Discover and read the best of Twitter Threads about #tweetorial

Most recents (24)

1/11 Welcome to this #CME #CNE #Tweetorial: Medicine During a Public Health Crisis: Just Culture in an Unjust World.

See CME/CNE info.:
#JustCulture #Healthcare #RaDondaVaught #MedTwitter Image
2/Per the Institute of Medicine (IOM), most medical errors arise from “faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them, rather than from reckless actions by individuals working within those systems.”
3/The just culture model serves as a guide for healthcare systems by incorporating features such as human factor design, error prevention, and steps to contain errors’ ramifications before they become critical.
Read 11 tweets
I've seen two patients in my training with ring chromosome 20 associated epilepsy, which inspired my recent talk at #CleClinicNeuro Peds Epilepsy GR, so I decided to distill it to a #neurogenetics #epilepsy #tweetorial 🤓 🧬
what is a 💍 chromosome? Rather than having a full complement of rod-shaped chromosomes like this:

2/ 🧵
affected individuals have at least one chromosome with circular formation, due to fusion of distal chromosome regions:

3/ 🧵 Kalane et al.  Int J Epil 2017; 04(01): 087-089
Read 18 tweets
1/19 Welcome to this #CME #Tweetorial on #Influenza and #PediatricFlu with @RishiDesaiMD, supported by an educational grant from Genentech.

See full CME info:
#MedTwitter #MedEd Image
2/Let’s begin!
Influenza (flu) can cause severe illness and death. In the US, during the 2019-2020 (pre-pandemic) flu season, 20,000 deaths occurred due to flu-related complications. Image
3/During the pandemic, social distancing, masking, and quarantining significantly reduced flu-related illnesses/deaths. In the US, during the 2021-2022 (pandemic) flu season, 5,000-14,000 deaths occurred due to flu-related complications (down from 20,000!). ImageImage
Read 20 tweets
1/Asking “How old are you” can be dicey—both in real life & on MRI! Do you know how to tell the age of blood on MRI?

Here’s a #tweetorial on how to date blood on MRI
#medtwitter #neurorad #radtwitter #RSNA2022 #RSNA22 #radres #neurosurgery #neurology #meded #neurotwitter #FOAMed Image
2/If you ask someone how to date blood on MRI, they’ll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age

But mnemonics are crutch—they help you memorize, but not understand. If you understand, you don’t need to memorize Image
3/If you look at the mnemonic, you will notice one thing—the T1 signal is all you need to tell if blood is acute, subacute or chronic

T2 signal will tell if it is early or late in each of those time periods—but that type of detail isn’t needed in real life. So let’s look at T1 Image
Read 21 tweets
What do you use for treatment for endocarditis caused by HLAR +ve Enterococcus faecalis?
🧵 Tomorrow
Lets talk about #Enterococcus #bacteremia 🧵
2 important species - E.faecalis, E faecium
E.faecium is generally more resistant, but lower risk of endocarditis
E.faecalis, usually S to Ampicillin, but IR to Quinopristin-Dalfopristin
Also, note- Enterococcus is IR to Cephalosporins, Aminoglycosides
Bacteremia source - Indwelling catheter, GI, Urinary tract
DOC for bacteremia - Ampicillin/Penicillin if S
If, Ampi R - Vanco/Teico
Combination therapy in case of suspicion of endocarditis or septic shock
Read 8 tweets
How many of you do Skin test before administration of antibiotics?
Most Indian hospitals test for antibiotic sensitivity, without knowing the basis of testing
Lets learn a lil about Antibiotic allergy testing 🧵
1. Skin test - Is done to identify hypersensitivity - which can be IgE or Non IgE mediated. Hence, sensitivity can be seen within 1h (IgE mediated) or >1h (Non-IgE mediated)
So, no guarantee that a patient with skin test negative will not have hypersensitivity later
Read 14 tweets
1/Tonsillar or peritonsillar abscess? That is the question! When you look at a neck CT, do you know which one to say?
A #tweetorial on #tonsillitis complications
#medtwitter #radtwitter #neurorad #radres #meded #FOAMed #FOAMrad #HNrad #medstudenttwitter #RSNA2022
2/First some anatomy. Palatine tonsils (or faucial to the cool kids) sit in the oropharynx between the two palatine arches: the palatoglossus arch in front and the palatopharyngeus arch in back. These are easily visible on physical exam.
3/These archs are actually just mucosa draped over the palatoglossus and palatopharygeus musculature, like kids drape sheets over themselves to dress up for Halloween.
Read 13 tweets
1a) Welcome to a new #accredited #tweetorial on the management of aFXa-DOAC-associated #hemorrhage and specifically the role of coag laboratory testing in these challenging cases.
1b) Our expert author is #pharmacist Craig Beavers, PharmD @beaverspharmd CV Clinical Pharmacy Specialist @UK_COP, and Immediate Past Chair of the @ACCinTouch #ACCCVT Section
2) This 🆓program is accredited for 0.5h CE/#CME for #physicians #physicianassociates #nurses #nurespractitioners #pharmacists and is supported by a grant from AstraZeneca. See statement of accreditation and faculty disclosures at
Read 37 tweets
1/Ready for a throwdown? MMA fights get a lot of attention, but MMA (middle meningeal art) & dural blood supply doesn’t get the attention it deserves.

