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Varun C. MD, DM Profile picture
@drcheruvarun
Apr 17 • 6 tweets • 6 min read Twitter logo Read on Twitter
Q for #medtwitter #cardiotwitter :

How many have noticed ECG being taken by nurses/students with this chest lead placement?

I see it so often but still gets on my nerves everytime!

Just curious if this is a common phenomenon? Image
@anunay_cardio @AdiG1993 @abadkhan2002 @suheildhanse @Hragy @drjatinanand @DrGJustinPaul1 @DrRajeshG1 @ashwinrajenesh @djc795 @rallamee @just1doctorwala @meshaljoseph
I am linking to am interesting article that shows that this lack of knowledge of accurate ECG lead placement extends even to cardiologists!
onlinelibrary.wiley.com/doi/abs/10.111…

DM if u want pdf.. ImageImage
@swapneilparikh @swatigar @SrihariNaiduMD
For those who are asking for the correct lead positioning this is the figure to remember 👇 Image
This is a fantastic workaround for when suction cups refuse to stay in position, either due the shape of the chest, mammary tissue, etc.
Thanks to @ashwinrajenesh for this!

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More from @drcheruvarun

Varun C. MD, DM Profile picture
Apr 12
Unfortunately the most inaccurate reading taken in a hospital is often the blood pressure. Nearly always guaranteed to be off.

Shown here are a few common errors made during BP measurement:

Can you spot them all?

There are at least 6 errors shown here.. answers in 2 hours. Image
Answers:
1. Back unsupported
2. Feet not planted on the floor
3. Cuff over shirt
4. Cuff too small for arm
5. Patient talking on phone
6. Patient's legs are crossed
7. Arm should be supported with cuff at heart level
Few more points to be remembered are all beautifully explained in this infographic 👇
Read 9 tweets
Varun C. MD, DM Profile picture
Mar 21
Short thread on what evidence means to us in medical field and why real doctors don't promote unproven and pseudoscientific Rx

Below is a classic example of a pseudoscience apologist who uses circular reasoning and appeals to ignorance to justify his stand against evidence 👇1/n
Let's break down his reasoning one-by-one and show why modern medicine gives so much importance to trials.

1) He states: "Absence of evidence is not evidence of absence" > This might be true except if after 1000s of years of tall claims, there is still absence of evidence 2/n
then that is telling. Trying to shift the burden of proof to absolve AYUSH proponents of responsibility is ludicrous to say the least.

e.g. If some folks believe that Elvis is still alive, then it's their prerogative to provide evidence for the same, not ours. 3/n
Read 8 tweets
Varun C. MD, DM Profile picture
May 30, 2021
So Dr. Reddy's has revealed the actual primary end point of their Phase 3 #2DG trial. They claim this was pre-specified and I guess we'll have to take their word 4 it.

But, wait a minute.. what was the +ve outcome they presented to DCGI? Was it time to 2 point improvement? 1/n
Umm, this sounds very different - they presented only proportion of patients with 1 point improvement at Day 3. Which if u recheck the last tweet, wasn't even one of their secondary end points! 2/n
What happened to all the other endpoints? Time to 2-pt imp, Time to reach pt 4, Time to pt 0, Time to negative PCR? What happened to these patients on Day 5, Day 7, Day 14??
Where is the test for statistical significance? Note that there is ZERO relevance of stating the RRR.. 3/n
Read 12 tweets
Varun C. MD, DM Profile picture
May 9, 2021
So, I suspect most don't really get what the big deal is in not reporting the primary outcome of a trial before commencing the trial, so here's a short #tweetorial..
So, let's say you're a competitor in a shooting contest, how do you measure your success? That's right - a target Image
Similarly, in clinical trials one starts with a target - aka primary endpoint. Generally this is the outcome of the trial you want to measure. These outcomes differ based on the kind of trial being planned. E.g. if we were planning a heart failure trial, some outcomes we might..
Read 14 tweets
Varun C. MD, DM Profile picture
May 7, 2021
Just leaving this here:
AYUSH 64 is an old formulation that was first tried in malaria and failed to show benefit compared to standard treatment. It was commercialised in 2014 by selling rights to Dabur and is being heavily promoted without any scientific evidence..
Abstract for the phase 2 trial in patients with Vivax malaria. No subsequent larger trials done.. Image
Reason why it's being repurposed for covid-19?
Simple: Helpless ministers don't have any idea what to do. They failed to arrange hospital beds or oxygen or ventilators or health capacity, so what else is left? You got it: promote pseudoscience BS.
Read 4 tweets
Varun C. MD, DM Profile picture
Apr 29, 2021
To those who have recovered from covid and are eager to share their experience:

PLEASE try not to make it into a promotion for a particular drug or treatment regimen

I've seen too many tweets that read "Doctor gave me this drug and in 5 days I was fine!"
This can be dangerous..
Your individual experience may mislead others to think that it's a simple matter of "what worked for him should work for everyone" which is not how medical science works..
As doctors we determine what works via clinical trials which have to be well designed and conducted
And we determine the best treatment approach for each individual patient based on different levels of evidence:
Read 5 tweets

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