There has been a lot of overlap between the two areas in the last few months:
🦠appropriate PPE use
🦠pre-op covid19 screening of asymptomatic patients
🦠OR & postop ward management/re-designs
other topics have been explored, such as the safety of laparoscopic surgery v laparotomy given risk/benefit of
overall surgical risk, operative time, potential aerosolization of particles via gas suspension and pneumoperitoneum
There's been increasing discussions (on and off #medtwitter) re cancelled surgeries, financial impact on hospitals, and what "elective surgery" means
as some hospitals start to increase surgical volume and project how long it will take to catch up on the queue, some thoughts: 1/
the complexities of these decisions at the institution/health system level AND at the personal level for patients and their families only serve to highlight how complex & nuanced surgical decision making and planning can be...
why were surgeries cancelled?
🚫increase available ICU and hospital beds
🚫staff deployment to other services incl COVID teams
🚫decrease patient risk post op complications (esp if they were covid + preop or acquired it postop)
@ebtapper@AtoosaRabiee@rrosenblattmd@ETSshow agree, would absolutely use in a talk if it contributed to your teaching goals
definitely "cite" the writer
one of the "perks" of using tweets in talks (ex. screengrabs) is that you can capture writer (profile) & date easily, but could also provide the hyperlink
Welcome back! Time for #tweetorial part 2 of #periopmedicine meets #meded
This time? #GME!
I’m going to continue to look at this through the lens of my experience practicing perioperative medicine as an #IMproud internist
Do you know what my first exposure to the concept and question of “is this patient of an acceptable risk to proceed to the OR?” Was?
Want to take a guess?
It was on a hepatology elective! We were consulted to inform #periop risk discussions for a young patient with cirrhosis scheduled for an open abdominal surgery (fyi, this can be high risk)
It was a lightbulb moment for me as an IM resident!
Periop wasn’t just cardiac… 3/N
It’s that time of year again!
Girl Scout cookies?
Well, yes…but for the purposes our discussion, it’s “COLD & FLU SEASON”
What do you do if a patient scheduled for surgery has a URI?
what is the theoretical concern?
That presenting for surgery, and the anesthetic management including intubation required to facilitate it, will lead to #perioperative complications if the patient has (or has recently had) an upper respiratory tract infection.
these concerns include the risk of periop pulmonary complications:
🔘airway hyperreactivity (during induction or emergence) ➡️laryngo/bronchospasm
🔘deeper infection like pneumonia
does this “biologic plausibility” translate into real-world events?
1⃣I’m not an anesthesiologist & don’t care for pts w PD #intraoperatively
2⃣I practice outpatient #PREoperative medicine, so I am not providing inpatient postop care
3⃣There are several high yield publications/resources, & much of this is pulled from my own experience
@JenniferBrokaw Caveats out of the way, let’s chat about why understanding #periop#ParkinsonsDisease management is so foundational.
Remember how Osler said to know syphilis is to know all of internal medicine?
Yeah…PD meets #periopmedicine is potentially THAT informative. 3/x
A Monday #Medthread: #medtwitter colleagues—what gets your BP and HR up the most in terms of delivering “bad news”?
in my #periopmedicine world, it’s telling a patient we might need to postpone or cancel their surgery
So…a #tweetorial to share my learnings over the years 1/x
Take a step back—remember that there’s no such thing as “preop clearance”.
The value added is preoperative evaluation and risk assessment, with patient + procedure-specific optimization
Inherent to this is communicating risk and concerns for it
The overwhelming majority of patients I evaluate in preop clinic are stable/optimized at the time of my evaluation, though my assessment still adds value by empowering intraop and post-op care, as well as facilitating pre-op patient instructions and empowerment 3/x
Friday #Medthread! I’ve been chatting lately that I should write a #tweetorial about how I’ve put my social media related/based activities on my academic/professional CV. So, without further ado... 1/x
these are excited times, & hopefully this won't be uncharted territory for too much longer as standards are set and more institutions embrace social media related activities...BUT for now...how do you show your uniqueness and innovations via #medtwitter#SoMe?? 2/x
1⃣these are my opinions (grounded in experience & many discussions)
2⃣I use the OHSU CV template (Scholarship/Service/Teaching)
3⃣employers may not be ready to embrace
PS--bonus points--name the TV show the GIF is from!! (probably not known/respected enough...)