A #tweetorial on dural vascular #anatomy

#neurosurgery #neurorad #Neurointervention #radres #medtwitter #neurotwitter #meded
2/Everyone knows about the blood supply to the brain. Circle of Willis anatomy is king and loved by everyone, while the vascular anatomy of the blood supply to the dura is the poor, wicked step child of vascular anatomy that is often forgotten
3/But dural vascular anatomy & supply are important, especially now that MMA embolizations are common for chronic recurrent subdurals. It also important for understanding dural arteriovenous fistulas as well.
Read 17 tweets

Why is the liver able to regenerate itself?

Somehow the liver has the incredible capacity to both heal itself after toxic injury and regrow after resection. No other solid organ in the body can regenerate like this.

#medtwitter #tweetorial
It's assumed that the ancient Greeks knew of the liver's unique regenerative capacity, based on the myth of Prometheus (his liver regrew daily after an eagle ate it).

At the same time, scholars have found no other ancient evidence of this knowledge.
Not until the 19th century was liver regeneration demonstrated experimentally.

H. Tillmans, in Germany in 1879, showed that the liver can regenerate after resection in animal models.
Read 25 tweets
Echo is one of the more skilled ultrasound exams you can do. Having learnt it and now teaching it, I see the same mistakes being made over and over again. I have put together thread on beginner mistakes in echo. #tweetorial #POCUS #FUSIC #askpocus
Before the specifics, the basics (which I won't go into too much detail about):
- Optimise depth and gain
- Position your patient if possible
- Hold the probe low and rest some part of your hand on the patient for stability
- If in doubt more jelly and press a little harder
This is the commonest mistake on PLAX I see. People struggle to revert to a PLAX from this RV inflow view (which in itself is useful beyond basic echo). An RV inflow view is obtained by tilting the tail up from the PLAX point. So, to get back to PLAX just do the reverse motion.
Read 14 tweets
PSA: don't withhold a QT prolonging drug just because the computer calculated a QTc above 450-460 ms. The computer correction is usually (>50% by the study below) very inaccurate. And it only takes 15 seconds to do it right (or at least better).

PMID: 27317349
#MedEd #tweetorial
Background: QT intervals change depending on HR. To compare them, one can correct for HR using many different formulas:
- Bazett
- Hodges
- Fridericia
- Framingham
- Rautaharju Image
Here's a graph comparing how each formula compares at different heart rates (technically 1/HR). You want the line to be flat. None are perfect, but you'll notice that one performs nearly as poorly as not correcting at all: Bazett. Image
Read 9 tweets
1/ For the fellows and #ACCEarlyCareer!

It’s a coronary thrombus! When to consider thrombectomy? What do you do? Let’s walk through this…#Tweetorial

#Cardiotwitter #Cardiology #STEMI
2/ Middle age patient with hx of CAD and PCI to LAD presents with significant SOB and elevated Hs-Trop. No chest pain. No ECG changes. Echo with inferior hypokinesis.

Here’s the diagnostic with a JR4.

Notice the filling defect in the RCA. This is thrombus. How do we know?
3/ Keys of #thrombus on angiogram

🔑 contrast staining
🔑 Lack of calcium on non con image
🔑 ovoid filling defect (complete lumen)

#Cardiotwitter #STEMI #TIMI
Read 25 tweets
1/They say form follows function! Brain #MRI anatomy is best understood in terms of both form & function

A #tweetorial on how to remember important functional #brain #anatomy

#meded #medtwitter #neurosurgery #neurology #neurorad #FOAMed #FOAMrad #radiology #medstudent #radres
2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.
3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)
Read 12 tweets
1/ Want to continue the learning streak of #Kidneywk ?
#MedTwitter #NephTwitter, we bring another #ASPNFOAM group tweetorial based on pathology webinar @ASPNeph on T-cell mediated rejection(TCMR) in kidney transplant (Tx) Image
Let's start with a vignette! 13 yr M with CAKUT s/p DDKT 6mo ago, p/w with doubling of Cr from 0.7 to 1.5 mg/dl, normal vitals and PE. UA normal. A lot of recent stressors and concern for non-adherence.
Sounds like a familiar scenario?
What is the potential cause of graft dysfunction in this patient?
Read 28 tweets
Picture this:

A patient presents with palpitations, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

A #tweetorial 🧵 1/7 EKG shows sine-wave pattern...Peripheral smear shows many...
To guide our thoughts, here are 2 tumor lysis syndrome (TLS) facts-

1) 🔑 Electrolyte balance across a membrane drives action potential

2) When cells die, they release electrolytes (& nucleic acids) from intra ➡️ extracellular space

🧵 2/7 Image
The lab criteria above 👆 was created with treatment-related TLS in mind…

but spontaneous TLS can actually have HYPOphosphatemia 🤔

Why can phosphorous be ⬇️ in spontaneous TLS?

