Nick Mark MD Profile picture
Nov 13 7 tweets 5 min read
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.🧵
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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!

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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…
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3️⃣ Download the app from the App Store.

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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

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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

Nov 11
Nomenclature question: what do you call it if someone has an elevated PaCO2?

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Medically they are synonyms. Both terms - hyperCAPNia & hyperCARBia - *mean* the same thing: having an increased PaCO2.

But the difference is a really big deal if you are a linguist.

2/
Etymologically, there is a (silly) difference:

Hypercapnia comes from the Greek word hyper (high) + the Greek word kapnos (smoke); both Greek roots 👍

Hypercapnia comes from the word Greek hyper + the *Latin* word Carbos (meaning charcoal); 1 Greek + 1 Latin root 👎

🤷
3/ Image
Read 5 tweets
Nov 11
Ok so #TwitterChaos is hilarious & as a bonus we’ll never need to see adds from these companies on Twitter again.

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Continued…
Nintendo
Read 4 tweets
Nov 9
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.

A 🧵
1/
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.

GR lecture: onepagericu.com/blog/from-zoo-…
3/
Read 8 tweets
Nov 2
More fun pulmonary physiology:

🤿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!)

ncbi.nlm.nih.gov/pmc/articles/P…

But why? Understanding requires a deep dive into the alveolar gas equation. A 🫁 pulm #physiology🧵.
2/ ImageImageImage
Before getting to the fun stuff, we should acknowledge that it’s *weird* for your PaO2 to increase while breath holding.

For comparison look how PaO2 DECREASES if you hold your breath on land: it plummets from 110 to 60 mmHg in just 35 seconds!

What makes diving different?
3/ Image
Read 20 tweets
Nov 1
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?

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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/ Image
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.

Why?

ncbi.nlm.nih.gov/pmc/articles/P…
3/ Image
Read 15 tweets
Nov 1
What is #MedMastodon & why might we need it?

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.

med-mastodon.com/web/home

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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.

I’m a better doc because of #MedTwitter
2/
Where else can you see the moment impactful research is published? Or hear the authors explain it & discuss with them?

Where else can you hear about the experience of colleagues around the world?

I’ve learned a lot and made some great friends IRL on here.
3/
Read 12 tweets

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