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Satya Patel, MD

@SatyaPatelMD

6 Sep

@MedTweetorials

1/18 Chest pain is a frequently seen reason for admission. Here's my take on when to consider ACS in patients with chest pain!
#MedTwitter #CardioTwitter #MedEd #FOAMed #MedTweetorial @MedTweetorials

2/18 Our evaluation of ACS starts with 3 things:

1⃣ History
2⃣ EKG
3⃣ Troponin

The primary focus of this thread is going to be on the history (a heads up - the flowchart at the end will go a little bit out of order)!

3/18 When taking a chest pain history, we ask lots of questions about associated symptoms and alleviating/aggravating factors, mostly because we were taught to obtain and report this history. But is there a more focused way to approach this?

Read 18 tweets

Satya Patel, MD

@SatyaPatelMD

25 Aug

1/7 Considering how to manage community-acquired pneumonia (CAP)? Is it CURB-65 or should it be CARB-65? No idea what I am talking about? Let's talk about azotemia and uremia!

#MedTwitter #FOAMEd #MedEd #NephTwitter #IDTwitter

2/7 The CURB-65 score has been used for diagnosis and treatment of adults with community-acquired pneumonia (CAP). The most recent IDSA CAP guidelines in 2019 (pubmed.ncbi.nlm.nih.gov/31573350/) referenced the 2007 IDSA CAP criteria for defining severity

3/7 The original article that describes validation of the CURB scoring system (ncbi.nlm.nih.gov/pmc/articles/P…) does NOT use the word "uremia," but instead references an serum urea level cutoff.

Read 7 tweets

Satya Patel, MD

@SatyaPatelMD

25 Jul

1/9 You admit a patient overnight with hyponatremia and you diagnose it as SIADH. But how are you going to manage it?

To review how to diagnose SIADH, check out the volume-based or ADH/RAAS-based approaches below.

#MedEd #FOAMed #MedTwitter #NephTwitter #Tweetorial

2/9 The cornerstone of treatment is to treat the underlying cause. Everything else is just a 🩹. It can sometimes be very hard to treat the underlying cause immediately (assuming you can identify it).

https://twitter.com/edgarvlermamd/status/756197181468663808?s=20

3/9 Free water restriction is going to help (to a certain degree), but make sure that it’s feasible for the patient (they often need to do this beyond hospitalization). Consider restricting 500 cc below their 24-hour urine output:

https://twitter.com/edgarvlermamd/status/756197181468663808?s=20

Read 9 tweets

Satya Patel, MD

@SatyaPatelMD

22 Jul

1/8 A patient with compensated HFrEF (EF 35%) has positive orthostatics. He is not hypovolemic. What medication is reasonable to prescribe?
#MedTwitter #MedEd #FOAMed #NeuroTwitter #GeriTwitter

2/8
💥Fludrocortisone will increase ⬆️ RAAS and can cause volume overload, so you should avoid it here
💥 Caffeine and ibuprofen are last-line agents to manage orthostatic hypotension
💥 Midodrine is probably your best bet here

3/8 You prescribe midodrine 2.5 mg PO q8h and end up titrating it up to 5 mg PO q8h over the course of a few weeks. The patient shows you their BP log and you notice that their nighttime supine BPs are elevated. What do you do next?

Read 8 tweets

Satya Patel, MD

@SatyaPatelMD

21 Jul

1/5 A 78 yo F with no prior medical history p/w progressive pill-rolling tremor, shuffling gait, and dizziness upon standing. She takes no meds. Orthostatics are ➕. What is the likely cause of her orthostatic hypotension?
#MedTwitter #MedEd #FOAMEd #GeriTwitter #NeuroTwitter

https://twitter.com/SatyaPatelMD/status/1417493742768902144?s=20

2/5 The answer is Parkinsonism! Parkinsonism is a synucleinopathy (the protein alpha-synuclein accumulates in neurons and glia) leading to autonomic dysfunction. Review this approach on orthostatic hypotension here:

https://twitter.com/SatyaPatelMD/status/1417493742768902144?s=20

. Let's keep going.

3/5 She is diagnosed with Parkinsonism, and started on carbidopa-levodopa BID with improvement in symptoms. Her family has hired 24/7 caregivers who ensure her PO intake is adequate.

Read 5 tweets

Satya Patel, MD

@SatyaPatelMD

19 Jul

@MedTweetorials

1/9 Let’s say you are about to do a thyroid exam. Before the exam you do not suspect goiter (pre-test prob of 50%). How does the exam influence your probability? Let’s review some LRs from McGee!
#MedEd #FOAMed #MedTwitter #MedStudentTwitter #EndoTwitter @MedTweetorials

2/9 You may think “well that’s nice, but my thyroid exam technique is not the best.” Don’t worry, the Stanford 25 has got your back (including this clinical pearl)!
stanfordmedicine25.stanford.edu/the25/thyroid.…

3/9 Now that you’ve identified a goiter, you will probably end up ordering some lab and imaging studies. But don’t leave the bedside just yet! Let’s first break down the differential for an enlarged thyroid (thanks again to the Stanford 25).

Read 9 tweets

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