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Syncope (pronounced “sin ko pea”) is the medical term for fainting or passing out. It is caused by a temporary drop in the amount of blood that flows to the brain. #syncope #consciousness #medtwitter Image
Syncope can happen if you have a sudden drop in blood pressure, a drop in heart rate, or changes in the amount of blood in areas of your body. If you pass out, you will likely become conscious and alert right away, but you may be feel confused for a bit.
Syncope is a common condition. It affects 3% of men and 3.5% of women at some point in life. Syncope is more common as you get older and affects up to 6% of people over age 75. The condition can occur at any age and happens in people with and without other medical problems.
Read 13 tweets
Hey #ChronicPain‼️
2 major public comment sessions require Ur attention,

1rst is FDA on use of Kratom,
Be sure to share Ur thoughts!💡… #opioids #drugs #libertarian #kratom #medtwitter #health #medicine #Pharmaceutical #spoonies #Disability #Disability
Here is the official FDA page for registering public comments, Pls check it out & remind your friends on social media like Facebook & Twitter… #chronicpain #pain #intractablepain #disabled #disability #health #VeteranSupport #military #libertarian #fda
Most important
FDA on MME (Morphine Milligram Equivalents)💊

its the system CDC based their arbitrary limits for pain meds in 2016 CDC Opioids Guidelines🩺⚕️

VERY IMPORTANT U SPEAK UP!✍️🖥️… #chronicpain #opioids #health #publichealth #medicine #medtwitter
Read 7 tweets
1/🧵🎥 This story has a GOOD ENDING!

Look how my patient’s right leg flails around. This is INVOLUNTARY. He’s trying to stop but his brain is doing this against his will. It is “hemiballismus” & was caused by a fungus deep inside his brain. Read🧵
2/ He was having these movements day & night. Unable to sleep. We admitted him to our ICU and realized the fungus Cryptococcus was causing a brain infection called meningitis. He had  no underlying immune diseases or other health problems.

Another 🎥, all shown w his permission
3/ His MRI showed 2 pockets of infection on both sides of his brain in a place called the basal ganglia, which controls movement. This area had to heal for him to rest and be at peace again.

Read 7 tweets
According to NHS’s latest data, the hospitalized death rate is seven times as high in fully vaccinated vs. unvaccinated
It’s not like this real-world presentation of mortality (& morbidity) for meaningless mitigation of #COVID19 wasn’t expected, per their own clinical trials results!

And note: this is in comparison to a failed adenovirus 💉 and not a real placebo (i.e. natural/acquired immunity)
Read 29 tweets
1/9 You admit a patient overnight with hyponatremia and you diagnose it as SIADH. But how are you going to manage it?

To review how to diagnose SIADH, check out the volume-based or ADH/RAAS-based approaches below.

#MedEd #FOAMed #MedTwitter #NephTwitter #Tweetorial
2/9 The cornerstone of treatment is to treat the underlying cause. Everything else is just a 🩹. It can sometimes be very hard to treat the underlying cause immediately (assuming you can identify it).
3/9 Free water restriction is going to help (to a certain degree), but make sure that it’s feasible for the patient (they often need to do this beyond hospitalization). Consider restricting 500 cc below their 24-hour urine output:
Read 9 tweets
US nationwide outpatient trial for early #COVID19 using existing, repurposed medicines. ACTIV-6 trial is sponsored by US gov @NIH. Participate from home. No travel required. Please spread the word. Info at…
There are a number of medicines being tested:
-fluvoxamine (luvox)
-inhaled fluticosone (flovent)
All of which have various degrees of promising data.

