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13 Apr, 6 tweets, 3 min read
1/ Good morning, #MedTwitter, and happy Tuesday! We’re excited to bring you our latest installment of #ReadingRoom today. Dim the lights; it’s time to clinically correlate!

What object is labeled in the CXR below? What is it used for? Image
2/ That, friends, is our dear friend: the NG tube. It is our portal for tube feeds and PO meds (technically Per Nasus?), or if you put the thing down flip it and reverse it you can use the NGT to decompress the stomach. Image
3/ Next question: should you place that order that says “OK to use NG tube”?

The graphic below shows a systematic approach to ensure correct placement. This one is good to go! Image
4/ Let’s look at another NGT. This one looks a little different - how? And why? What is it? Image
5/ This one is distinctive because of its thick, weighted tip - a Dobhoff.

Drs. Dobbie & Hoffmeister invented the smaller, more flexible tube, and added a metal tip wrapped in silicone in an attempt to increase the chances of successful placement. Image
6/ And that’s it for this week’s #ReadingRoom! You can find this post and more on our website: coreimpodcast.com/2021/04/13/wha…

Credits
Graphics: @SalimNNajjar Content: @TomMulveyMD

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More from @COREIMpodcast

CORE IM Profile picture
13 Aug 20
1/ It’s Thursday, #MedTwitter, which means it’s time to take out your calipers and get to business. It’s #12LeadThursday!

Remember to use your system to go through each and every ECG methodically.
2/ Rate: ~75bpm
Rhythm: NSR
Axis: ...
3/ Do you have a schema or framework for thinking about a right axis deviation? What’s your differential?

Let us know in the comments below, and check out the framework we’ve provided!
Read 7 tweets
CORE IM Profile picture
16 Jul 20
1/ Welcome back, #medtwitter, to the latest installment of #12LeadThursday - #covid19 edition! Let’s put those calipers to work!

Take a look at this ECG. Approach it systematically. What do you see?
2/ In the above ECG, you’ve got an irregular narrow complex tachycardia. What’s your final read? Reply with your reasoning!
3/ Let’s take a closer look. In the graphic below, we’ve highlighted what you would expect to see in flutter - and none of it is present here. Our patient is fibbin’ away, folks.
Read 6 tweets
CORE IM Profile picture
14 Jul 20
1/ Happy Tuesday, #medtwitter! It’s time to take that walk down the hall to radiology for another round of #readingroom - let’s go!
2/ Looking at the previous tweet, where is the abnormal air located?
3/ If you said mediastinum, you’re right! This is also well characterized on chest CT pictured below.

Next question: how on earth did air get into the mediastinum? Reply with your thoughts, differentials and/or schema!
Read 7 tweets
CORE IM Profile picture
11 Apr 20
1/ Good morning, #medtwitter! This 1 goes out 2 everyone who hasn’t had to interpret a blood gas since Steps, prelim year or their last episode of ER (@DGlaucomflecken).

FYI: this ain’t a course on Winter’s Formula. We’re talking practical vent adjustments today. #covid4MDs
2/ There are 4 variables we might want to adjust on the vent based on our ABG results: PEEP, FiO2, RR and Vt. The first two we adjust to achieve appropriate oxygenation while the latter two we adjust to achieve adequate ventilation.
3/ Now that we’ve had that brief review, take a look at the following gases. What’s the problem, and how might you fix it?

Keep scrolling through the thread for the answers!
Read 7 tweets
CORE IM Profile picture
5 Apr 20
0/ Buongiorno, #medtwitter! We bring to you a #tweetorial on ventilator management for all those folks who don’t normally manage ARDS who have stepped up to help in this pandemic.

All credit goes to @AvrahamCooperMD; the following tweetorial is his brainchild. Thanks, Avi!
1/ Many clinicians are being/will be called to manage ARDS on the ventilator.

Imagine that your patient has just been intubated. Let's walk through the steps of vent mgmt 101:
- Initial housekeeping
- Basic vent management decisions in ARDS
- Management of refractory hypoxemia
2/ First, confirm endotracheal tube position:
- Did capnography confirm tracheal placement?
- Are breath sounds bilateral?
- Is the tube placed appropriately on CXR? (typically 2-5 cm from carina)

Pic from SAEM bit.ly/3bJrTpa
Read 13 tweets
CORE IM Profile picture
26 Mar 20
1/ Good morning, #medtwitter, and welcome to another round of #readingroom #covid4MDs edition!

You should have a system for reading CXRs, and you need to approach each image systematically. Apply that system now and tell us: what do you see? Could this be #covid19?
2/ In short, yes, this could be COVID-19, and in this case it was. But it could’ve been something else. Or it could’ve been a normal CXR and they still might’ve had COVID-19.

Moving on, do you know what the current ACR recommendations are for imaging in suspected COVID cases?
3/ Each patient who goes to CT is followed up by a thorough scrubbing of the scanning room - a process that takes up valuable time and delays necessary scans. Only COVID patients with strong indications for CT should be sent to the scanner.
Read 7 tweets

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