Discover and read the best of Twitter Threads about #pccm

Most recents (14)

On a mission to make physical examination in the ICU great again in 2023: do you worry when the knees of your ICU patient look like the image below? #PCCM #MedEd…
Knee mottling should get ur attention, here is why: mottling score (0=no mottling, 1=coin size, 2=superior edge of the knee cap, 3=middle thigh, 4=groin fold and 5=anything higher than the groin fold) at 6 h was predictive of 14 day ICU mortality #MedEd…
Mottling score was predictive of mortality regardless of vasopressor dose needed. It was also associated with lactate levels and low urinary output. #MedEd
Read 5 tweets
This trend of #COVID19 followed soon after by #rhinovirus or #enterovirus (& we have it in our 🏠 , test-confirmed) is 👎👎. The 🫁 are taking a beating. Beware, especially folks w/ #asthma & other lung diseases. Masks on. 👀 recent CDC alert:…. #MedTwitter
If you are age 12+, it’s been at least 2 mos since your last dose of #COVID19 #vaccine or any # of #booster dose, & you haven’t gotten your updated #Omicron bivalent #boostershot, get it! Likewise anyone 6m old & up who hasn’t had a #FluShot this fall, go get one. Same day is👌.
There is unfortunately no vaccine vs #rhinovirus or #enterovirus. For that, our best bet is to improve air quality (open windows if possible, Corsi-Rosenthal boxes, etc), #MaskUp, & try to get those around us to #WearAMask too. Really concerned for folks with #asthma etc like us.
Read 4 tweets
PSA: You *CANNOT* use a "bougie" or Eschmann Intubating Stylet to do an endotracheal tube exchange. I have seen this mistake twice in the past 6 months. You will lose the airway. A simple look at the length of the bougie and an #ETT will make this clear.
The length of an adult ETT is about 32 cm and the length of the #eschmannstylete is 70 cm. This leaves no room in the center for you to grab it. When you retract the #ETT to the end of the stylet, its distal tip is still in the patient's mouth & entire stylet is covered
To do a tube exchange, you need 2x the length of the ETT and then some additional length to work with, else you risk retracting the exchange device too far and losing the airway. This is why they make an "airway exchange catheter" and its length is 83cm:…
Read 15 tweets
Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary
#pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate
(Like on Tinder, the more criteria you require, the more you narrow your pool, compromising sensitivity for specificity.) Transudates I will skip over. Most common #exudate is #parapneumoniceffusion #PPE. If there is or is likely to be #pneumonia, it's PPE. Next task is to...
Read 26 tweets
Hey #MedTwitter!!
This morning at our VA we had Chief @photon_ick give us a case of #ChronicSOB, where it turned out that the patient had #ABPA (#allergic bronchopulmonary #aspergillosis). It's a diagnosis we don't see too often, but one you'll definitely encounter here!! 🗝️👇
This is an #allergic condition, with 2 main predisposing conditions: #asthma & #cysticfibrosis
It can be more rarely seen in other lung disease/immunodeficiencies, but without the right lung environment like this, it is almost NEVER seen!!
There is no universally accepted criteria, but the #ISHAM criteria is often used. Let's check it out!

Traditional obligatory criteria:
- Serum #IgE RAST >0.35 OR Allergic Skin Testing (+) to A. fumigatus
- Total Serum IgE >1000 Image
Read 6 tweets
#Pulmonary Hypertension (pHTN) can really take your breath away!