An anniversary #Medthread!
One year ago today, I gave my OHSU #GrandRounds about #medtwitter for academic clinicians and immediately posted its accompanying #tweetorial.
My goodness, what a year!!
Some reflections and musings 1/x
an incredible year indeed, professionally AND personally--and definitely in no small part thanks to #medtwitter and the opportunity to prepare and give this talk about #SoMe
pardon my if the argument is getting a little circular...the coffee is still kicking in... 2/x
I truly truly had no idea. In probably a poor exam of my "beginning of the academic year commitment to say 'no' more often", I told my boss that I could fill the August 7th #GrandRounds slot on only a few weeks notice.
"Don't you have a talk about twitter prepared?"... 3/x
there 2 hours left in July 2019 on the west coast, so a belated/last minute #medthread w July-in-the-hospital thoughts in large part inspired by @ETSshow recent amazing episode w @drjenniferbest & the question--would YOU want to be a patient in the hospital in July? 1/x
@ETSshow@drjenniferbest brief background, I was born end of June in a teaching hospital, and grew up with stories that "it got different the day after you were born", so was aware that there was something "special" about July long before I considered a calling for medicine 2/x
@ETSshow@drjenniferbest back to the more recent past. Beyond being an intern, resident, attending, and patient myself in July, I have been the patient of a NICU BABY in July--a critically ill newborn in the neonatal intensive care unit 3/x
@DesaisSima@PDX_Tom The piece is in the online journal @MedEdPublish, & we really appreciate the reads. Because it is open-access, I won't regurgitate the entire piece, but I will share and sprinkle additional explanations on highlights 2/x
@DesaisSima@PDX_Tom@MedEdPublish the "12 Tips" piece chronicle our journey to create @OHSUIMRes for the @OHSUSOM@OHSUNews Internal Medicine Residency Program, and the reflections, musings, advise for others thinking about a programmatic account for internal medicine and non-IM residency/fellowship programs 3/x
Followup #Medthread#Tweetorial about #periop med management as promised!
Thank you to all who voted.
So...the answer was an MAO-I.
all the agents are ones to stop pre-op, but why was MAO-I the answer I was going for?? 1/x
First choice was Ephedra--definitely something to stop pre-op given it's sympathetic effect and risk of cardiovascular instability.
HOWEVER, Ephedra was banned by the FDA in 2/2004, so I haven't seen a patient on this in the preop setting in years 2/x
thinking about Ephedra is a good opportunity to this about herbal/nutraceutical/supplement management periop, given hypothetical or KNOWN risk of:
✅cytochrome up/down regulation
✅changes to platelet/coagulation function
✅drug/drug interactions 3/x
A quick, spontaneous Saturday #tweetorial#Medthread about periop OSA inspired by @cacace_frank's journal catch up (w my first response below). Going to make this interactive (& tag #periop hospitalists & anesthesiologists along the way)... 1/x
@cacace_frank rightfully so, #periop OSA is getting more and more attention. It, and the company it keeps (OHS, PHTN, R heart failure) are driving periop risk factors, for respiratory events (resp failure, esp with opioids on board) AND cardiac events 2/x
@cacace_frank society guidelines recommend screening for OSA pre-op (ex. STOP-BANG), but what do you do with a positive screen? recall, it only takes 3/8 points on STOP-BANG to get to "high risk". It's a patient risk/benefit AND systems-based Q re utilization of/access to sleep studies...3/x