a delay in their visa status, which delays credentialing.
2/
This is likely to lead to a 3-4 month delay in their being able to see patients at the conclusion of their training. This will effect 1200-1500 physicians who are completing residency here in the United States, most of which will be practicing in underserved areas.
3/
Read 10 tweets
HELP! I have a family member in Orange County, CA on a vent in critical condition for #COVID19. We are urgently seeking a person who has recovered from #coronavirus infxn w/ no symptoms in past 14d & able to donate plasma asap. Irvine/Tustin or LA area. DM me w/ leads. Pls RT.
Tweet #2: Thank you SO MUCH for your kindness! I'm getting many Qs, so answering them here for efficiency. People are asking what criteria they need to meet to donate plasma & which patients with #COVID19 can get plasma & how. See here: bit.ly/2WK2NT9.
Tweet #3: Others are asking if the donor has to be where the recipient is. The answer is no unless there is time urgency to get the product to the pt. Blood products are routinely collected at blood drives & shipped where the need is, but that does introduce a delay. #COVID19
Read 9 tweets
Short image tweetorial on thoracic ultrasound findings in pneumonia. #POCUS #IMPOCUS #FOAMed #FOAMus #Medtwitter #Meded #COVID19 @medpedshosp @cianmcdermott @msiuba @siddharth_dugar @grepmeded @NephroP @emresidents
Normal lung ultrasound. A-profile with thin pleural line with lung sliding. Linear transducer used.
Irregular pleural line with patchy B-lines. Seen in viral (including COVID19) and bacterial pneumonia. This patient had mycoplasma pneumonia. Linear probe used.
Read 11 tweets
1/
HOW TO TREAT ACTINIC KERATOSES AT HOME, a #tweetorial/#medthread

AKA:how to keep practicing #socialdistancing in the era of #COVID19 by staying at home and taking care of those precancers without having to come to clinic!

#dermtwitter #medtwitter #MedEd #FOAMed pc:@dermnetnz
2/
1st, a caveat. Nothing subs for an in person exam, so this is not free license to tx things without a derm eval.

The reason for this #thread is that as the doctor seeing all urgent #dermatology pts today, I've gotten MANY calls from pts hoping to come get their AKs treated.
3/
Before we get to txs, let's start with the basics. What is an AK?

Clinically they are erythematous papules & plaques with gritty (sandpaper-like) scale. Some can be quite big. Then we call them "hypertrophic AKs."

These are precursor lesions to squamous cell carcinomas.
Read 13 tweets
Hello guys! Isn't it fascinating that one virus infected the whole world - 176 countries, 6 continents & almost 300 thousand confirmed cases now - through possibly just ONE initial patient?

A thread on Patient Zero.

#COVID19 #Coronaviruspandemic #Epidemiology
Patient zero is a term used to describe the first documented human infected by a viral or bacterial disease in an outbreak. 

#COVID19 #MedEd #Epidemiology
Advances in genetic analysis now make it possible to trace back the lineage of a virus through those it has infected.Combined with epidemiological studies, scientists can pinpoint individuals who may have been the first people to start spreading the disease #MolecularEpidemiology
Read 11 tweets
1/
La pandemia por #COVID19 está en boca de todos en estos días y todos deberíamos estar familiarizados con las medidas que se deben tomar
Cambiaré el enfoque de la cuenta por esta ocasión para desmenuzar una de las medidas más importantes

El lavado de manos 🧼🤲

Abro hilo:
2/
Se tocarán los siguientes puntos básicos que nos ayudarán a entender el tema:
- Virus vs bacterias
- Bases del coronavirus
- Jabón vs Gel "Antibacterial"
- El lavado de manos en si mismo

¿Cuál de los dos piensas que es mejor?
3/
Usualmente los hilos de esta cuenta están orientados para estudiantes/profesionales de la medicina, pero en esta ocasión, dada la situación actual, pretendo que la información sea accesible para la población general.

Ahora si, iniciamos!
Read 30 tweets
With med, nursing, & PA schools around the world switching to online learning, profs are scrambling to figure out the tech and create content.

But guess what?

There are a number of great YouTube channels that have been producing UME level content for years!

A quick list:

1/
Of course, I'll start with my channel, Strong Medicine.

IMHO, my particularly good videos include ECGs, CXRs, PFTs, EBM, shock, AKI, hematology, antiarrythmics, cardiac auscultation, H&P, and a series on how to approach specific symptoms.

youtube.com/channel/UCFq5v…

2/
A great resource for teaching the physical exam is produced by my awesome colleagues @StanfordMed25:

youtube.com/user/eozdalga

3/
Read 11 tweets
Increase use Telehealth as an during #COVID19pandemic Decided to share my 5 year experience as a TelePCP internist
Lessons learned from #telemedicine

✅Do not assume any demographic will love/hate it. Ask all patients/caregivers. You will be surprise. #ageisjustanumber
2/
✅Rapport via video takes less time compared to telephone. Look for visual cues of engagement.

