Sara J. Hyland Profile picture
Periop and Emergency Medicine PharmD | Homesteader, cook, yogi, mama | Peaceful free-thinker trying to do some good✌
Dec 27, 2020 7 tweets 5 min read
Happy Holidays! I'm starting a #FOAMed gift exchange.

My gift to #MedTwitter is-

🎁5 reasons to continue your patient's #buprenorphine perioperatively!🎁 1) Turns out bup is a great analgesic, and is actually unlikely to have a ceiling dose for analgesia. Abruptly stopping someone's basal analgesic + inflicting painful stimulus = poor postop pain control!

pubmed.ncbi.nlm.nih.gov/29624528/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/
Jan 12, 2020 23 tweets 7 min read
Ortho rounds last Wednesday- "angry/drug-seeking patient refusing PT" and had just "fired his RN for not caring about his pain."
A (somewhat verbose) patient interaction story + clinical pearls about opioid metabolism:
1/n
ncbi.nlm.nih.gov/pmc/articles/P… POD1 elective TKA-

Surgeon: How is everything going?

Patient (visibly tense, tearful, diaphoretic): Terrible!! This is the worst experience of my LIFE- I have been in so much pain and nobody cares enough to even try to help me!

2/n
Jan 2, 2020 19 tweets 6 min read
Just read a uniquely eloquent perspective that should inform volume resuscitation, especially in septic patients.

Allow me to discuss some key points in my first #tweetorial.

doi: 10.1111/AAS.13533
onlinelibrary.wiley.com/doi/abs/10.111… First, which of these most closely resembles what you currently feel is the ideal DOSE and RATE of initial crystalloid fluids in #septic shock?