ACTIV-6 study is seeking to answer:
1) do these make people feel better faster?
2) do they prevent hospitalization?
The initial @NIHDirector press release on activ-6 trial explains some of the objectives and big picture activities of this outpatient trial. #IDTwitter #MedTwitter…
Read 9 tweets
@emresidents family! Let’s have a little #journalclub 🧵from the EMRA Research Comm. Agitation is super common problem(~2mil presentations per year) so what’s in your 🧰 to care for these patients? Let’s talk about it!📢
📄: IM Droperidol vs IM Olanzapine for Agitation in the ED
The journal: @AnnalsofEM
The paper:
The author: @jonbcole2
Before we dive in 🤿 what do you reach for when you need an IM medication for acute agitation? 🚑💉
Read 19 tweets
This quote reminds me - if you are med resident interviewing for #IDfellowship and want to change the world by working on RCTs in HIV and global health, come interview at the Univ of Minnesota #MinnesotaNice #medtwitter
What sort of fun trials could one be involved in as a fellow? How about a multisite RCT in Uganda, South Africa, and Indonesia on high dose (30mg/kg) rifampin in TB meningitis?…
Or are you a fun-guy or fun-gal, and want to explore new antifungal therapies for cryptococcal meningitis? such as orally absorbed amphotericin therapy with more trials to come over the next 3-4 years.…
Read 4 tweets
Let's talk about breakthrough symptomatic infections in fully vaxxed adults...

Today @SurvivorCorps will meet with the @CDCgov to present our data and ask for changes in policy to reflect real world evidence.

@CDCgov is only tracking hospitalized cases so we did it instead.
We ran a poll of our 170K member group and had 1949 fully vaxxed adults participate.

Our Key Takeaways:

-Vaccines Work (but not all the time)

-Of 1949 fully vaxxed adults there were 44 breakthrough symptomatic cases (we couldn't measure asymptomatics for obvious reasons)
-Vaccines will likely keep you from acute symptomatic Covid needing hospitalization

-*HOWEVER* 55% of breakthrough symptomatic cases led to Long Covid (this is staggering)

-(Narrator Voice: If I had J&J I would want a booster)
Read 18 tweets
**Thread **🧵

I don’t know if PROP is intentionally trying to be misleading but at this point there is no way they can be this willfully blind to the data.. This new article written today by their organization is highly misleading. I want to go through some of the things they
mention in their article.. So below they mention deaths from prescription opioids continue to contribute to drug overdose deaths.. 1st problem is that is not entirely accurate, 2nd is they don’t define what a prescription opioid death means.. This statement needs to be qualified.
What is the source, what drugs are involved. The data does not parse this out.. Many of the Rx opioid deaths involves drugs that were diverted, also combined with other drugs as well (psychostimulants, benzos, antidepressants, barbiturates etc) Rx deaths alone is most likely alot
Read 7 tweets
🧵 THREAD on @TheBMA report on medical staffing in England which did not get much airtime last week:…

Whilst the numbers are increasing, we just don't have enough doctors, esp GPs. #NHS #medtwitter

Here's the evidence:


We have some the lowest number of doctors per population in Europe. Image

Whilst the number of hospital doctors is rising, the numbers of GPs has not despite record numbers of new trainees.

With more and more work being diverted to primary care without resourcing and funding, can we be surprised? Image
Read 18 tweets
1/💡📝🧵"Building structural competency through community engagement" | @ClinicalTeacher

I tweet often about WHY health equity curricula should center #StructuralCompetency & community voices.

Our new #MedEd paper shows HOW we've tried to make it happen.… Masthead for our manuscript in The Clinical Teacher, titled
2/ My first #MedTwitter foray was sharing this project 👇🏽 in 2019.

Our vision was simple: Moving #MedEd from ahistorical discussions of health disparities ➡️ exploring fundamental causes, centering community voices, and honing in on hyperlocal inequities.
3/ We drew from two main pedagogical frameworks: #StructuralCompetency and community-engaged pedagogy (similar to CEnR/CBPR).