✅How and where we present ourselves matter. If we are teleworking be mindful of your surrounding background should appear professional.
3/
✅Be on time. Depending on the service you use the link to the appointment might expire. Is up to you to keep track.

✅You might need to ask the pt/caregiver to reposition the camera or smartphone. Do not be afraid to ask.
Read 10 tweets
Hello guys!

Here's an important thread on the possible implications of a #COVID19 outbreak in Sri Lanka! Please read carefully and responsibly! 

#CoronaVirusOutbreak #FlattenTheCurve #lka
1) If you've been to a govt hospital, you'd know that most of our government hospitals are already running over capacity under NORMAL conditions. We have 2 patients per bed in wards & 100% occupancy in ICUs 365 days. 

#COVID19 #SriLanka
2) 20% of COVID19 patients will need hospitalization, 5% of patients will need ICU care and respiratory support, about 2.5% will need very intensive care to survive. 

#COVID19 #CornonavirusOutbreak
Read 15 tweets
1/
BULLOUS PEMPHIGOID, a #dermatology #tweetorial!

#MedEd #FOAMEd #medtwitter #dermtwitter #medthread pc:@dermnetnz

A patient with active bullous #pemphigoid comes to see you. What do you expect on your exam?
2/
#bullouspemphigoid (BP) is an autoimmune blistering disorder where the pt's immune system makes auto-antibodies targeting BPAg 1&2 (BP230/BP180). Since these Ags are in the hemidesmosome, the split is lower in the skin, making for tense blisters.

pc: sciencedirect.com/science/articl…
3/
Clinically, tense blisters (as seen in BP) usually go with a negative nikolsky, whereas flaccid blisters (seen in pemphigus) would have a positive nikolsky.

An easy mnemonic is:
pemphiguS = Superficial
pemphigoiD = Deep
Read 13 tweets
A Friday #tweetorial #medthread about patient privacy on
#medtwitter #SoMe

There are many facets of patient privacy & professionalism concerns in this communal space—I’m going to focus on this through the
lens of case-based teaching

🧵
1/N
We know that #medtwitter & #SoMe enhance learning based on tenants of adult learning theory—this includes the microsimulation, mini-challenges, & active discussion of case-based learning.

However, how can we make this effective safe for our patients AND ourselves?

2/N
I want to introduce this concept—the term came to me a couple of weeks ago:

“POST THE PEARL, NOT THE PATIENT”

3/N
Read 25 tweets
Thanks #medtwitter #meded #nephpearls for answering this question! As suggested by the wisdom of the crowd, the correct answer is cyanide poisoning due to "vitamin B17." (Shout-out to @J_Corky who guessed early on). See tweetorial for discussion!
@J_Corky Wait, they didn't cover that in training? Vitamin B17 is not a vitamin - it's marketed as one, though, and used as alternative therapy for cancer and "general health." Some alternative rx is innocuous - vitamin B17 is not.
@J_Corky Let's call vitamin B17 what it is - amygdalin. Amygdalin is a compound found in Prunus species seeds - peach pits, apricot seeds, bitter almonds. See that -CN (cyano) moiety at the bottom of the structure? That's right - it is hydrolyzed by gastric acid to cyanide. 2/
Read 20 tweets
1//
Does knowing type of diabetes matter to clinicians and trainees

Yes, will try to explain why in this #tweetorial #medtwitter #MedEd #diabetes

Still hear residents/fellows start with 49 yo f with diabetes or insulin dependent diabetes or non insulin dependent diabetes...
2/
Type 1 diabetes: automimmune, usee to be called juvenile-onset or insulin dependent

Clearly need insulin at diagnosis

Typically lean, onset peaks during teenage years but can occur at later age..

Can check c-peptide with simultaneous glucose, GAD 65 Ab, IA2 Ab.
3/

LADA, latent autoimmune diabetes in adulthood

Often misclassified as type 2, think in non-obese with onset in 30s, 40s

Often started on oral glucose lowering medications, not controlled for very long... end up needing insulin

May have antibodies found in type 1
Read 9 tweets
#hapc call today, 6 new consults:
Avg pt age= 84
Avg # serious dx= 4
Most common dx: ES CHF, no tx option; ES Ca, no tx option; ES COPD, no tx option
Reason for consult: "Need you to talk about goals and EOL"

Me: So, have you started the convo?
Avg response: "Umm, not really"
1/
#medtwitter It's not easy to discuss late stage dx & end of life issues, but it's crucial. Patients & families deserve clear, honest, empathic info. We all need to know how to *at least* start the conversation. #PalliativeCare teams can help coach, or look for other resources
2/
And certainly at a tertiary care or teaching hospital, this should be hard-wired into the training. Make basic communication a required skill, like diagnosing PNA, placing a line, or running a code. #MedEd- we can, and must do better for our learners & our patients.
3/
Read 6 tweets

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