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
• • •
Missing some Tweet in this thread? You can try to
force a refresh
I’m all about using comparative physiology to understand critical illness but I gotta call BS on this.
The “mysterious EEG pattern” they described is burst suppression & the most likely explanation for it (and the mysterious prolonged unconsciousness) is OVERSEDATION.
They claim that deep sedation is neuroprotective based on a *theoretical* model of burst suppression.
We know for *actual studies* done in the ICU that the opposite is true: burst suppression in critical illness is associated with increased mortality. ncbi.nlm.nih.gov/pmc/articles/P…
2/
I’m all about the Painted Turtle & what we can learn from it - I’ve even written & given Grand Rounds on this subject! (See this🧵 & link below for example)
But the analogy of C Picta belli to critically ill humans is deeply flawed.
🤿A person takes a deep breath of ambient air & free dives (e.g. holds her breath without a SCUBA tank) in the ocean. At a depth of 40m an arterial blood gas is drawn.
Compared to an ABG drawn at the surface, the divers PaO2 at 40m is:
The answer is INCREASED.
We know because people have free-dived with an arterial line: mean PaO2 at 40m was 197 mmHg (after 45s of breath holding!)
Here’s another pulmonary physiology question that *everyone* who gives O2 to patients ought to know:
What is the primary mechanism by which supplemental oxygen can increase PaCO2 in someone with severe COPD?
1/
This is a hard question! You probably learned that "its bad to give someone with COPD ‘too much’ O2 because they might stop breathing”
Turns out hypoxic respiratory drive causing apnea is a MYTH..but there is an important truth here:
A🧵on Oxygen induced hypercapnia! 2/
Every myth has a little kernel of truth:
In the 80s it was shown that giving people with severe COPD (GOLD stage IV) high flow oxygen (15 lpm) made their minute ventilation (VE) drop then return (almost) to normal, but PaCO2 rose significantly.
A short thread explaining what it is & why I think it’s time to consider moving to a free, self-moderated medical community as a #MedTwitter alternative.
Despite its flaws I think Twitter is a great platform for medicine/science.
It’s a fantastic way to follow breaking news & scientific pubs. It’s a great way to hear what brilliant people think. It can be an OK way to engage in debate.