Samantha Wang Profile picture
May 28, 2020 โ€ข 5 tweets โ€ข 3 min read โ€ข Read on X
1/5 Myths in Medicine:
1.Docusate is an effective laxative
2.Oral iron requires TID dosing
3.HCQ for treatment of #COVID19
4. ๐—–๐—ต๐—ฎ๐—น๐—ธ ๐˜๐—ฎ๐—น๐—ธ๐˜€ ๐—ฎ๐—ฟ๐—ฒ ๐—ฒ๐—ฎ๐˜€๐˜† ๐—ฎ๐—ป๐—ฑ ๐—ฒ๐—ณ๐—ณ๐—ผ๐—ฟ๐˜๐—น๐—ฒ๐˜€๐˜€
2/5 The best #chalktalks are succinct, spontaneous, and seemingly breezy. But that does not mean they donโ€™t require hard work! Anything that looks easy and effortless actually took hours of preparation and repetition. #PrepandReps
4/5 Confession: it took me 8hrs to prep my 1st morning report teaching points as a chief resident. @StanfordChiefs @AshishSarraju @DrMitaHopp
I am faster now but still spend hours to create each โ€œchalk talkโ€ (albeit w/o chalk); I revisit it with each iteration to improve it.
5/5 Letโ€™s debunk the myth that chalk talks (&teaching) are easy and effortless. You donโ€™t need to be a master clinician, but you do need โœ๏ธand ๐Ÿ•’. If youโ€™ve ever thought about creating a โ€œchalk talkโ€, today is as good of a day as any. And remember: itโ€™s all about the #PrepandReps

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More from @DrSamanthaWang

Sep 24, 2020
1/15 #MedTwitter: You're admitting a 64YO male with ESRD on HD for hyperkalemia after missing dialysis. A troponin was checked & returned at 0.78 (nl<0.055 ng/mL), similar to his baseline. He is w/osymptoms and EKG is w/o dynamic changes. What would you call this #tropbump?
2/15 Have you ever been taught to think about troponin as being cardiac vs. non-cardiac in origin? Though this may be a nice framework, itโ€™s simply untrue: if youโ€™re measuring cardiac troponin I (cTnI), it is expressed only on myocardium(not skeletal muscle, unlike troponin T).
3/15 The lexicon to describe troponins is confusing!

"๐˜›๐˜ณ๐˜ฐ๐˜ฑ๐˜ฐ๐˜ฏ๐˜ช๐˜ฏ๐˜ฆ๐˜ฎ๐˜ช๐˜ข" is frequently used but is not very helpful. It is NOT a diagnosis or etiology, and should probably be abandoned as a term altogether.
Read 16 tweets
Aug 28, 2020
#MedTwitter: It is switch weekend/Friday! How do you like to sign-out your patient list to the oncoming physician?
I was once a proponent for the email sign out: putting words to paper (or screen) helped me organize my thoughts. And frankly, was more convenient.

But recently, I signed out to my colleague via phone and ๐Ÿ’™ it!
We ended-up talking not only about the patients on our list, but past experiences on similar undifferentiated/challenging cases, and our emotional/psychological well-being during present times.

I now prefer signing out via ๐Ÿ“ž and encourage you to try it as it:
Read 5 tweets
Aug 12, 2020
1/15: #MedTwitter: You are admitting a 50-year-old man with a hx GI bleed for a PE. You start a heparin drip. What do you titrate the drip to?
2/15: At my institution, heparin anti-Xa levels (HAL) are recommended, but we routinely draw both aPTT and HAL. Iโ€™ve always wondered WHY?

Thereโ€™s also the page: โ€œThe aPTT is supra-therapeutic but the HAL is therapeutic, which should we use?โ€

Letโ€™s de-mystify this!
3/15: First, letโ€™s understand unfractionated heparin (UFH).

UFH is a negatively charged, heterogenous mix of oligosaccharides. Heparin MUST bind antithrombin (AT) to have an anticoagulant effect. AT then inhibits Xa, thrombin (II), and other proteases.

pubmed.ncbi.nlm.nih.gov/27384570/
Read 16 tweets
Aug 4, 2020
1/14 #MedTwitter: The ED pages you for an admission: a 24-year-old male with a history of IVDU presenting with fever. How do you take his drug history?
2/14 As a resident, I fell into A + B, until @cuttingforstone taught me you need to know a lot more to appropriately Dx and Tx your patient. My mnemonic?

๐——๐—ฅ๐—จ๐—š: Drug, Route, User, Goods.
3/14 Buckle up for a deep dive into why a detailed drug history matters!
Read 15 tweets
Jun 22, 2020
1/9: A woman presents with diarrhea x 2 weeks that woke her from sleep. I love this fantastic framework for chronic diarrhea by @LindseyShipley8
2/9 We reviewed her admission EKG. What do you notice? Image
3/9 #MedTwitter: Whatโ€™s your ddx for low EKG voltage? Think back to physiology. The space between EKG leads &โค๏ธ can be filled with: ๐—ณ๐—น๐˜‚๐—ถ๐—ฑ (pleural/pericardial effusion), ๐—ฎ๐—ถ๐—ฟ (PTX, COPD), ๐—ณ๐—ฎ๐˜, ๐—ถ๐˜€๐—ฐ๐—ต๐—ฒ๐—บ๐—ถ๐—ฎ (dead tissue) or ๐—ถ๐—ป๐—ณ๐—ถ๐—น๐˜๐—ฟ๐—ฎ๐˜๐—ถ๐˜ƒ๐—ฒ processes.
Read 10 tweets
Jun 19, 2020
1/8 Weโ€™ve all had that moment as learners when we think weโ€™ve detected a key physical exam finding, and upon returning with the attending: that rash, cool extremity, or tremor has gone away.
2/8 @VillarPrados told me a great catch he made his intern year. He was admitting a gentleman with syncope. He heard a loud systolic murmur during cardiac auscultation and ordered an echocardiogram.
3/8 He presented the patient and this exam finding to his attending hours later. When they arrived at bedside to examine the patient, the murmur disappeared! At this point, @VillarPrados is feeling meek and second guessing himself. ๐Ÿ˜ณ
Read 9 tweets

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