I just finished reading One by One by One by @AaronLBerkowitz

4 thoughts:

1️⃣ This is a beautiful book. Aaron writes with lucidity and a deep sense of shared humanity

#medtwitter Image
2️⃣ I ❤️ the way he zooms in on individual stories and then zooms out. One chapter he’s in a ramshackle hut in rural Haiti, the next he’s building Haiti’s first neurology residency or meditating on the sociocultural basis for global health inequities
3️⃣ Through the stories he tells he actually manages to teach a decent bit of neurology (whether intentional or not)
4️⃣ If you have a beating heart and care about making a difference in the lives of other humans with beating hearts then you should read this book. Thank you @AaronLBerkowitz for sharing it with us.

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More from @AvrahamCooperMD

5 Sep
1/🧵
Why does Wenckebach AV nodal block (aka Mobitz type 1) present with progressive prolongation of the PR interval and eventually a non-conducted P wave? 

What causes this unique EKG pattern to arise?

#medtwitter #tweetorial
2/
Karel Frederik Wenckebach, a Dutch anatomist/physician, noticed a patient’s irregular pulse in 1898.

He astutely noted a repeating cycle of:
🫀 Progressive delay b/w the 𝑎 jugular venous wave and carotid pulsation
🫀 An 𝑎 wave w/o carotid pulsation

ncbi.nlm.nih.gov/pmc/articles/P…
3/
The pattern Wenckebach observed corresponds exactly w/ the progressive PR prolongation, followed by a non-conducted P wave, that characterizes what we call “Wenckebach” heart block.

💥 Amazingly, he observed this BEFORE the AV node was discovered.

litfl.com/karel-frederik…
Read 14 tweets
11 Jul
1/🧵

This is the incredible story of an anesthesiologist who, in 1946, purposefully paralyzed himself using curare.

Though conditions were controlled, by the end of the experiment he was wide awake and fully paralyzed, without any sedation.

#histmed #medtwitter #tweetorial
2/
Context:
Purified forms of the neuromuscular blocker curare came into clinical use for general anesthesia in the 1930s and 1940s.

There was an active debate at the time about whether curare causes paralysis alone or if it also sedates.

pubmed.ncbi.nlm.nih.gov/15402044/
3/
This question had major implications for the nascent field of anesthesiology.

Some practitioners began to use curare alone during surgery, without sedation, believing that curare adequately sedated patients in addition to paralyzing them.

pubmed.ncbi.nlm.nih.gov/15402044/
Read 23 tweets
23 May
1/🧵

Ever wonder why severe hypertriglyceridemia causes acute pancreatitis?

Are triglycerides themselves toxic to the pancreas or is there something else going on?

#tweetorial #medtwitter
2/
The association b/w ⬆️ triglycerides and pancreatitis was proposed after a 1975 study.

11 patients w/ previous pancreatitis volunteered to receive lipid-rich diets, increasing triglyceride levels to >600 mg/dL.

7/11 got recurrent pancreatitis. 

pubmed.ncbi.nlm.nih.gov/1145440/
3/
Hypertriglyceridemia actually accounts for up to ~10% of acute pancreatitis cases.

There is even a dose-response relationship, w/ the risk of pancreatitis increasing with higher serum triglyceride levels.

pubmed.ncbi.nlm.nih.gov/22898632/
Read 14 tweets
4 May
5:30 pm.

3rd year of medical school.

Internal medicine clerkship.

Medically “routine” evening discharge.

The patient happened to be homeless.

Tasks my resident gave me to do: make sure the patient had their prescriptions, a place to stay and a way to get there.
First I headed straight to the hospital pharmacy before they closed and picked up the scripts.

Then a taxi voucher from the nurses station.

Quick Google search and printed off 3 shelter options.

All of it went in a bag that we gave to the patient.
The whole thing took maybe 15 minutes.

I can still remember the look on her face when we gave her the bag.

Like she’d been seen and heard and cared about for the first time in a long while.
Read 4 tweets
11 Apr
1/ 🧵

Why can propofol infusion at high doses cause Propofol-related Infusion Syndrome (PRIS)?

To understand why we have to revisit the old adage of supply and demand.

#Tweetorial #MedTwitter
2/
Propofol is a sedative-hypnotic developed in the 1970s.

PRIS was first described in the late 1980s when several children had cardiovascular collapse and severe bradyarrythmias while on propofol.

🔑They all had received extended, high-dose infusions.

ncbi.nlm.nih.gov/pmc/articles/P…
3/
Subsequent case descriptions found that patients who developed PRIS also had:

❤️Severe rhabdomyolysis and diffuse skeletal and cardiac muscular necrosis
❤️Hypertriglyceridemia
❤️Lactic acidosis
❤️Multiorgan failure

Kids seem to be more susceptible.

pubmed.ncbi.nlm.nih.gov/10759487/
Read 18 tweets
7 Mar
1/🧵
Why does catamenial pneumothorax (pneumothorax that recurs with menstruation) almost always occur on the right side?

Why doesn't it affect both sides of the chest equally?

#medtwitter #tweetorial
2/
Catamenial pneumothorax was first described in 1958.

A woman presented w/ 12 episodes of right-sided pneumothorax over 1 year, recurring monthly w/ menstruation.

Thoracotomy revealed thoracic endometriosis.

pubmed.ncbi.nlm.nih.gov/13598643/
3/
Endometriosis = extra-uterine implantation of endometrial tissue

Mechanisms include:

💡Retrograde menstruation ➡️ abdominopelvic spread
💡Blood/lymph-borne deposition
💡Metaplasia

🔑Retrograde menstruation is considered the predominant mechanism.

ncbi.nlm.nih.gov/pmc/articles/P…
Read 18 tweets

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