1/ Have you ever been confused about the pulmonary management of neuromuscular disorders? If so, I promise you aren’t the only one! Check out this #tweetorial primer on the basics of NMD management. @VCU_PCCM @crit_caring_MD @AvrahamCooperMD @PulmPEEPs #CHESTTrainees #MedEd 2/ Neuromuscular diseases affect the respiratory system in 3 main areas:
1⃣Ventilatory Function
2⃣Cough Function
3⃣Swallowing and Airway Protection

As muscle weakness progresses, this will lead to alveolar hypoventilation with subsequent hypoxemia and hypercapnia.

1/Today’s 🧵 will focus on the pathogenesis of cystic fibrosis along with a brief discussion on the landscape of CFTR modulators. #tweetorial @VCU_PCCM @crit_caring_MD @lkbrath @PSinkam @NaumanChaudary1 @MichaeLheureux @AvrahamCooperMD 2/CF results from a pathogenic mutation on a single gene located on chromosome 7 that encodes the cystic fibrosis transmembrane conductance regulator protein (CFTR). The CFTR serves as a regulated chloride channel that is important in the viscosity of secretions. @mdlizs

1/Currently on my cystic fibrosis rotation with @NaumanChaudary1. See below for a brief 🧵from today's learning points on CF diagnosis. This flow diagram from @JPediatr demonstrates the appropriate diagnostic algorithm. #tweetorial @VCU_PCCM @lkbrath @PSinkam @crit_caring_MD 2/Sweat chloride testing can help confirm the diagnosis; however, in individuals with intermediate results (30-59 mmol/L) further testing needs to be completed. These charts from @CF_Foundation highlights sweat chloride testing results.

1/Delirium is a common problem that we see in our ICUs. It is associated with the following:

⬆️Mortality
⬆️Length of Stay
⬆️Institutionalization
⬆️Cognitive Decline
⬆️Depression, Anxiety
@VCU_PCCM @lkbrath @crit_caring_MD @PSinkam @VCU_IMRes @mdlizs @MichaeLheureux #MedEd 2/A snow globe is a great analogy to discuss and frame delirium with patient’s families. How well the snow is packed at the bottom of the globe can be thought of as predisposing factors. When the snow globe is shaken it represents active delirium from a precipitating cause.

1/ Have you ever heard your friendly pulmonologist use the terms “entrapped” or “trapped” lung and were confused about the terminology? If so you are not alone and this is the tweetorial for you! #MedTwitter #tweetorial @crit_caring_MD @lkbrath @VCU_PCCM @PSinkam 2/Let’s first start with some definitions. The term “non-expandable lung” is an umbrella term that is used to describe when the lung is unable to expand to the chest wall in order to achieve visceral and parietal pleura apposition. @AvrahamCooperMD @michellebr00ks @mdlizs

1/Pulmonary embolism is a commonly encountered condition; however, how comfortable are you with the acute diagnosis and treatment of the disease? Let's take a walk through the guidelines. #tweetorial #MedEd @VCU_PCCM @crit_caring_MD @lkbrath @PSinkam @AvrahamCooperMD @VCU_IMRes 2/ Venous thromboembolism is currently the 3rd most frequent acute cardiovascular syndrome encountered globally with an annual incidence rate ranging from 39-155 per 100,0000 population. bit.ly/3j4iP2s @michellebr00ks @cjchiu @mdlizs @mkashiouris @B_M_Wiese @ptfaddenMD

1/ What is your differential diagnosis for an individual who is having recurrent asthma exacerbations despite optimal therapy? @VCU_PCCM @crit_caring_MD @PDjack1984 @MichaeLheureux @KevinSwiatek @AndreaMytinger @lkbrath @PSinkam @samirashojaee @AvrahamCooperMD #tweetorial 2/ The differential diagnosis is broad but potential etiologies include:
1⃣ Does this patient actually have asthma?
2⃣ Infectious (bacterial, fungal, viral)
3⃣ GERD
4⃣ Congestive Heart Failure
5⃣ Vocal Cord Dysfunction
@mdlizs @mkashiouris @B_M_Wiese @ptfaddenMD @DxRxEdu

1/#MRPearls Pulmonary hypertension (PH) is a wide ranging disease that is associated with ⬆️ morbidity and mortality. How comfortable are you with right heart catherizations and the changing diagnostic criteria in PH? #tweetorial @AvrahamCooperMD 2/#MRPearls Right heart catherizations in the supine position remain the gold standard for the diagnosis of PH. This is typically done using a fluid-filled balloon-tipped thermodilution catheter. Check out this image to see the various wave forms within each heart chamber.

