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𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

May 22

Hey #medicine residents !!

PLEASE TRANSFUSE BLOOD PRODUCTS JUDICIOUSLY 🙏🏻

Not every patient with anemia needs blood and not is blood transfusion free of complications.

I'll list out a few TRANSFUSION REACTIONS in case you'll have forgotten about them 👇🏻

#MedTwitter

1/10

Let's start w/ TACO🌮

This isn't the good Mexican 🌮 we love🤣

This is pulmonary oedema resulting from overzealous transfusion🤷‍♂️

Risk factors: patients who can't handle fluids we'll, i.e. patients w/ kidney,heart disease etc

Totally avoidable complication🙏🏻

#MedTwitter

2/10

A close differential of TACO is TRALI. The symptoms are the same but this is non-cardiogenic pulmonary oedema.

So BNP will be normal here, neck veins won't be dilated

TACO needs diuretics and some restraint on your part🤣

TRALI=supportive care

#MedTwitter

3/10

Read 10 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Apr 18

What does the 𝐖𝐀𝐑𝐅 in warfarin stand for??

Any ideas?

This is an interesting thread, let's dive into the history of one of the most widely used anticoagulants 👇🏻

#MedTwitter

Let's roll back time, we are in the 1930s in 🇺🇲, the great depression is at its peak and American farmers are losing their cattle 😭

How ??

Somehow the 🐄🐮 are developing fatal internal hemorrhages 😭😭

No one knew why !!

#MedTwitter

Obviously, their fodder was considered to be affected by some bug, but it wasn't to be found 🤷‍♂️

There wasn't any change in their diet, they were being fed sweet clover hay for centuries !!

#MedTwitter

Read 7 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Apr 18

You are a young #medicine resident !!

35/♀️/ wheeled in with 1 e/o seizure f/b loss of consciousness😮

Urgent CT👇🏻

Husband reveals she was on blood thinners after her ♥️ surgery, 5 yrs ago 😱

How do you manage this patient?

Read this thread to know more 👇🏻

#MedTwitter

1/12

Yes, the CT shows a large hematoma

The patient was most likely on a vitamin K antagonist (VKA) post her prosthetic valve surgery!

The labs are back, she has also started to 🩸 through Foley's catheter😭

•CBC: 8/5600/201k
•INR: 8.8
•aPTT: 32s (control 29s)

#MedTwitter

2/12

This is a classic example of warfarin toxicity & unfortunately quite commonly seen here in 🇮🇳

Why ?

The therapeutic window is 👇🏻

#MedTwitter

3/12

Read 13 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Apr 14

You are a young #medicine resident in a busy emergency when a 26/♂️ walks in with 👇🏻

C/o cough and respiratory distress + facial swelling x 7days. He is unable to sleep as the symptoms ⤴️ on lying down 😮

What do you do next?

You read this thread👇🏻

#medtwitter

1/18

You immediately know what's going on, you ask for an urgent chest imaging. Only a chest Xray is available and shows 👇🏻

Damnnnnn 😮😮😮

What's that ??

#MedTwitter

2/18

That is a massive mass in the neck and the mediastinum, also B/L CP angles are blunted 😮😮

This looks like a malignancy l/t superior vena cava (SVC) syndrome!

This is a medical emergency and you must know what next to do before the oncologist gets there!

#MedTwitter

3/18

Read 19 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Jan 24

You are a young #medicine resident!

You are working in a heavy emergency when:
23,♂️,p/w acute breathlessness
You check his SpO2, it's👇🏻

You are worried and start him on supplemental 02, but he remains hypoxic😭

Read on for the diagnosis and a brief review!

1/20

#MedTwitter

Let's start with the causes of hypoxic that don't respond to supplemental oxygen !

🔸R➡️L cardiac shunts
🔸Methemoglobinemia
🔸Sulfmethemoglobinemia

The ABG that you sent is back!!

It shows a normal Pa02 but your pulse oximeter is still reading 85% 🤷‍♂️

2/20
#MedTwitter

Your registrar is smart and he asks you to send another sample, this time asking the lab for a methemoglobin value.

Voila !!

The lab says: 45% methemoglobin 😮

3/20

#MedTwitter

Read 20 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Dec 13, 2022

As a #medicine resident you'll come across 👇🏻 scenario often.

Your #surgery colleagues want you to opine on the type and duration of ANTICOAGULATION and also want to know why it occured in the first place🤷‍♂️

Let's dig deeper 👇🏻

1/24

#MedTwitter #DVT

Yeah, this is obviously a Deep Vein Thrombosis (DVT) !

It's fairly common, develops in about 1/1000 people 😮

Remember, DVT+PE = VTE

PE= pulm embolism
VTE= venous thromboembolism

⭐1/3 DVT develop PE⭐

The PE is what can lead to mortality!
Preventing PE is IMPORTANT 🙏🏻

2/24

DVT is not less of a monster !

Many w/ DVT will develop post thrombotic syndrome 😮 That's a lot of morbidity, leg pain, swelling, ulceration and all 😭

But
🔸Why does VTE occur ?
🔸Who's at risk of developing it ?
🔸Can we prevent it ?
🔸How does one treat it ?

3/24

Read 24 tweets

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