CORE IM Profile picture
Feb 23, 2022 5 tweets 3 min read Read on X
1/🚨New Episode & Segment Alert🚨

Grey Matters: Because medicine is rarely black and white!

Hosts: Alison Trainor, @FreedoBaggins
Discussants: @PishkoMD, Brett Carroll MD, Jeff Weinstein MD
Graphic: @samwoodworthmd

🎶 bit.ly/35hN1Fd
ACP: bit.ly/3oVhwbI
2/ Let's review some deep dives 👇

Where does the *strong rec* to anticoagulate for PE at least 1 month (if not the full 3 months) come from?!

We have natural history data tells us:
3/ How long do you hold DOACs for peri-procedure?

Let’s see what we can extrapolate from the PAUSE trial
4/ What do we know about IVC filters in preventing further embolization of DVTs?

PREPIC1 and PREPIC2 compared anticoagulation alone vs. anticoagulation plus IVC filter

❌ No difference in mortality
❌ No difference in symptomatic PE
5/ When to perform a liver biopsy in a patient with an active clot AND has failed outpt interruption of anticoagulation?

Look to the IR Consensus Guidelines! They can help estimate patient/procedure bleeding risk and guide your clinical decision making bit.ly/3haU0m0

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More from @COREIMpodcast

Sep 11
1/ 🚨 NEW #AtTheBedside: Moral Distress Part 1: Definitions, Causes & Consequences

Time to really name, talk about, and hopefully unpack some of the hidden weight we carry in the practice of medicine ⤵️

🖥️:
Sponsor: @Pan_Financial coreimpodcast.com/2024/09/11/mor…
Image
2/ Moral distress:

When clinicians are:
☀️ Stopped from taking what they believe to be ethically appropriate actions
☀️ Forced to take actions that are ethically inappropriate based on their professional obligations

Results in a sense of complicity & wrongdoing
3/ Moral distress occurs at:

☀️Patient or family level
☀️Unit or team level
☀️System level
Read 8 tweets
Jun 5
1/ 🚨 NEW #5Pearls on HFpEF!

HFpEF is:
- Clinical syndrome of heart failure w/ EF 50%+
- ☂️ term | Heterogeneous disease 

HFpEF is NOT:
- Classic high BP, causing stiff ventricles

🖥️ :
ACP CME:
Sponsor:  coreimpodcast.com/2024/06/05/hfp…
bit.ly/CIMCME
coreimpodcast.com/Freed
Image
2/ Clinically, HFpEF is:

🫀Dyspnea on exertion
🫀PND
🫀Orthopnea
🫀Fatigue
🫀Exercise intolerance
🫀JVD
🫀Pulmonary rales
🫀LE edema
3/ On echo, HFpEF is NOT:
🫀Just diastolic dysfunction

**Diastolic dysfunction CAN be seen in HFpEF 

But, it was not observed on resting echocardiograms of ⅓ of HFpEF patients in the Paragon-HF trial ‼️
Read 7 tweets
May 13
1/ 🚨 NEW #5Pearls episode on Cardiorenal Considerations 🫀🫘

So many diuretic options, so which to choose and why?

Use the toolkit ⤵️ for all your diuresis needs!

🖥️:
CME: 
Sponsor:  bit.ly/3wx8tnB
bit.ly/CIMCME
coreimpodcast.com/Freed
Image
2/ Not all AKI in heart failure is cardiorenal syndrome!

In pure cardiorenal, expect a “bland” UA with no:
🥩 Protein
🩸 Blood
🦠 Granular or other cell casts!

**Remember, keep a broad differential for AKI
3/ You suspect volume overload in a patient…what dose of diuretic do you start with?

2.5x their home dose of diuretic (in IV form)!

IV options include:
💉 Furosemide
💉 Bumetanide

**Bumetanide drip at higher doses is associated with myalgias
Read 9 tweets
Jun 8, 2023
1/ Time for #12LeadThursday!

What’s the axis and do you notice anything about the precordial leads? Image
2/ What do you see on ECG to identify extreme axis deviation?

Negative deflection in lead I + negative deflection in aVF = extreme axis deviation Image
3/ What about the precordial leads?

Do you notice dominant R waves, S waves, or T-wave inversions? Image
Read 5 tweets
Apr 13, 2023
1/ What better way to end off a week of pacemakers and ICDs than recapping and revisiting our #12LeadThursday series!

🧵 Image
2/ Which patients get pacemakers?

Think of 2 big buckets: conduction disease and heart failure Image
3/ Let’s start with conduction disease!

Refresh your memory with this past byte - 80 y/o M with hx of CABG…what's the rhythm?
bit.ly/40cAry0
Read 15 tweets
Jan 18, 2023
1/ Atrial Fibrillation: #GrayMatters Series

What do you do with that episode of #Afib when sick or post-op in the hospital?

What type of monitoring is best?

🎧: link.chtbl.com/Afib
🗒️: bit.ly/3QPiLFt
CME: bit.ly/CIMCME
Sponsor: go.amboss.com/CoreIM-E9
2/ When do you start AC for new Afib post-op?

We hope this infographic will be handy for the many times we may be in the gray zone!

From @accpchest guidelines

A few things to consider:
🤔 Patient specific risk
🤔 Blood thinner of choice
🤔 Bleeding risk of the surgery
3/ Credit to the team that worked tirelessly on this!

Hosts: Dr. Nick Villano, @Ali_Trainor, @FreedoBaggins
Off-air producer: @ShreyaTrivediMD
Experts: @jasonmatosmd, @PoojaJagadishMD, @gregorykatz
Graphic: Josie Levey

🎧:link.chtbl.com/Afib

coreimpodcast.com/2023/01/18/dia…
Read 5 tweets

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