Though "community-based medical education" and "service learning" are widely used, we know these approaches often aren't enough:
Read 9 tweets
1/9 Let’s say you are about to do a thyroid exam. Before the exam you do not suspect goiter (pre-test prob of 50%). How does the exam influence your probability? Let’s review some LRs from McGee!
#MedEd #FOAMed #MedTwitter #MedStudentTwitter #EndoTwitter @MedTweetorials
2/9 You may think “well that’s nice, but my thyroid exam technique is not the best.” Don’t worry, the Stanford 25 has got your back (including this clinical pearl)!…
3/9 Now that you’ve identified a goiter, you will probably end up ordering some lab and imaging studies. But don’t leave the bedside just yet! Let’s first break down the differential for an enlarged thyroid (thanks again to the Stanford 25).
Read 9 tweets
1/🧵Is my LIFE WORTH MORE than yours if I get #VACCINATED & you don’t? Or if I’m a COVID nurse?

ECMO is advanced life support in short supply that can save lives in extreme #Covid19.

Q 1 of 4:
If a #DeltaVariant surge creates too much demand…WHO GETS MY LAST ECMO MACHINE?
2/ How about essential worker status?

Q 2 of 4: Two #Covid19 patients are admitted on the same day & the virus has destroyed their lungs equally. You only have 8 ECMO machines & 7 are already in use. If forced to choose, WHO DO YOU PRIORITIZE?

Q 3 or 4: Two #Covid19 patients are admitted on the same day & the virus has destroyed their lungs equally. You only have 8 ECMO machines & 7 are in use. If forced to choose, WHO DO YOU PRIORITIZE?
Read 21 tweets
1/🧵 Should nurses & doctors be REQUIRED to get COVID19 #Vaccination@JAMA_current

Many hospitals already do this with flu vaccines (exceptions made for medical & religious reasons). Why not with #COVID? Let’s unpack…
2/ Do Healthcare Professionals (HCP) get infected with COVID?

Are HCPs at risk of infection & death due to their occupation?
YES & YES (+/- since PPE works if used properly)

HCP clearly become infected with SARS-CoV-2 w many experiencing severe outcomes, including deaths.
3/ Can HCPs have asymptomatic infection with #COVID?
Can HCPs spread this infection to others?
Asymptomatic individuals often have a HIGH quantity of virus & have been proven to cause many other infections.
Read 10 tweets
Seen it a thousand times☹️

#NobodyWillBelieveYou how pain, elderly, cancer, hospice patients & more can be so casually abandoned by once-trusted doctors

& Ur family, Normies & media will not believe U… #health #chronicpain #drugs #medicine #medtwitter
I know a telehealth company
they get calls all day from patients kicked off their meds

When its a medical professional they often say:
"I heard this was happening, but I didn't believe it.
MY DOCTOR would never do such a thing."… #NobodyWillBelieveYou
We see this phenomenon in the UK especially

folks rely completely on medicine to save their lives & take care of their families, its expensive

No one wants to think about how the medical system may be hurting them… #NobodyWillBelieveYou #health #medicine
Read 31 tweets
the issue with addiction & dangerous warning labels for things that are obviously dangerous is that we water down the effect of warning labels

& the stupid things don't even work… #smoking #drugs #fda #health #medtwitter
it is one thing to push for more warning labels if it is proven they save lives,

It is another thing to push labels when there isn't evidence they do much of anything positive
it is my major concern of the anti-CRT curriculum push by folks like @realchrisrufo (whom I generally respect)

There is little evidence to suggest the education equivalent of graphic education labels is going to stop activist teachers from doing their thing,

Read 4 tweets
where the heck are they getting these?

"roughly twelve percent of patients prescribed an opioid for chronic pain develop an opioid-use disorder, & as many as 29 percent of chronic pain patients misuse prescription opioids."… #chronicpain #opioids #drugs
this is dumb,
just as warnings on cigarettes for addiction is dumb,

they are pointless warnings that only put more fear & higher costs into these products,

& encourage black-market behaviors… #chronicpain #opioids #health #medtwitter
And why are we getting the FDA more involved with pain treatment best practices?

