Travis Smith, DO Profile picture
Assoc Dean of Clinical Ed & Assoc Prof of Emergency Medicine @1LECOM. FSU & UF grad. Aging & Longevity. God. Golf @medtweetorials @hdx @EMBoardBombs @CPSolvers
Shanil Keshwani Profile picture Saurin Kadakia Profile picture Navnit Gupta Profile picture Sarah Owens Profile picture Matze Profile picture 6 subscribed
May 30, 2021 5 tweets 2 min read
Some cool #Syphilis Pearls from an article that @k_vaishnani shared… Primary syphilis first manifests into a painless chancre at the site of inoculation 1 to 6 weeks later… Hematogenous dissemination then can occur typically 4 to 10 weeks later, giving rise to secondary syphilis. <40% of pts w/ syphilis have primary syphilis diagnosed. These “Secondary” lesions last for several weeks before spontaneously resolving. Coined “early, latent infection”
May 29, 2021 14 tweets 3 min read
Some optics neuritis pearls in a short #Medtweetorial 🧵…. We all know that optic neuritis is frequently associated with multiple sclerosis (MS). But optic nerve inflammation can exist from autoimmunity, infection, granulomatous disease, paraneoplastic disorders, & demyelination Image Classical ON from MS is unilateral, moderate, painful color vision loss with an afferent pupillary defect & normal fundus examination.
Oct 1, 2020 14 tweets 4 min read
If you have not listened to the @CuriousClinPod most recent podcast (Episode 10: Why does metronidazole treat both bacterial and parasitic infections?) then I suggest you tune in.…

I'll summarize their show notes here in short #medtweetorial First a question:

Was metronidazole first used as an antibiotic or as an antiparasitic?
Oct 1, 2020 11 tweets 3 min read
When you order a serum alcohol level, what does the lab measure? An answer and a quick #Medtweetorial on false elevations in #ETOH If you guessed NADH, you would be correct.
Sep 26, 2020 24 tweets 5 min read
A Teal pain in the neck:

Follow along for a short #medtweetorial on #CervicalArteryDissection

or see the full handout here…

from @EMBoardBombs @blakebriggsMD @IltifatMD This review will focus on spontaneous dissections, not traumatic, as well as the pathophys, risk factors, presentation, diagnosis, and management.

Cervical artery dissections are a common cause of stroke in young(<50 years )w/ some reports of up to 20% being from dissections
Sep 26, 2020 17 tweets 7 min read
Time for some #SpacedRepetition from @CPSolvers @DxRxEdu @rabihmgeha

Some chat recap #ClinicalPearls and bonus pearls from #VirtualMorningReport on Friday Sept 25th…

Case by the brilliant @Rafameed Image A 31-year-old M born and raised in Brazil w/ no PMH presented with a 3 mon history of worsening DOE, orthopnea, 7kg weight loss, abdominal distention, dry cough, and syncope

Base rate of disease for an ID case with @k_vaishnani and @Rafameed is very high
Sep 22, 2020 24 tweets 27 min read
We didn't have a #Neuro case today on @CPSolvers #VMR with @AaronLBerkowitz but don't worry! Let's recap a prior episode for some #SpacedLearning @DxRxEdu @rabihmgeha

With @ddeng_22 @KannuBansalMD… A 26 yo M w/ a PMH of nodular sclerosing hodgkins lymphoma p/w left-sided facial droop, L arm weakness, and dysarthria.

He presented 12 hours after onset and his symptoms had resolved.

3 months prior he had an autologous stem cell transplant and is currently on Brentuximab.
Sep 21, 2020 12 tweets 4 min read
While on the topic on #Angioedema with @EMBoardBombs

It was mentioned about tPA causing angioedema. It is scary and happened to me. I didn't know about it until it happened to me.

Follow along for a short #medtweetorial case report with some tips.… Image The most dreaded adverse effect of tPA, hemorrhagic conversion of an ischemic stroke.

But there is another scary, unusual & potentially life-threatening adverse effect of tPA. ANGIOEDEMA

It usually affects the side of the tongue ipsilateral to the stroke.
Sep 17, 2020 17 tweets 6 min read
Check out this great review on BRUE's or “brief resolved unexplained event” @EMBoardBombs by @blakebriggsMD and @Lmellick here,…

Or follow along for a short #medtweetorial review on the highlights. #EM #EMPeds #EmergencyMedicine #MedTwitter What is a BRUE? It reflects a general “catch-all” CC

The old term was ALTE (apparent life-threatening event), but this term was too broad and incorrectly assoc symptoms and SIDS.

It peaks in incidence at <2 months of age but can occur anytime within the first year
Sep 12, 2020 22 tweets 28 min read
Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha @dminter89
Chat recap of the #ClinicalPearls #VirtualMorningReport

Episode 140 - Virtual Morning Report - September 11, 2020… Image Let's start with an initial PR:

A 27 y/o male with no PMH from Mexico presents with 10 days of generalized abd pain, vomiting, diarrhea, fever, & yellowing of his eyes

Deploy our Jaundice Schema;…
Sep 9, 2020 4 tweets 2 min read
Some nice learning tips from a case report on #AdrenalInsufficiency

I wish all articles had them!