🧵 3/7
Read 9 tweets
1/ Step 1 - Don’t
👉Shut anything off
👉Touch the vent
👉Remove restraints
👉Pause sedation
if you have not explicitly asked permission to do so.

[This is a survival thing! For the pt… (and you 😉)]

A #tweetorial @medtweetorial about critical care things for #neurologists
Vibe check for the #neurologists out there. Do you like doing ICU consults?
#MedEd #NeuroTwitter #NeuroTwitterNetwork #EmoryNCCTweetorials
Tip 1⃣: Induction meds for intubation have different hemodynamic profiles.

In emergent situations, explicitly tell whoever is intubating the patient’s BP goals.

For ex: AIS = ⬆️ BP good; induction with propofol (frequently = hypotension) is suboptimal.

Reminders are 🔑
Read 25 tweets
A 17-year old male presented with a breast lump . Gross and Microscopic images from the excised lump ( shown in the images). Identify the true statement? (Options in the comments) #pathology #PathTwitter #PathTwitterFamily #pathtweetorial #tweetorial #MedTwitter #pathboards ImageImageImage
Diagnosis is juvenile papilomatosis.
Observe "swiss-cheese appearance" in gross and microscopy.
Other conditions with Swiss cheese appearance Image
Read 7 tweets
1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!

Here’s a #tweetorial of a lumbar grading system that’s easy, reproducible & evidence-based

#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad
2/Lumbar stenosis has always been controversial. In 2012, they tried to survey spine experts to come to a consensus as to what are the most important criteria for canal & foraminal stenosis. And the consensus was…that there was no consensus. So what should you use to call it?
3/Well, you don’t want just gestalt it—that is a recipe for inconsistency & disagreement. But you don’t want to measure everything either—measurements are not only cumbersome, they introduce reader variability & absolute measurements don’t mean the same thing in every patient.
Read 15 tweets
Since we’re all just sitting around waiting for twitter to implode & feeling bad about the layoffs, how about some #tweetorials?

This one is a fave of mine, inspired by my deep confusion at a conference and @nondogmatist’s kind explanation scribbled on the conference program.
Also, for no particular reason at all, this might be a good week for you to brush up on your Difference-in-Difference methods.

Just in case there’s a paper which uses them that you want to be able to follow………
Another fun #tweetorial is this one by @epidemiolakshmy, who took the time to clearly explain the idea behind one of my #EpiCartoons👇🏼
Read 4 tweets
🚨 Alert! We are excited to share our new preprint in which we define the roles of individual class I molecules on brain endothelium in the regulation of T cell responses and development of neuropathology in experimental cerebral malaria…
CD8 T cell engagement of brain vasculature has been implicated in the neuropathology of cerebral malaria. In this work we interrogated human and mouse data during infection and noted upregulation of activation and Ag-presentation molecules or transcripts in brain endothelium
When either class I was ablated, the mice were normal at baseline and also established normal peripheral plasmodium infection and peripheral immune responses. However, T cell interactions with brain endothelium were disrupted during infection
Read 11 tweets
1/ Seizures are scary. But what about seizures that continue to occur even after you’ve used your first, second, and third line agents? Let’s talk about super refractory status epilepticus #Neurotwitter #Meded #Medtwitter #tweetorial
2/ We have a 50 yo M with hx of HTN, DM, and testicular ca in remission who was admitted for witnessed seizures @MUSCNeuroICU
3/ The patient was placed on EEG and found to have the following:
Read 18 tweets
1/One important aspect to stroke care is well... ASPECTS.😂

Here’s a #tweetorial to help you remember this basic #STROKE scoring system

#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radiology #radres #neurology #Neurosurgery #CT #meded #neurotwitter
2/ASPECTS stands for “Alberta Stroke Program Early CT Score.” It is meant to replace gestalt-ing what percent of the MCA territory is infarcted. Instead, it uses a 10-pt score to semi-quantitate the amount of infarcted tissue in the MCA territory on non-contrast head CT
3/You can think of it as a scorecard for the MCA.

For each region of MCA territory NOT infarcted, the pt gets one point

So the highest score possible is 10, and lowest score possible is 0
Read 18 tweets
1/ Have you ever been confused about the pulmonary management of neuromuscular disorders? If so, I promise you aren’t the only one! Check out this #tweetorial primer on the basics of NMD management. @VCU_PCCM @crit_caring_MD @AvrahamCooperMD @PulmPEEPs #CHESTTrainees #MedEd
2/ Neuromuscular diseases affect the respiratory system in 3 main areas:
1⃣Ventilatory Function
2⃣Cough Function
3⃣Swallowing and Airway Protection

As muscle weakness progresses, this will lead to alveolar hypoventilation with subsequent hypoxemia and hypercapnia.
3/ Objective means to assess respiratory muscle function include:
1⃣Maximal Inspiratory Pressure
2⃣Maximal Expiratory Pressure
3⃣Forced Vital Capacity (Supine)
4⃣Peak Cough Flow

MIP <60 mmHg and nocturnal oximetry are effective in detecting early respiratory insufficiency.
Read 15 tweets

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