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February Teaching Rounds - Recap

Part 1 of 2.

Because #spacedlearning is an endless journey...

Join us #medtwitter & #medstudenttwitter
Day 2 - Upper GI bleed

1. 4 common pathways to a working Dx of an overt upper GI bleed

2. 3 common diagnosis...

3. 2 KEY questions!

More here -
bit.ly/2V9pboc
Day 3 - H20 toxicity

1. Hyponatremia = excess H20 = H20 toxicity.
The is true is most, but not all cases

2. Why do we care?
When neurons swell they don't work well...

3. @jackpenner's @CPSolvers video & schema bit.ly/3b64K0T

More here - bit.ly/3bUWUri
Day 4 - Fever - Part 1

1. Fever is a specific, but insensitive, clue to "inflammation"
There are many other roads to the world of inflammation - use them!

2. Most, but not all, elevated temperatures, represent a fever.
Consider hyperthermia early.

bit.ly/37MoljA
Day 5 - Fever - Part 2

1. On day 1, the focus is on infection.
Base rate = these 6 infections.

2. Two key scenarios that change the base rate = travel + immunocompromised.

In these scenarios, the spotlight doesn't shift, it EXPANDS.

More here -
bit.ly/2Pbf6mW
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More from @rabihmgeha see all

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Rabih Geha
@rabihmgeha
Teaching Rounds Day 11/15

Hypoxemia...

Beyond the Mechanism & Back to the Bedside

Join us, #medtwitter & #medstudenttwitter
I fondly remember learning about hypoxemia in medical school and breaking it down by mechanism

1. Low FiO2
2. Hypoventilation
3. Impaired diffusion
4. Shunt
5. V/Q mismatch - the go-to answer every time!
This was a great way to understand hypoxemia, but I haven't found myself using this approach clinically.
Read 12 tweets
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Rabih Geha
@rabihmgeha
Teaching Rounds Day 10/15

Weight Loss

2 Key Steps

2 Common Pitfalls

...and 1 intriguing question.
Not all weight loss is concerning.

>5% loss over several months should get us thinking about an underlying cause.
Side note...

See how we snuck in the time course there?

If weight loss is at hand, the "When" of the problem representation = subacute/chronic.

We still have the "Who" and "What" to figure out.
Read 22 tweets
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Rabih Geha
@rabihmgeha
Teaching Rounds Day 8/15

Cellular lysis...

Not all cells are equal.

Join us, #medtwitter & #medstudenttwitter
"Why you do always start your talks with a vague statement and not actual learning objectives, Rabih?" - a dear friend

🤣🤣
I think it's more fun this way AND
75% of teaching is making sure everyone is having fun.

When it comes to learning

Climate > Content
OK.
Back to Cellular Lysis!

Each organ, and it's associated cells, are very different from each other.

But there is a common denominator.

Most cells have
1.K
2.Phos
3.LDH

in abundance... Image
Read 15 tweets

Related threads

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Kartik Kalra
@kkalra_22
Hi #medtwitter. Another awesome day deconstructing electrolytes. Join us as we diagnose and manage severe hypernatremia! #tweetorial #FOAMED #nephtwitter @TheSkeletonKG
1/17
What’s the highest level of sodium you have seen with patient walking in your office. renalfellow.org/2020/01/17/ske…
2/17
You are on consult service and get a page from ER for a stat consult. Patients sodium is 183 !!! You rush to the ER to evaluate the patient. If you are allowed to ask one question, then what would it be?
Read 18 tweets
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Paul Young
@DogICUma
Here’s what we did in the #PEPTICtrial, what we found, and what I think it all means. #CCR20 @jama_current
We conducted an international, randomized, open-label, cluster crossover, registry-embedded trial to compare strategies of stress ulcer prophylaxis in mechanically ventilated adults implemented at the level of the ICU jamanetwork.com/journals/jama/…
The primary outcome was in-hospital all-cause mortality up to 90 days. Secondary outcomes were clinically significant upper GI bleeding, C. difficile infection, ICU and hospital length of stay.
Read 28 tweets
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Nicholas Zaorsky, MD MS
@NicholasZaorsky
In this thread, I will compile my medical illustrations in oncology and #RadOnc.

Many are from textbook w @DanTrifMD
amazon.com/Absolute-Clini…
based on @ARRO_org study guide for board exams.

A picture is worth 1000 words.
Here is oncology in a few pics.
@DanTrifMD @ARRO_org @SpringerNature Starting with pediatrics:
Rhabdomyosarcoma treatment paradigm for cancers of head/neck depends on parameningeal vs non-parameningeal location. PM is an unfavorable site, affects stage. #sarcoma #HNCSM
@DanTrifMD @ARRO_org @SpringerNature CNS/brain anatomy from sagittal view.
#BTSM
Chapter from @cgr0105, Sameer Nath, from University of Colorado
Read 49 tweets
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Gabrielle Mayer
@gabmayer
Hey #medtwitter and #medstudenttwitter! A while ago, I gave a #dermatology presentation on the intersection of derm and #trans health.

I learned a lot. So here's a #medthread on some of the takeaways I found most valuable.

1/10
Let's start with our transfeminine pts.

Derm can provide a number of facial feminization procedures (FFP): e.g. botox, soft-tissue augmentation.

These FFPs can be more affordable/less invasive than feminizing surgeries such as forehead or mandibular contouring.

2/10
Note: tho traditionally considered "cosmetic", these interventions have MATERIAL psychosocial benefits – studies show that facial feminization has a demonstrated positive impact on QoL + mental health outcomes.

3/10

ncbi.nlm.nih.gov/pubmed/26818277

ncbi.nlm.nih.gov/pubmed/20461468
Read 10 tweets
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Sonja Raaum
@SonjaRaaum
I want to put a 🙌 out to #MedTwitter

I may not tweet a lot but I do follow and gain quite a bit so I want to share how it has changed the way I carry myself and provide care.

It’s a thread.
2/
 Patient asks the case manager when the doctor is going to see him

I spent 30 minutes updating him earlier that day 🤔

Pre-twitter: ok
Post-twitter: Sir, I’m in charge of your care, tell me a bit more about why you didn’t think I was your doctor.
#WomenInMedicine @AMarshallMD
3/
 Overhear the nurses talking about a patient who made a veiled but serious threat to them during the course of care.

Pre-twitter: I’m sorry.
Post-twitter: 😠 that’s not OK. How can I support you?

#MedTwitter #NurseTwitter
@BrowofJustice
Read 11 tweets
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Dan Wheeler
@WheelerMed
1/ Have had the privilege of observing rounds lately as part of @UCSFMedicine's Learning/Caring Environment team.

Some early thoughts:
1) Every AM, trainees are asked to perform a multitude of competing, time-sensitive tasks

2) These tasks are not always compatible w/ rounding
2/
 3) There is incredible heterogeneity in what "rounding" looks like and how long it lasts (b/w institutions, b/w teams, but also from day-to-day on same team!)

4) Is there any other profession that has this much variability in one of its core activities?
3/
 5) With new attendings/residents every few weeks—each of whom has different expectations for "rounds"—the goalposts are constantly moving for our trainees

6) Facing shifting expectations, it's tough to feel autonomous or like you’re working toward mastery (⬆️ burnout risk)
Read 5 tweets

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