Discover and read the best of Twitter Threads about #pulmcc

Most recents (4)

THREAD
Recently in our #MICU, I took pics of the oxygen sats of patients on oxygen supplementation.

What is the optimal oxygen supplementation strategy for a clinically stable patient in the ICU?

Follow me down this #tweetorial rabbit hole. #medtwitter #pulmcc #AIMW19
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Given that population health improvements often come from small benefits in large populations, and the fact that #oxygen is one of the most commonly prescribed interventions in the #ICU, there is potential for benefit if we can correctly titrate our oxygen titration.
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I’m going to refer to hypoxia and hyperoxia in this #medthread, and I’d like to (somewhat arbitrarily) define these terms. I’ll call hypoxia anything below 90% and hyperoxia anything above 96%. This is based upon some of the literature I will discuss.
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Read 23 tweets
(Thread)
I’m going to discuss how physician payment rates in the US are set and suggest a reason why #primarycare is poorly valued from a salary standpoint in the U.S. I’ll also suggest how anyone interested can work to improve payment for #primarycare.
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I am targeting younger physicians and medical students - this may be too simplistic for some, and go into the weeds too much for others. But the whippersnappers are the ones that are more likely to lead change, and so that is the audience here.
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Disclaimer: I am an academic #pulmcc physician, not a #primarycare physician. So I’m in a procedure-heavy specialty. I'm also not an expert in health policy, so feel free to gently correct anything that seems off.
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Read 27 tweets
[THREAD] Our tips on small bore chest tube placement for pleural effusion! Performed by a resident @BostonCityEM supervised by fellows @BUPulmonary. We'd love your input! Not a comprehensive guide. Made with written patient authorization. #meded #FOAMcc #pulmcc
For new large unilateral effusions such as this, we place a chest tube if fluid pH <7.2, glucose <60. Without fluid studies, we place a tube empirically if effusion is large, loculated, infected, or likely to reaccumulate- except CHF/fluid overload.
First step: ultrasound. We position the probe with marker to the head, as lateral as possible. Intercostals tend to sag as you move towards the midline, so you could hit them when going above the rib. Lateral access is safest.
Read 24 tweets
Here are some rules I emphasize when teaching central line placement, usually for IJ triple lumens and HD lines. Not a comprehensive guide, just some things I've seen trainees miss (including myself). I'm a fellow so I am by no means an expert and I'd love your input! [THREAD]
Prep is everything. Room, bed, trash, table, etc. Make it easy! Move bed up, IVs and trash on opposite side of table--make space. Raise bed. Head down. Confirm ultrasound(US), image the length of vessel (for overt clots/stenoses). Clean hair, leads, tubes out of the way.
Before starting, I ask everyone to alert me if I've broken sterility to create a global expectation. Breaking sterility happens, you didn't "mess up." Don't hesitate, just get more PPE. I always bring a few sets -- proper setup helps maintain sterility. Just ask my daughter!
Read 16 tweets

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