older lady with vascular dementia & osteoporosis with acute on chronic LBP with new T12 compression fracture with bad pain
she is confused, nonverbal, writhing, grimaces, winces when you push her T12 spinal process
Aug 27, 2024 • 8 tweets • 3 min read
We started a #NewsYouCanUse lecture series for our Division
Here are 6 bite-sized evidence based pearls to consider incorporating into your practice & teaching
Links in QR code
1. Use pip-tazo extended infusion for empiric therapy IF worried about pseudomonas
I can now prescribe it again without the hoops & hurdles of ID approval!
@DrToddLee @dralicehan
Oct 23, 2023 • 23 tweets • 5 min read
Finished a brief stint on the faculty hospital medicine service in a safety net hospital
Lots of skin/soft tissue infections, addiction, & inability to care for self
Run down of every single patient I saw with a teaching pearl (or two)
I saved the best for last
1| AUD intoxication->fall->inability for self care
system pearl 🦪: there's a real donut hole in the safety net (& many hospitals frankly) for patients who don't have acute rehab needs, but need custodial care in the short term
what I do know is they don't need to see me daily
Oct 18, 2023 • 15 tweets • 6 min read
Wow
Just read perhaps the greatest article about a doctors’ diagnostic skills
Not in the medical literature, but in an economics journal!
If you think about diagnosis, follow along
It won’t disappoint
@RogueRad
1| THE ISSUES
Diagnostic test thresholds have an inherent sensitivity/specificity tradeoff
But if the test involves doctoring (ie history or exam finding) is this tradeoff still true?
Aug 7, 2023 • 16 tweets • 3 min read
5 cases I reflected on after a 5 day stint on service in the hospital
1A. Pt with AUD & freq falls was still orthostatic after 3L IVF & attributed possibly to dysautonomia
But HR change was ~30 beats with much less dramatic BP drop
ΔHR/ΔSBP >>> 0.5 so very c/w low preload (here hypovolemia)
Here are my top 12 studies from 2022 in no particular order that influence Hospital Medicine
I avoided:
-only abstracts (sorry SABATO & TRANSFORM-HF)
-COVID since the disease as we once knew it is uncommon
-Subspecialty or critical care only implications
For agitated delirium it’s safe to treat with haloperidol & probably also saves lives
This upends what I thought I knew about delirium treatment
1| This thread is for other parents who are also deciding about #COVID vax for their toddlers (2-4 yo) who have ALREADY had Omicron
TLDR: Will wait to see: 1) vax effectivness vs BA4/5; 2) whether new vax to O variants available; 3) most importantly, how day care policies evolve
2| Disclaimers:
-I believe COVID mRNA vax for adults is among the most remarkable scientific innovations in our history
-I am vaxxed with pfizer x3 (and my DNA hasn't been altered)
Sep 3, 2021 • 25 tweets • 8 min read
The community masking trial in Bangladesh by @Jabaluck@mushfiq_econ et al is AMAZING & EXCEPTIONALLY well done
Joy to read & I learned a LOT
Encourage all scientists in related disciplines to read, even if not your content
2| Let's start with MI def. Billing codes less accurate than adjudicated MI outcomes, yes? Could be nondiff misclassification which bias to null. But could also be diff w/ ascertainment bias (look harder, anchoring) knowing CCTA result, since 2/3rds normal or nonobstruct.