For today's #MTC, Chief @photon_ick, PGY3 Dr. Armando Martinez, & #CTEPH expert Dr. Demos Papamatheakis reviewed a super cool case of a legit #SPY diagnosed with pHTN & CTEPH, flown to #UCSD for management!
1. pHTN is increased pressure in the #pulmonaryarteries
2. Most common symptoms include: EXERTIONAL #dyspnea, fatigue, pleuritic chest pain, and even #hemoptysis🩸
3. It's typically diagnosed on #ECHO showing dilated arteries, right❤️strain, & elevated RV systolic pressure!
4. There are 5 #WHO Classes of pHTN, distinguished based on physiology and treatment options:
1⃣ Pulmonary Arterial Hypertension
2⃣ pHTN 2/2 LV failure
3⃣ pHTN 2/2 Respiratory/Lung disease
5⃣ Other causes Image
Read 7 tweets
We' ll continue our vasoactive medication review with our old frined dobutamine! #chestcritcare
It is primarily a Beta-1 agonist, but it acts on Beta2 and alpha as well, making it a great inotrope, and also an ok vasodilator (in high doses alha agonism kicks in, and some vasoconstriction may occur…
Dobutamine is used in the treatment of cardiogenic shock, it improves symptoms, but it has been associated with increased in-hospital mortality and future HF readmissions. It is also associated with arrhythmias and it has been rarely associated with eosinophilic myocarditis.
Read 7 tweets
Continuing the vasoactive meds week, we will talk about dopamine. It is a precursor of norepinephrine, inducing its release. There are dopamine receptors in the renal, splanchnic, coronary and cerebral vascular beds; stimulation of these receptors cause vasodilation. #critcare
Again, since our historical "nerdiness" was so well received, this is one of the first papers that talked about dopamin in shock:…
And this is their conclusion:"Because dopamine increases myocardial contractility, selectively redistributes perfusion to essential viscera and allows a pharmacologic titration of effect, it is a logical first-choice catecholamine for treatment of shock and refractory HF."
Read 7 tweets
I don’t like posting depressing posts but I think it’s time. When this all began, I would walk into the #COVID unit with the energy of a #hype man at a #hiphop show. I hate COVID19 but I love being an #ICU doctor & getting people better. Today I am mentally & physically exhausted
Other than my AM commute, I’ve seen daylight only once this week - today when I had a few minutes for a #coffee break. Today was also the first time I got home before 10 pm, but before I even had a chance to take my #decontamination shower... Image
I got called about yet another complex #COVID admission by my even more hard-working #PCCM fellows. The amount of face-to-face time required to take good care of these patients cannot be truly appreciated unless you’ve worked in an #ICU. The days are long & the work is relentless
Read 7 tweets
🗂️THREAD: U.S./global #COVID19 clinical/research patient/healthcare worker registries seen on #medtwitter

Many specialty-society/focused registries launched in last few weeks, attempt to collect them here

List 👇🏽

2/n: @SCCM's VIRUS: Viral Infection and Respiratory Illness Universal Study @covid19registry

Inclusion criteria 👇🏽…

Find out if your site is already enrolled:…

#Pulmonology #Pulm #CriticalCare #PCCM
3/n: International #COVID19 Dermatology Registry led by @DrEstherFreeman @AADskin

Looking for:
1. #COVID19 pts who develop #skin findings
2. #dermatology pts who develop #COVID19

h/t @DrStevenTChen #dermtwitter
Read 11 tweets
(1/) I want to bounce around a disease model for #COVID19. This is hypothesis, some parts are hand-wavy, but I'd like to think a lot is also based on evidence. I'll try to clearly distinguish knowns from assumptions as we go...

#COVID2019 #SARSCoV2 #medtwitter #FOAMcc #FOAMed
(2/)First, whatever #COVID19 is, it doesn't sound like #ARDS. Physiology doesn't line up
1-Easy to vent, but hard to oxygenate. Normal lung compliance
2-Deteriorate rapidly
3-Responds to proning, PEEP, & prolonging I:E
4-Tendency to suddenly de-recruit…
Read 23 tweets
The U.S. Citizenship and Immigration Services announced on March 20 the suspension of premium processing for H1B visas.
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.
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.
Read 10 tweets
2/ PRVC = Continuous Mandatory Ventilation, Pressure Limited, Time Cycled with Adaptive Targeting.

SETTINGS: Tidal volume, Insp Time, Fio2, PEEP, RR

Breath to Breath feedback of exhaled TV, compared to target with adjustment of subsequent insp pressure to lead to steady TV

PRVC - Marquet Servo i
Autoflow - Drager
Adaptive Pressure Ventilation - Hamilton Galileo
Volume Control + - Puritan Bennett
Volume Targeted Pressure Control, Pressure Controlled Volume Guaranteed - Engstrom
Read 7 tweets
I’m a fellowship director who just finished reviewing over 400 applications for 8 fellowship spots.

The following is a #thread on writing a personal statements.
(Spoiler alert: I find 99% of them to be TERRIBLE.)

The following are MY preferences and proclivities. Some will ring true for other PDs, some may not. And Turi McNamee wrote very eloquently about this in @AnnalsofIM in 2012.…
I’m going to tag @davidschulman , @jennifer_jwm , @KristinBurkart3 , @DrMCMiles, @GenevaTatemMD, who are PD colleagues in #pccm, and @sanjayvdesai , @TKapetanos , @MitchGoldmanMD, @abbyCCim, @jenchoi_iu and any others who are PDs. I’d love to hear from them on this topic.
Read 28 tweets

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