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4 Mar, 7 tweets, 8 min read
1/#MedTwitter, want to learn more about antiracism in medicine?

We encourage you to check out our Antiracism in Medicine series for deep dives on racism in medicine, structural inequities, police violence and health, and more.

The first 6 episodes are available here:
2/ Episode 1: Racism, Police Violence, and Health

Join us for a deep dive on police violence and health with special guests @RheaBoydMD and @RRHDr.

Listen here: bit.ly/2D0jqT3
3/ Episode 2: Dismantling Race-Based Medicine Part 1: Historical and Ethical Perspectives

Join us for a deep dive w/ @EdwinLindo,
@LashNolen, @rohankhaz & @dereckwpaul: bit.ly/ARCP_Ep2
4/ Episode 3: Structural Inequities & the Pandemic’s Winter Surge

Join us for a gripping discussion w/ @TheAtlantic award-winning journalist @edyong209, @dereckwpaul & @UREssien: bit.ly/33EDKDH
5/ Episode 4: Dismantling Race-Based Medicine Part 2

We invite @AmakaEMD
& @tsaiduck77 to discuss the limits & harms of race-based medicine in clinical practice.
@jazzminciara @rohankhaz @UREssien

Listen here: bit.ly/3mskSOH
6/ Episode 5: Racism, Power, & Policy

In this episode, we invite scholars @CamaraJones &
@DrAlethaMaybank to imagine the antiracist health system of the future.
@LashNolen @rohankhaz @NaomiFFields

Listen here: bit.ly/39Jl5c2
7/ Episode 6: Racism, Trustworthiness, and the #COVID19 vaccine

We're joined by 2 forces @gcsmd & @gradydoctor to discuss why the pandemic is the moment to ensure trust in medicine.
@LashNolen @TsaiDuck77 @UREssien

Listen here: bit.ly/2NE0FKq

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More from @CPSolvers

The Clinical Problem Solvers Profile picture
16 Mar 20
1/ #MedTwitter, we have another lactic acidosis case!

Find the last two here:
(1) bit.ly/33gz9pu
(2) bit.ly/2U95Ktm

You just placed a pt on precaution for COVID & get a page about your next admission...

56M p/w R leg pain 1 hr after injuring his shin at home.
2/ T 99F, BP 127/78, HR 84, R 13, 98%
The R leg is bruised, swollen, and tender.

X-ray was w/o fracture, but U/S showed a large hematoma in the anterior R lower leg.

Patient reports frequent nosebleeds & bruising during the past year. Denies a FHx of bleeding conditions.
3/ Labs:
Hgb 11
PLT 220
Blood smear - normal
BMP - normal

aPTT 99 (25-36)
PT 12 (10-13)
Fibrinogen 300
Plasma vWF antigen - normal

Need a bit of a refresher on coagulation studies? Luckily, @CPSolvers is working on a schema for you! #MedTwitter, we’d appreciate your feedback!
Read 11 tweets
The Clinical Problem Solvers Profile picture
16 Mar 20
#MedTwitter we wanted to share some of the pearls that came from our first virtual morning report yesterday.

We have another TODAY @ 12pm PST/3pm EST

Zoom link coming soon.

Here are yesterday's teaching points:
Hyperkalemia can lead to fatal arrhythmias.

Treatment includes 3 stages:
1. cardiac membrane stabilization (e.g., IV calcium gluconate)
2. shifting potassium (e.g., B2-agonists, insulin, bicarb)
3. eliminating excess potassium (e.g., loop diuretics, K-binding resins, dialysis)
Spontaneous tumor lysis syndrome (TLS) is rare, but can occur with aggressive tumors (e.g., leukemia, lymphoma, small cell cancer).

Electrolyte derangements in TLS include hyperphosphatemia, hyperkalemia, hyperuricemia, and hypocalcemia.
Read 7 tweets
The Clinical Problem Solvers Profile picture
13 Mar 20
1/ #Medtwitter, a new case is here! Check out the last one here: bit.ly/33gz9pu

68M w/ fatigue, 20lb weight loss & dry cough x6 mo. No fevers but has frequent drenching night sweats.

How do you approach unintentional weight loss? Check out our schema below!
2/ No issues chewing or swallowing food, post-prandial pain, vomiting, or diarrhea.

VS T 37C BP 135/60 HR 82 RR 14 98% RA
On exam, he had a non-tender left 3x3 cm supraclavicular mass.

CBC and CMP were normal.
Lactate 5.3 mmol/L
3/ Elevated lactate is surprising given the patient’s story.

Take a minute to reflect on less uncommon causes of elevated lactate.

Looking at this schema through the lens of knowing the patient has a supraclavicular mass, does it filter the diagnoses in this schema?
Read 9 tweets
The Clinical Problem Solvers Profile picture
12 Mar 20
1/ #Medtwitter, we have a case for you, including a new #IllnessScript from @jackpenner & @EmmaHLevine!

32F presents with fevers, chills, & malaise x 5 days. Pt is somnolent and accompanied by her husband who denies localizing symptoms.

VS T 39C BP 120/60 HR 100 RR 14 100% RA
2/ While the RN is out of the room, the telemetry alarms for V-tach. When the RN returns, the monitor shows sinus rhythm.

Husband reports that the patient appeared to yell out and then was shivering violently for ~2 minutes.

What in this telemetry strip suggests artifact?
3/ You notice that although at quick first glance, the morphology in lead I and II might resemble a wide complex rhythm, lead III shows sinus tachycardia.

Therefore the limb leads I and II are capturing artifact (probably from movement of the patient).
Read 7 tweets
The Clinical Problem Solvers Profile picture
16 Feb 20
1/ #MedTwitter, thanks for joining us last week for our case #tweetorial (bit.ly/38rGrZs)! We have more clinical reasoning practice for you today!

67F w/ HTN, HFpEF & RA (on chronic prednisone & PCP PPx) p/w 3 days of progressive dyspnea, malaise & productive cough.
2/ As you get more information, what clinical reasoning tool can you use to determine how the data you gather increases or decreases the probability of the diseases you’re considering?
3/ ANS: Likelihood ratio. LRs help us decide how much each test result increases or decreases the probability of a specific disease.

For example, her history of HF has an LR of ~5 for HF as the cause of her dyspnea, increasing the probability of a HF exacerbation by ~30%.
Read 16 tweets
The Clinical Problem Solvers Profile picture
11 Feb 20
1/ #MedTwitter, we have a new edition of the “Clinical Reasoning Corner” coming this week, which means it’s time for some more clinical reasoning practice!

Follow along and let us know how you’re thinking about the case!

Today’s chief complaint is fever & abdominal pain.
2/ You’re called to admit a 52F w/ cirrhosis 2/2 Hepatitis C who is p/w 3 wks of progressive abdominal distension, and 2 days of abdominal pain & fevers.

She has a fever to 38.6C, scleral icterus, a diffusely tender abdomen, and a positive fluid wave.
3/ You and your colleague wonder whether or not she has ascites and recall a number of physical exam findings associated with it.

What clinical reasoning tool can you use to determine how each exam finding impacts the probability of ascites?
Read 11 tweets

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