A 🧵 on 🏮𝗛𝗬𝗣𝗢𝗦𝗣𝗟𝗘𝗡𝗜𝗦𝗠

Few questions

🛑 46yrs old male patient with hypersplenism due to tropical splenomegaly is planned to undergo splenectomy.

What all vaccinations should he receive❓️

What should be the ideal timing for vaccinations❓️

#MedTwitter #MedX 👇 Asplenia and hyposplenism can be either anatomic or functional.

Anatomic asplenia is most often due to surgical removal of the spleen.

Functional asplenia and hyposplenism result from conditions that lead to atrophy, infarction, engorgement, or infiltration of the spleen.

A🧵 on
5️⃣ categories of ascitic fluid infection that can happen in long standing ASCITES
#MedTwitter #MedEd #MedX

First a question ❓️

A patient with ascites underwent difficult and traumatic paracentesis.
......contiunued in 🧵 👇 Ascitic fluid analysis had PMN count of 100/mm3 & multiple organisms were grown on culture of fluid.

Diagnosis❓️

A.SBP
B.Secondary bacterial peritonitis
C.Polymicrobial bacterascites

Did you know that the tunable diaphragm technology of
3𝗠 Littmann stethescopes🩺
helps you to convert the chest piece into a bell & diaphragm merely by application of pressure.

No need to turn it to hear different frequencies of sounds on auscultation.

More in 🧵
#MedTwitter First of all, let's review the parts of a conventional stethescope.

🧠 CSF HSV PCR is diagnostic of HSV encephalitis but may be negative if done during the first 72h of onset of illness.

A🧵 on

Why is it important to distinguish herpes simplex encephalitis from other viral encephalitis & how to do that❓️

#MedTwitter #MedEd #MedX The distinction of HSV encephalitis from other viral
encephalitis is important because in virtually every other instance the therapy is supportive, whereas
specific antiviral therapy💉 is available for HSV, and its efficacy is enhanced when it is instituted early.

A🧵

This 🇮🇳 doctor is the co-author of one of the most highly cited scientific papers in the world & also is credited with the discovery of

💥ATP
💥Folic acid
💥Methotrexate
💥Aureomycin (the parent of tetracycline)
💥Diethylcarbamazine

Do you know his name❓️

#MedTwitter Millions live longer, more satisfying lives because of folic acid vitamin, tetracycline antibiotics anti-filarial and anti-cancer drugs developed under the research direction of Dr. Yellapragada Subbarow🙏

💥 𝗡𝗘𝗪: November 2023

💥 Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in
𝗖𝗜𝗥𝗥𝗛𝗢𝗦𝗜𝗦 : Expert Review

💥 American Gastroenterological Association ( AGA)

💥 A 🧵 on
12 BEST PRACTICE ADVICE STATEMENTS 👇

#MedTwitter #MedEd #MedX ♦️1
Vasoactive drugs should be initiated as soon as the diagnosis of variceal hemorrhage is suspected or confirmed, preferably before diagnostic and/or therapeutic endoscopy.

In 1984, to demonstrate that H. pylori caused gastritis, Professor Barry Marshall an Australian physician, drank a beaker of H.pylori culture.

He became ill with nausea & vomiting several days later

A🧵on discovery of H.pylori & it's association with peptic ulcer

#MedTwitter The discovery of H. Pylori (🦠) had been made by chance one afternoon in 1979, while Professor Robin Warren, an Austarlian pathologist was at work on a routine gastric biopsy sample in the pathology laboratory at the Royal Perth Hospital.

A 🧵 on STORMS in medicine.
First a question ❓️

PRAZOSIN is helpful in management of which among the following conditions❓️

💥Electrical storm
💥Cytokine storm
💥Thunderstorm Asthma
💥Thyroid storm
💥Parathyroid storm
💥Dystonic storm
💥Autonomic storm

#MedTwitter #MedEd Brief overview of these emergency conditions.

One of these conditions warrants activation of disaster management protocol 🚑 ⛈️

Which one is that❓️

Read on👇

A 🧵 on LACTULOSE

💥Correct method to give lactulose enema in Hepatic Encephalopathy (HE) Coma :

300 mL mixed with 700 mL tap
water or normal saline, given as a 30 to 60 minutes retention enema every 4 to 8 hrs until patient is
able to take medication orally.

#MedTwitter How lactulose helps in Hepatic Encephalopathy❓️ Read on 👇

💥The non‐absorbable disaccharide lactulose (β‐galactosidofructose) was first introduced into clinical practice in 1966.

A🧵 on FIBRINOLYTICS

First a fact check 👇

INTRAVENOUS THROMBOLYSIS can be successfull if given

A. Within 30minutes to 12 hrs in STEMI

B. Within 3-4.5 hrs in Acute ischemic stroke

C. Within 14 days in Pulmonary embolism

Choose ✅️TRUE statement/s among above #Medtwitter ✅️TRUE statement/s among the above three

The BRUGADA family has contributed immensely to field of
🫀Cardiology & Electrophysiology

A 🧵 on

💥𝗕𝗥𝗨𝗚𝗔𝗗𝗔 𝗘𝗣𝗢𝗡𝗬𝗠𝗦
☑️Brugada Syndrome
✅️Brugada Pattern
☑️Brugada Phenocopy
✅️Brugada Algorithm
☑️Brugada Criteria
✅️Brugada Sign

#MedTwitter #MedX
Read on👇 💥𝗕𝗿𝘂𝗴𝗮𝗱𝗮 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲 (BrS)
is a rare arrhythmogenic cardiac channelopathy characterised by ECG findings of ➡️

🔴 ≥0.2mV of ST segment elevation
➕️
🔴 Negative T-wave in more than one anterior precordial leads (v1 v2, v3)

A🧵 on alkali therapy.
First a Question❓️

A patient of diabetic ketoacidosis presented in a stupourous state with hypotension.

