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Oct 27 • 4 tweets • 2 min read
1/ #tweetorial

Management of Atrial Fibrillation (AF) with Rapid Ventricular Response (RVR) - KEY POINTS

➡️ Patients with atrial fibrillation who are unstable due to an RVR should be treated with synchronized cardioversion.

- Read More: manualofmedicine.com/topics/cardiol…

#meded #foamed
2/
➡️ Medications commonly used to control heart rate in atrial fibrillation include :

👉Calcium channel blockers (CCBs)
👉Beta-adrenergic blockers
👉Digoxin
👉Amiodarone.

#cardioed #CardioTwitter
3/
➡️ Calcium Channel Blockers or Beta Blockers are the first-line medications for most patients with Afib with an RVR.

➡️ All AV node–blocking medications are contraindicated for rate control of Afib in the setting of WPW, where conduction occurs through the accessory pathway.
4/
➡️ Contraindications to the use of beta-blockers in the treatment of atrial fibrillation include hypotension, severe CHF, severe COPD, and acute asthma exacerbation.

➡️ Consider digoxin for rate control in the patient with hypotension or an acute exacerbation of CHF.

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More from @ManualOMedicine

Manual Of Medicine Profile picture
Jan 11
1/ #tweetorial

💠 Caustic Ingestions - Key Points

➡️ Serious ingestions can immediately result in perforation, shock, and even death.

➡️ Caustic materials cause tissue injury by chemical reaction.

- Read More : manualofmedicine.com/topics/emergen…

#meded #foamed #medtwitter
2/
➡️ Acids cause coagulative necrosis, which results in a self-limiting burn pattern

➡️ Alkaline materials induce liquefactive necrosis with diffusion into deeper layers of the injured mucosa. Even low concentrations of alkaline ingestion can cause extensive injury.
3/
➡️ Caustic Ingestion can provoke injury from the mouth, the airway, down through the esophagus to the small intestine.

➡️ Long-term complications can lead to strictures and an increased risk of esophageal cancer.
Read 9 tweets
Manual Of Medicine Profile picture
Dec 30, 2021
1/ #tweetorial

💠 Boerhaave Syndrome - Key Points

➡️ Boerhaave syndrome is a spontaneous rupture of the esophagus from barotrauma related to retching or any sudden increase in intraabdominal pressure against a closed glottis.

manualofmedicine.com/topics/gastroe…

#medtwitter #foamed #meded
2/
➡️ Classically, we associate Boerhaave syndrome with Mackler triad:

👉 retrosternal chest pain
👉 vomiting
👉 subcutaneous emphysema
3/
➡️ Boerhaave syndrome should be suspected in any patient who presents with retrosternal chest pain, neck pain, or epigastric pain, especially if it began after an episode of severe retching or bearing down against a closed glottis (weight lifting, defecation, childbirth, etc)
Read 8 tweets
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Dec 20, 2021
1/ #tweetorial

💠 Anticipate Bleeding and Reverse Coagulopathies in Liver Failure - Key Points

➡️ Blood clotting in the setting of chronic liver disease is complex and may result in a net prothrombotic or antithrombotic state.

manualofmedicine.com/topics/gastroe…

#foamed #medtwitter
2/
➡️ Favoring bleeding (antithrombotic state) are:

👉 reductions in hepatically produced procoagulant factors (II, VII, IX, and X) and fibrinogen.

👉 thrombocytopenia due to reduced thrombopoietin production, splenic sequestration, and production of antiplatelet antibodies.
3/
➡️ Favoring thromboses (prothrombotic state) are:

👉 reductions in a strong anticoagulant factor (protein C).

👉 increased platelet activation due to elevated von Willebrand factor levels.
Read 10 tweets
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Dec 6, 2021
1/ #tweetorial

💠 When an Appendicitis Doesn’t Follow the Rules

➡️ Acute appendicitis is the most common abdominal emergency.

-- Read More: manualofmedicine.com/topics/gastroe…

#medtwitter #meded #foamed
2/
➡️ It occurs when there is obstruction of the appendiceal lumen, from a:

👉 fecalith
👉 tumor
👉 infection
👉 hyperplasia of lymphoid follicles
3/
➡️ Classic symptoms include pain that is initially vague and periumbilical followed by a more localized parietal pain in the right lower quadrant.

➡️ Only 50% of people present with these classic symptoms; in the other 50%, appendicitis can be difficult to diagnosis.
Read 10 tweets
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Nov 25, 2021
1/ #tweetorial

💠 Pearls in Syncope ECG Interpretation.

➡️ In the patient with syncope, the ECG should be scrutinized for signs of Ischemia, Bradydysrhythmias, Tachydysrhythmias, and Conduction delays.

--Read More:
manualofmedicine.com/topics/cardiol…

#meded #foamed #medtwitter #cardioed
2/
➡️ Additional critical diagnoses to consider that can be detected with ECG:

👉Ventricular Preexcitation (WPW)
👉Brugada syndrome
👉Long or short QT syndromes
👉Hypertrophic Cardiomyopathy
👉Arrhythmogenic right ventricular dysplasia
👉Catecholaminergic polymorphic VT
3/
➡️ Ventricular Preexcitation (WPW)

👉 PR segment < 120 ms
👉 QRS complex > 110 ms
👉 Slurred upstroke of the initial part of the R wave (delta wave)
➖ Type A: delta wave in all precordial leads, R > S in lead V1
➖ Type B: negative delta waves in leads V1 and V2
Read 10 tweets
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Nov 18, 2021
1/ #tweetorial

💠 Beyond Diuresis – Treatment Adjuncts in Cardiogenic Pulmonary Edema.

➡️ Diuretics have traditionally been a mainstay of therapy for cardiogenic pulmonary edema.

manualofmedicine.com/topics/cardiol…

#meded #foamed #medtwitter #cardiotwitter #cardioed
2/
➡️ Diuretics may not be the preferred initial therapy for those patients with vascular failure, who are often euvolemic, or those with cardiogenic shock, who are often hypovolemic.
3/
➡️ In these patients, the emergency provider should first optimize preload and afterload reduction with the use of noninvasive positive pressure ventilation (NPPV), nitrates, or inotropes as indicated.
Read 8 tweets

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