Discover and read the best of Twitter Threads about #periopmedicine

Most recents (14)

A #periopmedicine-meets-#COVID19 #tweetorial #Medthread

There has been a lot of overlap between the two areas in the last few months:
🦠appropriate PPE use
🦠intubation
🦠pre-op covid19 screening of asymptomatic patients
🦠telehealth
🦠OR & postop ward management/re-designs

1/
other topics have been explored, such as the safety of laparoscopic surgery v laparotomy given risk/benefit of
overall surgical risk, operative time, potential aerosolization of particles via gas suspension and pneumoperitoneum

one article:
jmig.org/article/S1553-…

2/
I’ve also captured my thoughts about how we resume “elective” surgical volume as states and countries start to “reopen” in this #tweetorial

I'm not going to revisit these subjects here. But...

3/

Read 24 tweets
There's been increasing discussions (on and off #medtwitter) re cancelled surgeries, financial impact on hospitals, and what "elective surgery" means

as some hospitals start to increase surgical volume and project how long it will take to catch up on the queue, some thoughts: 1/
the complexities of these decisions at the institution/health system level AND at the personal level for patients and their families only serve to highlight how complex & nuanced surgical decision making and planning can be...

2/
brief background

why were surgeries cancelled?
🚫preserve PPE
🚫increase available ICU and hospital beds
🚫staff deployment to other services incl COVID teams
🚫decreased spread
🚫decrease patient risk post op complications (esp if they were covid + preop or acquired it postop)
Read 20 tweets
1/ I haven’t written a #periopmedicine #tweetorial in a while, but last night @etsshow tapped me on the shoulder w a request for a #Medthread re preop evals via #telehealth

The specific❓was re assuaging surgeon (& I’ll add anesthesiologist) concerns re the lack of an exam

🧵
2/ Background 1️⃣–telehealth across the board has rapidly expanded given the challenges of providing care while keeping safe distances due to #covid19

We’ve had an incredible amount of institution level support for this at @OHSUnews @OHSUSOM!

news.ohsu.edu/2020/04/13/ohs…
3/ Background 2️⃣–telehealth for PREOP has been a goal for years w go-live in June.

Why?

To meet the care needs in a large, rural state—many of our sicker/older patients lived very far away & w limited socioeconomic means to get to preop clinic before surgery
Read 26 tweets
By request (incl @afedwardMD @SaraJPharmD @bethgarbitelli), a #periopmedicine #tweeetorial #MedThread about marijuana management

This is one of my longer tweetorials—there’s a lot to cover!

Also, no silly weed or "high" GIFs…my purpose here is to teach, not stereotype...

1/N
Why do we need to ask about how we can best manage marijuana use perioperatively?

❇️ use is increasing
❇️ multiorgan effects
❇️ potential for intoxication or withdrawal
❇️ interaction with anesthetic agents
❇️ risk of postop complications

2/N
What do we mean when we say “marijuana”?

the Cannabis plant (species incl sativa, indica, & ruderalis), which contains > 500 chemical compounds, 100+ of which are “cannabinoids”

Potential ”medicinal” effects:
Antiemetic
Muscle relaxant
Anticonvulsant
Analgesic

Photo Wiki

3/N
Read 28 tweets
A New Year’s (+1 day) #periopmedicine #medthread #tweetorial

What do New Year’s resolutions and pre-op optimization have in common??

1/N
Let’s warm up with a quiz
What is the most common New Year’s resolution?

2/N
According to this resource, the top resolution is to exercise more

This is certainly applicable to the subject of periop optimization...
...as are other potential resolutions such as drink less, lose weight...

3/N
goskills.com/Soft-Skills/Ar…
Read 22 tweets
Welcome back! Time for #tweetorial part 2 of #periopmedicine meets #meded
This time? #GME!
I’m going to continue to look at this through the lens of my experience practicing perioperative medicine as an #IMproud internist

1/N
Let’s start with an “origin story”.

Do you know what my first exposure to the concept and question of “is this patient of an acceptable risk to proceed to the OR?” Was?

Want to take a guess?

2/N
It was on a hepatology elective! We were consulted to inform #periop risk discussions for a young patient with cirrhosis scheduled for an open abdominal surgery (fyi, this can be high risk)
It was a lightbulb moment for me as an IM resident!
Periop wasn’t just cardiac…
3/N
Read 24 tweets
#periopmedicine #tweetorial time!
Thank you for the votes—“clinical pearl” was the clear front runner, so here we go—with a TWIST!

HOW & WHY can you utilize the periop space to clinically TEACH

That’s right, this is a #periop #meded #medthread!