1. It is important to include primary adrenal insufficiency in the differential diagnosis for significant hyponatraemia even with the absence of hyperkalaemia. 2. Hypo-osmolar hyponatraemia with urine osmolality greater than serum osmolality and urinary sodium excretion >20 mmol/L, typically seen in syndrome of inappropriate antidiuretic hormone (SIADH), can also be seen in adrenal insufficiency, due to increased vasopressin secretion.
Sep 6, 2020 7 tweets 1 min read
Contaminated blood cultures have been recognized as a troublesome issue for decades. This comes at a big cost, with additional costs associated with this unnecessary treatment were approximately $1,000 per patient. While target rates for contamination have been set at 2 to 3% (30, 131), actual rates seem to vary widely between institutions, from as little as 0.6% to over 6%. What organisms, when isolated from blood cultures, usually represents contamination?
Sep 2, 2020 25 tweets 29 min read
Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

September 1st Ep. 132:…
w/@AaronLBerkowitz @medrants @G_Khafaji @MariaMjaleman

Teaching points illustration by @sukritibanthiya Image First, let's start w/ an initial PR:

A 49 y/o F w/ a PMH of HTN, ETOH/THC abuse p/w bilateral leg weakness that started a week ago following during an admission for CAP that has since gotten worse along with urinary and fecal incontinence
Aug 29, 2020 9 tweets 2 min read
There has been some interesting discussion about Relative vs Absolute Risk Reduction as some don't really understand it.

I don't blame those who don't, but it is important if you want to inform others about the findings, you must not be misleading...👇👇 You can read the document here if you like reading documents,…

Or you can follow along tweetorial style
Aug 25, 2020 10 tweets 4 min read
If you haven't signed up with the @CPSolvers yet, I highly recommend it! They send great recaps of episodes w/ spaced repetition teaching pearls! See tweetorial below

Episode 116: Dr. Dardia presents a case to Arsy, Dr. Maus, and Dr. Brooks,… A 67-year-old man presented with subacute respiratory symptoms w/ night sweats & was found to have multifocal pulmonary infiltrates, anemia, & a protein gap.

He completed antibiotic tx w/ clinical resolution of his respiratory symptoms, but on repeat labs.....
Aug 23, 2020 22 tweets 6 min read
Lazarus rises: #NarcoticOverdose and reversal…

Check out this great short board-style review on #Opioid overdose and reversal agents #Narcan @EMBoardBombs

or follow along this short thread below 👇👇 Opioid abuse is an epidemic that has its roots in poor prescribing practices by physicians.

In the US alone, ~5 million people were estimated in 2015 to have used heroin at least once in their lives.

329,000 reported use within the past month.
Aug 23, 2020 12 tweets 4 min read
Need a refresher about what ABnormal saline is? First listen to this episode on the @CuriousClinPod…

Then review their great episode show notes here,…

Or follow this short thread for some cool facts from the shownotes Saline was originally used in the 1830s by a Scottish physician named Thomas Latta to treat cholera patients during an epidemic that affected most of Europe.

His solution contained the following:
•Sodium 134 mmol/l
•Chloride 118 mmol/l)
•Bicarbonate 16 mmol/l
Aug 19, 2020 24 tweets 28 min read
Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 17th Episode 119:…
W / @MohitHarshMD @KromerHaylie & Ninand Bhat Image Let's start with an initial problem representation:

A 75 y/o M w/ a PMH of COPD, CAD, & aortic valve replacement p/w 2 weeks of dyspnea on exertion, 1 month of LE edema, 20 lb weight loss & recent onset PND and Orthopnea
Aug 16, 2020 25 tweets 28 min read
Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 12th Episode 115:…
w / Sonia Silinsky Krupnikova @Flower_freeland @pri_athavale
Teaching points @sukritibanthiya Image Let’s start with an initial problem representation:

A 50 y/o F w/ a PMH of remote gastric bypass, anemia, MGUS & hereditary elliptocytosis p/w worsening fatigue, dyspnea on exertion, chronic chest discomfort and trouble sleeping at night
Aug 14, 2020 19 tweets 26 min read
Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 11th Episode 114:…
W / @Anu08877649 Joshua Morris & @Rafameed
Teaching points illustration by @sukritibanthiya Image Let’s start with an initial problem representation:

A 55 y/o M w/ no known PMH except a 30 pack-year history of tobacco abuse presents with recurrent syncope (lightheaded prodrome) over last 2 mon along w/ R shoulder pain, 15 lb weight loss for 3 months, and an occasional cough
Aug 11, 2020 25 tweets 34 min read
Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 10th Episode 113:…
w/ @kiaracamacho96 @RizwanDania & Maria Jose Vides
Teaching points illustration by Sukriti Banthiya Image Let's start with an initial problem representation:

A 73 y/o M w/ a pmh of DM2, depression, hypoTh, BPH presents w/ a few days of nocturia & LE pain & brought in bc he was found lying on the floor of his bathroom disoriented after experiencing dizziness, blurry vision & falling