Are the other dozen agencies dictating best practices not enough?
Read 6 tweets
My (preaching to the choir) 🔥 take: digital educational skills -- whether teaching on #MedTwitter, podcasting, or making videos -- are essential #meded skills for the 21st century. And we can teach these to future educators.

A Tweetorial🧵:
Last year, @ShreyaTrivediMD @StaciSaundersMD and I at @iMedEducation started a curriculum to teach digital educational skills to our @BIDMC_IM residents.

We just published this article going over our curriculum and providing tips for you to do it too:
We ended up integrating our curriculum into a pre-existing one-to-two week Senior Teacher rotation, which had two great benefits:

1⃣MUCH easier to get off the ground
2⃣Stressed that traditional educational principles are transferable for teaching digitally
Read 10 tweets
Diabetic foot

A thread 1/10

Diabetic foot is a long term complication of diabetes mellitus (⬆️blood sugars) involving the feet. It presents with a foot ulcer (wound).

📸Ace Medial
📸SRB's Manual of Surgery 📸SRB's Manual of Surgery

Anyone with uncontrolled diabetes is at risk of developing a diabetic foot.


💥 Reduced blood flow to the legs. This reduces the healing ability of any wound that develops on the feet and increases chance of infection and gangrene.

💥 ⬆️Blood sugars that affect-
Read 11 tweets
1/🧵 PRIMARY vs SPECIALTY #PalliativeCare:

When I combine intensive care w palliative care as an ICU doc, I’m delivering PRIMARY palliative care. I often consult a board-certified palliativist for additional help, & this is SPECIALTY palliative care. Today…
2/ Today the most complicated thing I did in the ICU were NOT bronchoscopy or restarting a heart. It was helping people navigate these massive life choices, often shifting the treatment ladder we are climbing from the wall of cure to the wall of comfort. To me it’s the best…
3/ To me, primary #PalliativeCare is the most nuanced and critically important part of my vocation as an Intensivist. Just as the Winter gets you to a mountains 🏔, but Summer keeps you there, Palliative Care is not what brought me to the ICU but it definitely keeps me here.
Read 6 tweets
A blood pressure reading lower than 90 millimeters of mercury (mm Hg) for the top number (systolic) or 60 mm Hg for the bottom number (diastolic) is generally considered low blood pressure. #medtwitter #CardioTwitter #lowBP
Low blood pressure might seem desirable, and for some people, it causes no problems. However, for many people, abnormally low blood pressure (hypotension) can cause dizziness and fainting. In severe cases, low blood pressure can be life-threatening. #dizziness #fainting
Symptoms of low BP •Dizziness or lightheadedness
•Blurred or fading vision
•Lack of concentration
Read 21 tweets
Our pandemic isn’t over. A thread about families who have been double-vaxxed but see no end light at the end of the tunnel. Families like mine. (1/28)
Yesterday I sat on my front porch and watched kids across the street running a lemonade stand. They were laughing and having so much fun. Despite their masks, it was one of the most “normal” things I’ve seen in months. (2/28)
Life in Canada is getting back to normal. At of midnight tonight in Ontario, restaurants, bars and movie theatres can open their doors. Large-ish social gatherings are allowed outside again, as well as smaller indoor gatherings. (3/28)
Read 30 tweets
Can we talk about all the “kids don’t need masks” hot takes from “experts” that keep cropping up?

I’m exhausted and frustrated and just need to lay some thoughts out there

A 🧵

#pandemic #parenting #tweetiatrician #medtwitter #covid #vaccines #masks
I’ve been bombarded with DMs, comments, articles arguing for a back to normal for kids that ditches all masks for kids + insists covid isn’t bad for them.

The main tactic is the same old using stats + missing the big picture to ultimately argue covid isn’t dangerous for kids
The reality of covid risk to kids is much messier. It involves understanding the complexities of mortality rates, how all children deserve to live a life free of vaccine-preventable disease, how the known + unknown long term effects scare pediatricians more than acute disease
Read 14 tweets

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