1/ #MRPearls Have you ever had the clinical situation arise where you had to choose between vitamin K, prothrombin complex concentrate (PCC) & fresh frozen plasma to reverse warfarin in a clinically significant bleed? #tweetorial
@VCU_IMRes @rabihmgeha @DxRxEdu @michellebr00ks 2/ #MRPearls The first question you need to ask yourself is does this patient have a clinically relevant bleed? Do you know the definition as defined by the International Society on Thrombosis and Hemostasis (ISTH)? @marinanaz @MarkZieglerMD @nchadha3 @pchawla8 @murtipatel_

1/ #MRPearls Epistaxis is a common complaint seen in both the inpatient and outpatient settings with approximately 60% of the general population having an episode of epistaxis in their lifetime with a pretty clear bimodal distribution (<10yo and >50yo). #Tweetorial @VCU_IMRes 2/ #MRPearls Most epistaxis actually occurs in the anterior nose at Kisselbach's plexus; however, cannot forget about posterior bleeds because they can lead to significant hemorrhage. @marinanaz @MarkZieglerMD @nchadha3 @pchawla8 @murtipatel_ @DrKisselFace @EmilyKRoseMD

There are not enough words to describe how @AudreyBJernigan has inspired me both professionally and personally. Her passion for educating the masses is beyond any other person I have ever met. Plus, she got me to do medical twitter! (1/4) @VCU_IMRes Her desire to be the ultimate team player has not only pushed our chief class but also our residents. I could not think of a better way to wish you a happy birthday other than through twitter. (2/4) @DrDaniGenMed @marinanaz @DrKisselFace @RaslanRasha @nehahipp @LauraLee714

#MRPearls Can consider fecal immunochemical test (FIT) for blood for colorectal cancer (CRC) screening. It directly measures hemoglobin in the stool and should be repeated annually. The sensitivity for CRC is 73.8% and 23.8% for adenomas >10mm. @VCU_IMRes @AudreyBJernigan (1/4) #MRPearls Fecal occult blood test (gFOBT) identifies hemoglobin by turning guaiac reagent paper blue. It should be done annually. Requires dietary and med restrictions. Not an ideal option given sens. 70% for CRC. Sens. 23.9% for adenomas >10mm. (2/4)

1/ #MRPearls How comfortable are you in diagnosing and managing peripheral artery disease? #Tweetorial @VCU_IMRes @AudreyBJernigan @michellebr00ks @abouzaki_md @AbbateAntonio @VCUHealthHeart @rabihmgeha @cjchiu @AdamRodmanMD @jackpenner @tony_breu 2/ #MRPearls It is estimated that atherosclerotic peripheral artery disease affects more than 200 million persons worldwide, including at least 8.5 million persons in the United States. @JeremyTurling @CVC_Coalition @padadvocate @CardiacRisk @VascProtection @American_Heart

1/#MRPearls Hope you got your calipers ready today because we are going to briefly discuss prolonged QT intervals. @VCU_IMRes @AudreyBJernigan @chrisLyoungmd @ktwaybill @JCHillyard @CoryRTrankle @AjayPMD @jaideeppatelmd @VCUHealthHeart #tweetorials 2/#MRPearls The QT interval refers to the time duration between the onset of the QRS complex and the end of the T wave as it returns to the baseline. QT interval represents the time taken for ventricular depolarization and repolarization. @kalahasty @abouzaki_md

#MRPearls The bronchial artery circulation is a relatively high pressured system and is responsible for 90% of life threatening hemoptysis cases. (1/7) @VCU_IMRes #Tweetorial #MRPearls In contrast, the pulmonary artery circulation is a low pressured system with most episodes of non-life threatening hemoptysis occurring from this circulation. (2/7) @mkashiouris

#MRPearls Have you ever gotten a chest x-ray that showed a pleural effusion and you questioned what further evaluation that you should proceed with? (1/18) @VCU_IMRes #tweetorial #MRPearls What are the most common causes of pleural effusions? (2/18)