1/15 #MedTwitter: You're admitting a 64YO male with ESRD on HD for hyperkalemia after missing dialysis. A troponin was checked & returned at 0.78 (nl<0.055 ng/mL), similar to his baseline. He is w/osymptoms and EKG is w/o dynamic changes. What would you call this #tropbump?
2/15 Have you ever been taught to think about troponin as being cardiac vs. non-cardiac in origin? Though this may be a nice framework, it’s simply untrue: if you’re measuring cardiac troponin I (cTnI), it is expressed only on myocardium(not skeletal muscle, unlike troponin T).
Aug 28, 2020 • 5 tweets • 1 min read
#MedTwitter: It is switch weekend/Friday! How do you like to sign-out your patient list to the oncoming physician?
I was once a proponent for the email sign out: putting words to paper (or screen) helped me organize my thoughts. And frankly, was more convenient.
But recently, I signed out to my colleague via phone and 💙 it!
Aug 12, 2020 • 16 tweets • 6 min read
1/15: #MedTwitter: You are admitting a 50-year-old man with a hx GI bleed for a PE. You start a heparin drip. What do you titrate the drip to?
2/15: At my institution, heparin anti-Xa levels (HAL) are recommended, but we routinely draw both aPTT and HAL. I’ve always wondered WHY?
There’s also the page: “The aPTT is supra-therapeutic but the HAL is therapeutic, which should we use?”
Let’s de-mystify this!
Aug 4, 2020 • 15 tweets • 5 min read
1/14 #MedTwitter: The ED pages you for an admission: a 24-year-old male with a history of IVDU presenting with fever. How do you take his drug history?
2/14 As a resident, I fell into A + B, until @cuttingforstone taught me you need to know a lot more to appropriately Dx and Tx your patient. My mnemonic?
𝗗𝗥𝗨𝗚: Drug, Route, User, Goods.
Jun 22, 2020 • 10 tweets • 4 min read
1/9: A woman presents with diarrhea x 2 weeks that woke her from sleep. I love this fantastic framework for chronic diarrhea by @LindseyShipley8
2/9 We reviewed her admission EKG. What do you notice?
Jun 19, 2020 • 9 tweets • 4 min read
1/8 We’ve all had that moment as learners when we think we’ve detected a key physical exam finding, and upon returning with the attending: that rash, cool extremity, or tremor has gone away.
2/8 @VillarPrados told me a great catch he made his intern year. He was admitting a gentleman with syncope. He heard a loud systolic murmur during cardiac auscultation and ordered an echocardiogram.
May 28, 2020 • 5 tweets • 3 min read
1/5 Myths in Medicine:
1.Docusate is an effective laxative
2.Oral iron requires TID dosing
3.HCQ for treatment of #COVID19 4. 𝗖𝗵𝗮𝗹𝗸 𝘁𝗮𝗹𝗸𝘀 𝗮𝗿𝗲 𝗲𝗮𝘀𝘆 𝗮𝗻𝗱 𝗲𝗳𝗳𝗼𝗿𝘁𝗹𝗲𝘀𝘀
2/5 The best #chalktalks are succinct, spontaneous, and seemingly breezy. But that does not mean they don’t require hard work! Anything that looks easy and effortless actually took hours of preparation and repetition. #PrepandReps
May 27, 2020 • 8 tweets • 2 min read
1/8 Recently, I was called to bedside to evaluate new tachycardia + hypertension (SBP >180) + AMS in a patient with MS. We were initially concerned for hypertensive encephalopathy, except he had no prior hx htn and BPs on previous admissions were always normal.
2/8 We didn’t have an immediate framework for acute tachy + HTN but we went back to physiology when approaching this combination of vital sign change: 𝘀𝘆𝗺𝗽𝗮𝘁𝗵𝗲𝘁𝗶𝗰 𝗵𝘆𝗽𝗲𝗿𝗮𝗰𝘁𝗶𝘃𝗮𝘁𝗶𝗼𝗻. When do you see this?
Apr 3, 2020 • 7 tweets • 3 min read
1/7 Just listened to @HiddenBrain’s episode on the 1918 Influenza Pandemic. A few resonant highlights:
though often referred to as “Spanish Flu”, the 1918 Flu pandemic did not originate in Spain, but occurred simultaneously in Europe, America, and Asia and overlapped with WWI.
2/7 Spain did not participate in WWI and ergo, did not have a media blackout on the pandemic coverage unlike the rest of Europe and America. Because newspapers in Spain covered the first public stories of the flu, many presumed it started in Spain.
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