1/N
This is going to be a 2-parter, because I have that much to say.
Stay tuned for #tweetorial part 2 later this week

I’m hoping to be comprehensive and apply a broad arc about #meded to #periopmedicine

Today we start with #UME (medical students), later #GME
2/N
For starters, what are your current thoughts on teaching in the #perioperative setting?
3/N
Read 24 tweets
A #periopmedicine #tweetorial/#medthread

It’s that time of year again!
Sunday football?
ERAS applications?
Girl Scout cookies?
Well, yes…but for the purposes our discussion, it’s “COLD & FLU SEASON”

What do you do if a patient scheduled for surgery has a URI?

1/N
what is the theoretical concern?
That presenting for surgery, and the anesthetic management including intubation required to facilitate it, will lead to #perioperative complications if the patient has (or has recently had) an upper respiratory tract infection.

2/N
these concerns include the risk of periop pulmonary complications:
🔘respiratory failure
🔘airway hyperreactivity (during induction or emergence) ➡️laryngo/bronchospasm
🔘deeper infection like pneumonia

does this “biologic plausibility” translate into real-world events?

3/N
Read 23 tweets
#Periopmedicine #Medthread!
Based on requests (esp @JenniferBrokaw), a long over-due #tweetorial with my advice & pearls for providing patient-centered care for the surgical patient with #ParkinsonsDisease
1/x
@JenniferBrokaw Caveats
1⃣I’m not an anesthesiologist & don’t care for pts w PD #intraoperatively
2⃣I practice outpatient #PREoperative medicine, so I am not providing inpatient postop care
3⃣There are several high yield publications/resources, & much of this is pulled from my own experience
2/x
@JenniferBrokaw Caveats out of the way, let’s chat about why understanding #periop #ParkinsonsDisease management is so foundational.
Remember how Osler said to know syphilis is to know all of internal medicine?
Yeah…PD meets #periopmedicine is potentially THAT informative.
3/x
Read 28 tweets
A Monday #Medthread:
#medtwitter colleagues—what gets your BP and HR up the most in terms of delivering “bad news”?
in my #periopmedicine world, it’s telling a patient we might need to postpone or cancel their surgery
So…a #tweetorial to share my learnings over the years
1/x
Take a step back—remember that there’s no such thing as “preop clearance”.
The value added is preoperative evaluation and risk assessment, with patient + procedure-specific optimization
Inherent to this is communicating risk and concerns for it
2/x
The overwhelming majority of patients I evaluate in preop clinic are stable/optimized at the time of my evaluation, though my assessment still adds value by empowering intraop and post-op care, as well as facilitating pre-op patient instructions and empowerment
3/x
Read 23 tweets
A Thursday #MedThread #Tweetorial. Consider this an “ode to uncertainty and curiosity” meshed with my clinical practice passion #periopmedicine inspired by many recent #medtwitter, podcast, & IRL role models and conversations about… 1/X
* Stepping into the tension of clinical uncertainty
* Self-reflecting & identifying when we’re on
the edge of uncertainty
* Being able to say “I don’t know”
* Seeing what’s on the margin of our knowledge
* What it means to be “curious”
@ETSshow @CPSolvers @DxRxEdu
2/X
Also drawing from @Gurpreet2015 OHSU #GrandRounds week—as adult learners & clinicians, we must create micro-learning challenges for ourselves:
* What’s the next step
* What else
* What if
* What’s the next logical question to ask the patient, myself, a colleague?
3/X
Read 22 tweets
I’ve been musing re aortic stenosis so it’s #periopmedicine #tweetorial #MedThread time!
This is a composite of multiple patient encounters w common themes:
Goals:
-review periop guidelines re aortic stenosis
-some physical exam teaching
-discuss role of patient counseling 1/N
2/N
First, how good are we at diagnosing severe AS by exam?
3/N Hypothetically:
patient comes for a preop evaluation/risk assessment (not “clearance”) and reports a history of a murmur
You ask more Qs-how long have you know, what have you been told about it, when was your last ECHO, what kind of follow-up were you were told you needed?
Read 20 tweets
THREAD Friday mini #tweetorial! Despite having a learner w me in #periopmedicine clinic the last two days, I neglected to tweet any #postitpearls (though lots of great learning + pt care!). BUT had 2 back-to-back cases raising questions of weight we place on self-reported pt info
2/ will be intentionally vague to protect PHI without diluting learning value...for all the talk re #EHR clutter, EHRs helping propagate accurate info but also "chart lore" false info, #backtobedside, #patientsbeforepaperwork...when can you "take a pt's word for it" in preop?
3/ pt A-early 50s, elective ortho surgery (though pain affecting QOL & activity levels), VERY vague "MI" and "CAD" history in chart from decade ago, no immediately available records, some risk factors for premature CAD (tobacco) but no interval events...
Read 18 tweets
#periopmedicine clinic #postitpearl with new learner type for me—NP student all day! Great conversation even before 1st patient of the day, starting with best case/worse case model
here's the link to the article itself ncbi.nlm.nih.gov/pubmed/26280462
my NP student also found this great youtube video walking through the conceptual framework!
Read 3 tweets

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