1/ Do you prescribe Incentive Spirometry (IS) for postoperative patients?

Is the routine use of IS to prevent postoperative pulmonary complications (PPCs) a "Thing We Do For No Reason?"

Let's explore IS in the following #tweetorial!

#MedTwitter 2/ PPCs are extremely common and associated with a high rate of morbidity and mortality following surgery.

While no one agrees on which conditions we should include in PPCs, most agree that atelectasis (collapsed lung tissue) is the most common PPC.

1/
Why is metformin associated with lactic acidosis? Do we need to routinely stop metformin when admitting patients with Type 2 Diabetes Mellitus (T2DM) to the hospital?

Let's explore these questions by looking at the history of metformin in the following #histmed #tweetorial. 2/
Metformin, a biguanide, works by decreasing hepatic glucose production and increasing insulin sensitivity.

It is a first-line therapy in T2DM because it's inexpensive, well-tolerated, helps with weight loss, and has very low risk of hypoglycemia.

ncbi.nlm.nih.gov/pmc/articles/P…

1/ Did you know that you can import an Excel spreadsheet schedule into Google Calendar?

This thread is designed for new chief residents or any folks who schedule conferences/events and want to convert a spreadsheet into individual calendar events.

#TipsForNewChiefs 2/
During my time as a @uclaimchiefs we shared a google calendar to track tasks during the week. We also scheduled conferences via shared spreadsheets.

Importing the spreadsheet allowed me to view what conference was scheduled without constantly referencing the spreadsheet.

1/ Email inbox got you down?

This thread is designed for new chiefs residents (and faculty!) on a topic I got very little coaching on before my chief resident year: Email Management.

Keep reading for Tyler’s Top 10 email tips!

#TipsForNewChiefs 2/
My transition to chief year was abrupt. I went from being a decent doctor to a crappy administrator overnight. In this new role I went from receiving a few junk emails/day to hundreds of emails at all hours. The following tips are strategies that helped me survive my inbox.

1/ Why are hypodermic needles and IV catheters referenced by gauge numbers?

And why does the needle diameter get smaller as the gauge number increases?

Let's explore the obscure history of IV sizing in the following #histmed #tweetorial. 2/ The gauge numbers on modern hypodermic needles are adapted from the Birmingham Wire Gauge (BWG), a system developed during the Industrial Revolution in the early 1800s to standardize the British cottage industry of iron and steel wire manufacturing.

1/
Why does obesity cause a "falsely low" B-type natriuretic peptide (BNP) in patients with heart failure?

I often hear this used to explain unexpectedly low BNP results, but I've never really understood why.

Let's explore in a #tweetorial.

#medtwitter #cardiotwitter 2/
Before we answer this question, a quick poll.

What is the main physiologic mechanism of BNP?

1/ "Who feels comfortable evaluating a tracheostomy?"

Today on the wards we talked trachs. Though we see patients with trachs regularly I find it is a topic that few learners are comfortable with.

The following 🧵 is my "Hospitalists' Guide to Tracheostomies" 2/

Where are trachs placed anatomically?

Trachs are placed between the cricoid cartilage and the sternal notch around the 2nd to 4th tracheal ring. These can be placed surgically or percutaneously at the bedside.

1/
Does atelectasis cause post-operative fever?

I occasionally hear atelectasis listed in the differential diagnosis for early post-op fever (EPF) but this idea has never made much physiologic sense to me.

Let's explore this question in the following #tweetorial. 2/
Like many US medical students, I first learned this central dogma of post-op fever on my surgical clerkship through the perpetuation of a rather cumbersome and inelegant mnemonic involving the letter W.

1/ Why are EKG waves named starting with the letter P? What happened to letters A through O?

I’m guessing you’ve probably never wondered this, but if you’re curious, here’s a brief historical #medthread / #tweetorial on how the EKG waves got the names they did. 2/ The first electrical tracings of the heart were obtained in 1887 by A.D. Waller, a British physiologist and physician, who used a Lippmann capillary electrometer to capture the tracings.

ncbi.nlm.nih.gov/pmc/articles/P…

1/ Ok #medtwitter, here goes my first attempt at a #tweetorial, inspired by a recent question on wards from a learner I didn't know the full answer to:

“How good is a tuberculosis (TB) 'rule-out'?”

To try to answer this question we'll first start with a case. 2/ A 62yo female w/ recent renal transplant and remote hx of pulm TB s/p 1y DOT presents with fever. 4 wks PTA was hospitalized for 2 wks of cough, unintentional 20lbs weight loss & large LUL cavitary lesion on CT.