Nick Mark MD Profile picture
Nov 13, 2022 7 tweets 5 min read Read on X
Thousands have made the jump from #MedTwitter to #MedMastodon!

One issue I’ve heard is “I can’t get the app to work” or “I can’t find the server”

Good news: there are many mobile apps to choose from. Personally I think Meta-text & Tooot are easier to setup.

Here’s how.🧵
1/
1️⃣ Setup a #MedMastodon account:

The easiest way is just follow this invite
med-mastodon.com/invite/JLmsx3H6

You should see something like this.👇

Choose a name (or “handle”), enter your email address, & makeup a (secure) password.

That’s it!

2/
Once you confirm your email you should be able to login through the browser. Done

2️⃣If you prefer an app, you can choose from many options in the App Store.

Personally, I like Metatext; it’s open source, free, no ads, & doesn’t collect any user data!
apps.apple.com/us/app/metatex…
3/
3️⃣ Download the app from the App Store.

4/
4️⃣ Open the app and enter the name of your server where it says “instance URL”

If you created an account at #MedMastodon (step 1️⃣ in this tweetorial) you should fill in “med-mastodon.com

⚠️ be careful to include the dash

Click login
5️⃣ Enter the handle & password you chose in step 1️⃣
(if you are already logged in through the browser on your phone it may skip this step 😁)

🆒 Bonus: you can connect to multiple Mastodon accounts via Metatext. If you have another account that you want to keep, just add it

6/
That’s it! Take a look 👀

The Mastodon experience is a lot like Twitter… with a few things that make it better IMO: Small self moderated, no hate speech/misinformation, no algorithm, just a feed

(If there’s interest I’ll do an explainer about some of the differences.)

7/7

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More from @nickmmark

Jul 16
The media silence on this is deafening.

Did he have a head CT? What did it show?
Did he have stitches? Tetanus shot?

The NYT ran nonstop stories about Biden’s health after the debate but can’t be bothered to report on the health of someone who was literally shot in the head?
To the people in the replies who say it’s impossible because of “HIPPA”
1. I assume you mean HIPAA
2. A normal presidential candidate would allow his doctors to release the info. This is exactly what happened when Reagan survived an assassination attempt.
washingtonpost.com/obituaries/202…
My advice to journalists is to lookup tangential gunshot wounds (TGSW).

Ask questions like:
- what imaging has he had?
- what cognitive assessments?
- has he seen a neurosurgeon or neurologist?
- he’s previously had symptoms like slurred speech, abnormal gait - are these worse?
Read 4 tweets
Jun 30
You've probably heard "don't give lactated ringers because it raises lactate"

This statement is ~98% false, but there's one crucial practice-changing fact that you need to know.

A 🧵 all about lactic acid and lactated ringers!
1/
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First off, we should ackowledge the obvious: Lactated ringers does in fact contain lactate... 28 mEq/L in fact

BUT there's one little detail to remember:
Lactate ≠ Lactic acid

When we measure "lactate" we care about the ACID (H+) which lowers pH & causes organ dysfunction
2/ Image
But the correlation between pH & lactate is really bad!

Look at this analysis of lactate vs pH in 171 ICU patients.

There is a *weak* correlation in people with arterial lactate > 5, but even w/ lactate =10, pH ranged from 7.5 to 7.05. Quite a spread!

3/ ncbi.nlm.nih.gov/pmc/articles/P…
Image
Read 10 tweets
Jun 13
If you intubate you need to read the #PREOXI trial!
-n=1301 people requiring intubation in ED/ ICU were randomized to preoxygenation with oxygen mask vs non-invasive ventilation (NIV)
-NIV HALVED the risk of hypoxemia: 9 vs 18%
-NIV reduced mortality: 0.2% vs 1.1%

#CCR24
🧵
1/

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Hypoxemia (SpO2 <85%) occurs in 10-20% of ED & ICU intubations.

1-2% of intubations performed in ED/ICU result in cardiac arrest!

This is an exceptionally dangerous procedure and preoxygenation is essential to keep patients safe.

But what’s the *BEST* way to preoxygenate?
2/
Most people use a non-rebreather oxygen mask, but because of its loose fit it often delivers much less than 100% FiO2.

NIV (“BiPAP”) delivers a higher FiO2 because of its tight fit. It also delivers PEEP & achieves a higher mean airway pressure which is theoretically helpful!
3/
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Read 15 tweets
Jun 12
Results from #PROTECTION presented #CCR24 & published @NEJM.
- DB RCT of amino acid infusion vs placebo in n=3511 people undergoing cardiac surgery w/ bypass.
- Reduced incidence of AKI (26.9% vs 31.7% NNT=20) & need for RRT (1.4% vs 1.9% NNT=200)

Potential game changer!

🧵
1/
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I work in a busy CVICU & I often see AKI following cardiac surgery.

Despite risk stratification & hemodynamic optimization, AKI remains one of the most common complications after cardiac surgery with bypass.

Even a modest reduction in AKI/CRRT would be great for my patients.
2/ From Nature reviews nephrology  https://www.nature.com/articles/nrneph.2017.119
During cardiac surgery w/ bypass, renal blood flow (RBF) is reduced dramatically. This causes injury, especially in susceptible individuals.

But what if we could use physiology to protect the kidneys?

Renal blood vessels dilate after a high protein meal increasing RBF & GFR!
3/ https://www.jtcvs.org/article/S0022-5223(18)33243-4/fulltext
Read 11 tweets
May 3
A slightly tricky blood gas case:

77 yo with respiratory distress, RR 30, SpO2 80% on non-rebreather at 15 lpm

CXR & TTE are unrevealing

pH 7.58 / PaCO2 24 / PaO2 >500 / HCO3 22

MetHb 0% CarboxyHb 0%

The ABG looks like this: Image
The answer is sulfhemoglobinemia.

Sulfhemoglobinemia is a *permanently* modified hemoglobin associated with exposure to TMP/SMX, dapsone, phenazopyridine, & other amino & nitro compounds.

It has an altered oxy-hemoglobin dissociation curve.

2/

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Sulfhemoglobinemia is easily confused with methemoglobinemia. Both have very dark colored blood & present with cyanosis. Diagnosis typically requires a specialized lab.

Spoiler: you may have heard that SulfHb is green. It isn’t really. You’re thinking of Vulcans’ blood.

3/
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Read 7 tweets
Apr 28
This story is absolutely shocking.

Philip Morris International (PMI) spent millions to influence medical education by buying a series of “CMEs” at Medscape!

How else has big tobacco tried to normalize vaping & influence the medical community?

🧵
1/
theexamination.org/articles/medsc…
Recently it was revealed that Philip Morris International (PMI) had SPONSORED CME materials about smokeless tobacco products on Medscape.

I had the opportunity to review these “CME” materials & they are pretty shocking!
2/

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One truly incredible thing about this “CME” was that it has NO DISCLOSURE SLIDE!

The fact that people teaching about vaping don’t disclose their financial ties to the tobacco industry is absolutely bonkers!

Why isn’t there a sunshine act for this?
3/
Read 19 tweets

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