Profile picture
, 20 tweets, 16 min read
My Authors
Read all threads
The amazing @icu_nivare gives a talk on HOMEOSTASIS in ICM! Here is my Tweetorial on his brilliant talk. #FOAMed #ESICMphysio IT'S ALL ABOUT BALANCE.
Three main topics of this Tweetorial and @icu_nivare's lecture. All about the salt! #ESICMphysio
A brilliant overview of OSMOREGULATION and VOLUME REGULATION. #ESICMphysio
As a side note - Finfer talks about ICU fluids here: ncbi.nlm.nih.gov/pubmed/30072710

and @Manu_Malbrain and @icu_nivare here: annalsofintensivecare.springeropen.com/articles/10.11…
ALDOSTERONE = Na and Water Reabsorption
ADH = Water Reabsorption
These are the key players.... #ESICMphysio
A bit more about ADH in critical care also here: 2013 = link.springer.com/article/10.118… and a good one here from 2008: watermark.silverchair.com/mkn021.pdf?tok…
Try to decipher the left hand side 😂#ESICMphysio - this could be a great self-test quiz #FOAMed
Very important common errors in understanding water and sodium... #ESICMphysio #FOAMed
Also not realising that: OLIGURIA IS NOT ALWAYS A BAD THING! #ESICMphysio #FOAMed
On the note of Oliguria - here is a narrative review from 2018: ncbi.nlm.nih.gov/pmc/articles/P…
Steps 0 to 2 of HYPONATRAEMIA INVESTIGATION
STEP 3 of HYPONATRAEMIA INVESTIGATIONS and the final general principles. #ESICMphysio #FOAMed
Some useful papers on hyponatraemia in ICU...
2013: annalsofintensivecare.springeropen.com/articles/10.11…
2014: ncbi.nlm.nih.gov/pmc/articles/P…
2017: reliasmedia.com/articles/14161…
Some common pitfalls when it comes to hyponatraemia... #ESICMphysio
HYPERNATRAEMIA diagnostic work-through... WHY is the patient losing water through their urine? #ESICMphysio #FOAMed
Common pitfalls of hypernatraemia Ix.... #ESICMphysio
STEP 1 + case examples. Hypernatraemia. #ESICMphysio #FOAMed
STEP 2 HYPERNATRAEMIA TREATMENT + case examples. #ESICMphysio
STEP 3 Hypernatraemia Treatment #FOAMed #ESICMphysio
COMMON PITFALLS in the treatment of hypernatraemia #ESICMphysio #FOAMed
Missing some Tweet in this thread? You can try to force a refresh.

Enjoying this thread?

Keep Current with Dr. David Lyness

Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Related hashtags

#FOAMed #ESICMphysio

More from @Gas_Craic see all

Profile picture
Dr. David Lyness
@Gas_Craic
Thematic talk today about the ROLE of RCTs in Intensive Care Medicine. **TWEETORIAL** #ESICMphysio #FOAMed #FOAMcc
Randomised controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and are an integral component in the hierarchy of evidence which guide current clinical practice. #ESICMphysio ... but...
There are some problems... ncbi.nlm.nih.gov/pubmed/20413119 Image
Read 14 tweets
Profile picture
Dr. David Lyness
@Gas_Craic
Today we're going to take a look at BIOENERGETICS in ICU in this quick Tweetorial :-) #ESICMphysio #FOAMed #FOAMcc
Bioenergetics = biochemistry concerned with the energy involved in making and breaking of chemical bonds in the molecules found in biological organisms. It can also be defined as the study of energy relationships and energy transformations and transductions. #ESICMphysio
Mitochondrial functions incl production of energy, activation of programmed cell death, and a number of cell specific tasks, e.g., cell signaling, control of Ca2+ metabolism, and synthesis of a number of important biomolecules. ncbi.nlm.nih.gov/pmc/articles/P…
Read 37 tweets
Profile picture
Dr. David Lyness
@Gas_Craic
So - the candidates from #ESICMphysio are off to engage in their workshops - so I thought... let's hold a virtual workshop here on MECHANICAL VENTILATION! #FOAMed @ESICM
Let's start off at the very beginning. This is a HUGE topic... obviously not going to cover everything. But let's start off at the very beginning and look at my Tweetorial from yday from Prof Barnes talk on the physics of ventilation... #ESICMphysio
@MedCramVideos do a REALLY good series for beginners - for free - on YouTube - 5+ videos on Ventilators and how they work: youtube.com/results?search…
Read 30 tweets

Related threads

Profile picture
Zaf Qasim
@ResusOne
Recently our team had to manage a patient who presented critically unwell from post-tonsillectomy hemorrhage - something you may not see that often but can be a true life-threat!

