Arjun Arya, MD, MSc. Profile picture
hey, hi, hello | PGY1 EM @HennepinHC | #FOAMed | diversity | leadership | dad jokes | always a work in progress
Dania Abu-Jubara Profile picture 1 added to My Authors
4 May
Alright #MedTwitter & #MedStudentTwitter, I’m going to interrupt your regularly scheduled #COVID19 programming to talk about Blood Pressure, Shock & Using the Force (#MayTheFourthBeWithYou) to assess it! So,

Where would a measured blood pressure be highest?

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Blood Pressure (BP) in the body behaves as a hydraulic system and undergoes a process known as “systolic amplification.”

When two ocean waves run into each other, the resulting wave is a smaller but taller spike!

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This is exactly what happens in the body thanks to vascular bifurcations and narrowing! As the initial hydraulic wave runs into bifurcations and bounces backward, it gets added to the next wave.

Amplification of systolic pressure is the result of reflected waves!

3/
Read 15 tweets
28 Feb
Because #COVID19 / #coronavirus is so hot right now, here’s a little #tweetorial on

How To Emotionally Not Explode During Pandemic 2019 (and Survive!)

First question on everyone’s mind is basically “will I die?” & here is what we know so far.

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When nerds study this question, the CFR or the Case Fatality Rate becomes THE tool. It’s the best early measure we have to predict the likelihood of death from exposure to #COVID2019.

What is the CFR for COVID19? About 2.3%.

Others -
SARS : 9.6%
MERS: 34.4%
Flu: 0.5%

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Knowing HOW it’s calculated is important to tease out any nuance.

Easy math: deaths / confirmed cases.

The CFR is HIGHLY dependent on good data, and good data can be hard to come by. In the US, we don’t even have enough testing kits to have accurate “confirmed cases.”

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Read 11 tweets
26 Jan
Alright #medtwitter, #medstudenttwitter, & #CriticalCare, today’s #tweetorial is on the ever challenging and misinterpreted lactate!

So, what does lactate most appropriately represent?

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If you’re like me, you had lactate = anaerobic respiration = hypoxia drilled into your head.

First, is this real? And then, most importantly, is this clinically relevant?

To unravel this mystery-we need to know where lactate comes from!

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Lactate is made in the cytoplasm according to this reaction:

ncbi.nlm.nih.gov/pmc/articles/P…

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Read 20 tweets
21 Dec 19
#medtwitter #tweetorial on one of my favorite, elegant little mechanisms. This is something every #resident and #medstudenttwitter will see ALL the time! Bonus inclusion: a simple way to think about macro/micro-cytosis.

So, why is basically everyone in the hospital anemic?

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Principles:

- it is useful to remember that the venous blood “drawn” for a lab test is composed of many parts: plasma, RBCs and WBCs.

- Hemoglobin (Hgb) is a direct measure of the actual Hgb molecule within the RBCs

&

- hematocrit (Hct) is the % volume of RBCs

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So why can we “cheat” and just multiply the hemoglobin by 3 to get the hematocrit?

Well - in a healthy RBC, approximately 1/3 of its space is a hemoglobin molecule!

So, imagine each RBC as just a Hgb molecule wearing a coat! The Hgb is 1/3 of the space, the coat 2/3s!

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Read 17 tweets
16 Dec 19
Alright #medTwitter and #medstudenttwitter, time for an Introduction to EKG #tweetorial 🙌🏽 full of GIFs, pearls & fun!

We are going to start off w/ some key principles and get all the way to the basics of a 12-lead #EKG!

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First— just as YOU see an EKG, the EKG “sees” the heart! Only, since it’s paper and not smart, it needs many more “eyes” than you do.

Every EKG lead is an eye (electrode) that is seeing the heart’s electricity from its own perspective.

These are the EKGs 12 eyes:

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If an electrical signal from the heart is moving toward one of the leads, in the directions the arrows are pointing, it will show up as an upward i.e positive deflection on the EKG.

“So like a P-wave?” Yeah! Exactly!
But how?

3/28
Read 28 tweets
8 Dec 19
#tweetorial time for SUPER FAST, no WINTER or (difficult) MATH evaluation of Anion-Gap Metabolic Acidosis:

THE METABOLIC SEESAW. YEE HAW.

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The metabolic seesaw:

dBC dAG
———————🔺———————
(more BC)

dAG = delta Anion Gap
dBC = delta Bicarbonate.
Toward the Center = more bicarbonate

This will all make sense in a moment.

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Scene: patient w/ anion-gap metabolic acidosis

Your ?: is their compensation appropriate? Do I need more labs? Who and what is a winter and why do they have a formula?!?!

Answers: seesaw only, a chemistry is all you need!

3/12
Read 12 tweets