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So many great minds currently involved in UK-wide #POCUSforCOVID
Brief tweetorial to summarise learnign points from @giovolpicelli
1/ CXR is inferior - GV stopped doing CXR except in certain circumstances #POCUSforCOVID
2/ CT reserved for complex patients in which complications suspected eg. chronic lung disease #POCUSforCOVID
3/ LUS is useful for COVID19 diagnosis - not prognostication. CT preferred for disease quantification and prognostication #POCUSforCOVID
4/ Technique/ protocol - in publication. Use curved-linear transducer in longitudinal orientation to evaluate anterior, lateral and posterior chest #POCUSforCOVID
5/ Those that say now is not the time to start learning LUS - @giovolpicelli says that basics are 'easy' - like learning the basics of a new language. Lots of immersive exposure available at the moment! #POCUSforCOVID
Finally - excuse any typos! Over and out...
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Scott Mintzer 🧠
@scott_mintzer
thestar.com/calgary/2019/0…

I don’t have medical facts, but it points up the confusion many people (even in healthcare) have about different kinds of CNS infections.

So, a brief #tweetorial on meningitis and the like. /1
There are two main types of nervous system infections: meningitis and encephalitis.

ENCEPHALITIS is infection of the brain substance. It presents with marked alteration of mental status, along with fever & elevated white blood cell count. Other symptoms are variable. /2
MENINGITIS is infection of the lining around the brain (& spinal cord). Cardinal symptoms are severe headache, nausea/vomitting, light sensitivity, and, above all neck stiffness.

It looks different than encephalitis. Alteration of mental state may or may not be present. /3
Read 20 tweets
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NephSim
@Neph_Sim
1/ The answer to our last poll: cisplatin

nephsim.com/case-13-diagno…

Below, a brief #tweetorial to walk through a simplified approach to #hyponatremia

Step 1: What type of hypoNa are we dealing with here?

Ex: Na 128 meq/L, glucose 500 mg/dL, BUN 20 mg/dL serum osm 292 mosm/kg
2/

Remember the difference between tonicity (a measure of EFFECTIVE osmoles) & osmolality (measure of both EFFECTiVE & INEFFECTIVE osmoles)

Effective osmoles cannot cross between the ECF and ICF, thus draw water across the cell membrane.

nephsim.com/image-gallery/
3/

If serum osm not low with hypoNa, we must look for the presence of ⬆️effective & ineffective osmoles (that ⬆️osmolality)

-If we find⬆️ effective osmoles ➡️ HYPERtonic hypoNa

-If we find ⬆️ INeffective osmoles ➡️ HYPOtonic hypoNa

-If neither ➡️ PseudohypoNa
Read 9 tweets
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Steven Chen
@DrStevenTChen
Want to hear a joke?

What's bumpy & painful, & "read" all over?

A #tweetorial/#medthread on ERYTHEMA NODOSUM!

Now that I've lost a few hundred followers from that terrible opener😳, let's get started👇👇

#MedEd #FOAMEd #dermatology #dermtwitter #medtwitter pc: @dermnetnz
1/
Why talk about erythema nodosum (EN) in the first place? Well, most medical professional recognize it, will see it, but may need some help past that! If that's you, read on.
1st, exam: As the name implies- red nodules! It's usually on the legs, & they are often ill-defined.
2/
EN is commonly seen in young healthy pts, & women >> men. Of course, the patient's history is critical, as EN is a reactive process to something else! It's inflammation in the subQ fat (a panniculitis). The rash itself isn't dangerous, but should prompt looking for a trigger.
3/
Read 13 tweets
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Samira Farouk, MD, MS, FASN
@ssfarouk
1/
A brief #tweetorial on the calcineurin inhibitors #CNI and their toxicities. Let's start with a quick poll.

Which of the following describes the main mechanism of action of #CNI?
2/

On to the mechanism of #CNI. Calcineurin inhibitors bind to the "immunophiliins" for which they are named. Cyclosporine (CsA) binds cyclophilin and tacrolimius(FK506) binds FK binding protein.

The CNI-immunophilin complex is the superhero which then inhibits calcineurin
3/
 Meet calcineurin, whose superpower is a calcium-dependent PHOSPHATASE: enzyme that uses H2O to cleave phosphoric acid into a phosphate ion and an alcohol (read: removes phos)

Normally, calcineurin dephosphorylates NFAT - allowing it to freely swim into the nucleus.
Read 10 tweets
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Amar Kelkar MD
@amarkelkar
A brief #tweetorial for those curious as to why I spend countless hours on a non-specialty medical organization. The basic premise of the @AmerMedicalAssn House of Delegates is actually simple. #healthpolicy #publichealth #MembersMoveMedicine 1/
It’s a representative democratic body consisting of members of societies from the US states and subspecialties of medicine, convening twice a year as the @AmerMedicalAssn House of Delegates (HoD). The majority of each meeting is spent deliberating policy proposals. #AMAmtg 2/
Any member or organization can bring resolutions with various policy goals to the HoD to be debated and voted on. These go through a multistep vetting process where everyone has the opportunity to speak on and amend these policies under the rules of parliamentary procedure. 3/
Read 11 tweets
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Elliot Tapper
@ebtapper
Hepatopulmonary Syndrome - or is Portopulmonary hypertension? What’s the diff (brief #tweetorial)
Pulm complications of #cirrhosis can be devastating. This month on rounds, I was reminded that these conditions are confusing.
#meded
Step 1:
Recognize when a pulmonary complication could be present or clinically important (4 transplant)
This is how they looked when first described:
1. Portopulmonary: Dyspnea without hypoxia (Fig 1)
2. HPS: Hypoxia (Fig 2)

Step 2:
TTE (Fig 3)
Ordering "agitated saline" echocardiography will always be funny

TTE▶️most sensitive way 2 dx HPS(Fig1)
The bubbles dont go right▶️left immediately (like with septal defects) but do after a few heart beats
Bonus: do not rely on pulse ox!(Fig2)
Screen or go 2 TTE on by symptoms
Read 8 tweets

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