(pictured is only one of several buckets)

My tips here:

1/x
#tweetorial
#foamed
Tip 1: Call for help early!

This patient did well because of excellent #teamwork from scene to OR. We received an alert from the EMS team, and informed ENT early (not in house) to the situation and need for OR. Anesthesia and OR team were also informed to prepare for this

2/x
Tip 2: Keep the patient sitting upright

Position is key. This patient was awake & alert, and keeping them upright allowed them to spit out the blood. Give them the suction to use also.

3/x
Read 9 tweets
Profile picture
Matt Spraker
@SprakerMDPhD
As promised, here is a #tweetorial on spatially-fractionated radiotherapy aka Lattice aka GRID.

If you missed the #CTOS2019 talk by @Notorious_RBE, this one is for you!
Spatial fractionation aims to intentionally deliver heterogeneous dose: alternating “hot” and “cold” areas with a differential of 30-100% Rx.

Thats right: you want 30% cold spots in tumor. (👇 #MedPhys reaction).
It seems crazy, but it is associated with excellent response and limited toxicity. Per reports. That are retrospective.

Dramatic response in rads refractory sarcoma: link.springer.com/article/10.100…

Case series of 71 palliative patients: ncbi.nlm.nih.gov/pubmed/1052442…
Read 14 tweets
Profile picture
Arghavan Salles, MD, PhD
@arghavan_salles
Folks, this is a big study out today in @nejm by @kbilimoria et al. This is the most comprehensive assessment of mistreatment in surgical training that I have seen. Kudos to the authors for taking on this important issue. Here's my #tweetorial on it.

1/
@NEJM @kbilimoria I’m going to focus on the women but want to acknowledge there are other important data—about racial discrimination and men—in this paper.

They surveyed residents at 262 programs and got responses from >7400 residents. Of those, 40% were women.

2/
@NEJM @kbilimoria @YueyungHu @ryanellismd A few points before going into the results: 1. These data were collected after the in-training exam. I have concerns about people’s mindset after a several-hour exam and their ability to really engage with the sensitive questions asked by this group.

3/
Read 17 tweets
Profile picture
Ellie Caniglia
@elliecaniglia
Hey everyone! Here’s a #tweetorial on our new paper on why we often can’t make #causalinference using #distancetocare as an exposure or instrument! cc: @epiellie
There are 3 problems with #distancetocare as an exposure for estimating causal effects. Let’s walk through them.
The first problem that probably comes to mind is #confounding 🙀Choices about where to live and where to locate care facilities are complicated and depend on a lot of things we might not be able to measure (e.g. socioeconomic status).
Read 10 tweets
Profile picture
Erik Reinertsen
@erikrtn
1/ Why is lactate elevated in sepsis or septic shock?

@dolan_russell & I explore this common #ICU pimp question via #tweetorial.

We're taught that ↓O2 revs up anaerobic metabolism causing ↑ lactate. But wait, there's more...

#medtwitter #FOAMed #meded #FOAMcc #criticalcare
2/ In homeostasis, lactate is continually produced and metabolized; serum concentration is at steady state.

Which of the following organs is responsible for the majority lactate consumption and metabolism?
3/ The liver is responsible for ~70% of lactate metabolism.

Patients with hepatic dysfunction can have ↑ lactate 2/2 ↓ clearance or ↑ production. Also, cirrhotics are more prone to hyperlactatemia in setting of sepsis.

Diving deeper, how does the liver metabolize lactate?
Read 13 tweets

Trending hashtags

#nephjc #tweetorial #DunningKruger #AHSM #highyield #FOAMed #targettrial #nephrology #ICU #lupus #dermtwitter #Tweetorial #cardiovascular #cPRA #Afib #dermatología #Dermatologists #derm #medthread #CV #POCUS #medtwitter #oncology #dermjc #medstudenttwitter
Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!