ABG ➡️ pH -7, HCO3 - 9 mEq/L, K-5mmol/L.

Along with other measures a decision was made for alkali therapy with sodium bicarbonate.

#MedTwitter How to give?
A.50 mEq of NaHCO3 in 300 mL of saline over 45min with target blood levels of HCO3 to 12mEq/L & pH upto 7.2

B.Isotonic NaHCO3 drip at 100ml/hr till pH>7.35

C.IV bolus 2 mEq/kg every 5min to raise pH to 7.4

D.IV bolus 1mEq/kg every hour to raise HCO3 upto 16mEq/L

A 🧵 on FIRST AID in snakebite🐍

First a question ❓️

How important is 𝙠𝙞𝙡𝙡𝙞𝙣𝙜/𝙘𝙖𝙥𝙩𝙪𝙧𝙞𝙣𝙜 the snake ( for identification) which has bitten the victim, for the management of snakebite❓️

Answer and discussion in 🧵 👇
#MedTwitter #MedEd #MedX How important is to capture the snake for identification in management of snake bite❓️

What is your answer❓️

💥AMIODARONE is a class III antiarrhythmic drug which is widely used in ER for treating arrhythmias.

A 🧵 on situations where blind use of amiodarone in emergency can be counterproductive ⚠️⚠️⚠️

With alternate therapeutic options

Read on...👇
#MedTwitter #MedEd #MedX ❌️Arrhythmias secondary to prolonged QT interval.

Amiodarone can furthur prolong QT resulting in asystole or VF.

✅️Use DC shock in unstable , MgSO4 in stable TdP, treat underlying cause of prolonged QT.

image @LITFLblog

A🧵

35yr 👨 known HIV+ve 💉IV drug abuser presents in status epilepticus at ER

Impossible to secure an intravenous line due to thrombosed veins and ongoing seizures.

Which drug can be given intramuscular to control seizures❓️

#MedTwitter #MedEd #MedX
#epilepsy Which drug can be given via intramuscular route in management of Status Epilepticus?

Answer in 🧵

60 Yr old man reports new onset right sided headache, sometimes severe at night for past one week.

What is the treatment of choice ❓️

#MedEd #MedTwitter #RheumTwitter #MedX Drug of choice❓️

PRAZOSIN is helpful in management of which among the following conditions?
#MedTwitter A 🧵 on STORMS in medicine.

Brief overview of these emergency conditions.

Extrapoints if you can point out which one of these require DISASTER MANAGEMENT STRATEGY

💥Electrical storm
💥Cytokine storm
💥Thunderstorm Asthma
💥Thyroid storm
💥Dystonic storm
💥Autonomic storm

A patient of diabetic ketoacidosis presented in a stupourous state with hypotension. ABG ➡️ pH -7, HCO3 - 9 mEq/L, K-5mmol/L. Along with other measures a decision was made for alkali therapy with IV sodium bicarbonate for severe acidosis. How should the Rx be given?
#MedTwitter A.50 mEq of NaHCO3 in 300 mL of saline over 45min with target blood levels of HCO3 to 12mEq/L & pH upto 7.2

B.Isotonic NaHCO3 drip at 100ml/hr till pH>7.35

C.IV bolus 2 mEq/kg every 5min to raise pH to 7.4

D.IV bolus 1mEq/kg every hour to raise HCO3 upto 16mEq/L

INTRAVENOUS THROMBOLYSIS (fibrinolytic therapy) can be successfull if given

A. Within 30minutes to 12 hrs in STEMI

B. Within 3-4.5 hrs in Acute ischemic stroke

C. Within 14 days in Pulmonary embolism

Choose the ✅️correct statement/s among the above.

#Medtwitter #MedEd ✅️TRUE statement/s among the above three

Drug of choice for ANAPHYLAXIS in a patient with no response to Epinephrine?
Patient is on Propranolol 60 mg BD for essential tremors.
#MedTwitter #emergencymedicine #CriticalCare Which drug should be given?
#MedTwitter #MedEd #MedicalStudentTwitter #IMGs #IMG #medicaleducation #medicalinternship #medicineresidency #internalmedicine #doctors #madaktari #Medicos #medicina #médecins #Medizin #Likitoci #medicine #medical #FOAMed #FOAMim #FOAM4GP

27 yrs old patient, detected to be pregnant when she missed her periods one day back. She has Graves disease on Rx for past 3 years, presently on Carbimazole 5mg daily and not on propranolol. She was euthyroid with Rx for past 1 year. Best strategy ?
Present reports 👇 A. Stop carbimazole and monitor by weekly/fortnightly TSH, FT4 levels and follow up.

B. Switch to PTU 50mg bd and do FT4, TSH after 2 weeks and review

C. Switch to PTU 50 mg bd + LT4 50mcg OD. TSH, FT4- 4wkly

D. PTU 50mg BD and Propranolol XL 20mg , Monthly TSH,FT4-followup