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Josh Ronen, M.D. Profile picture
Josh Ronen, M.D.
@jronenMD
BC IM doc @UCSFDHM via @ttuhscmed and @rossmedschool | Asst. Prof. Clinical Medicine @UCSFMedicine | Fellow c/o ‘24 @ACPIMPhysicians | Posts ≠ medical advice
Apr 30, 2023 • 8 tweets • 3 min read
Just listened to @BedsideRounds episode #72 entitled “Problems” with Dr. Adam Rodman. Why do we spend so much time on documentation and why does it matter? @Gurpreet2015 @AdamRodmanMD podcasts.apple.com/us/podcast/bed… 1. How we document is how we think: as early as the 18th century, notes started off with communicative and didactic purpose
-19th into 20th century notes: closer to the modern H&P.
Apr 29, 2023 • 7 tweets • 5 min read
Day 3/Lecture 1: CKD
1. Cr and cystatin C: Cr has a diet source, cystat C does not (nor muscular influence). Musc young pt w/o RF and neg UA with an inc Cr has just that, not AKI!
2. Indications for Nephrology Referral in patient's with CKD (see photo). #IM2023 @ACPIMPhysicians ImageImageImageImage 4. SGLT2i + Finerinone (non-steroid MRA) attenuates CKD progress and HF hospitalization (not Semaglutide except w/CAD pts) even w/o hx of DM. + effect after max RASi on board.
5. Tx pts w/ DM+CKD with GFR > or = 30 cc/min w/ SGLT2i (Empa, Dapa, Canag).

#IM2023 @ACPIMPhysicians Image
Apr 29, 2023 • 8 tweets • 3 min read
Day 2/Lecture 5: For my fellow CVD Hospitalists - ACS updates in 2023!

1. Chest pain should not be described as atypical.
2. hsTNT: approved in 2017, more testing will result in more positive results (28% T1MI, 225% in T2MI)

#IM2023 @ACPIMPhysicians 3. In women with CP, focus on history that emphasizes accompanying symptoms more common in women with ACS.
4. ACC guidelines don’t specify when you should load with P2Y12 inhibitors. ESC guidelines clearly DO NOT rec them in patients w/ unknown coronary anatomy and….

#IM2023
Apr 28, 2023 • 5 tweets • 4 min read
Day 2/Lecture 4: analyzing thought processes behind clinical reasoning with cases! Premature closure, framing and anchoring biases ARE a thing in the diagnostic process.

#IM2023 @ACPIMPhysicians ImageImageImageImage Think about your PR and schema based on the patient’s presenting complaint, trust your H+P, and resultant medical decision making! Practice holding off clinching Dx in PR. Can elaborate in A/P of note. Compare typical and atypical PRs. #IM2023 @ACPIMPhysicians Image
Apr 28, 2023 • 4 tweets • 3 min read
Day 2/Lecture 2: full house for the one and only Brad Sharpe with Updates in Hospital Medicine! @UCSFDHM @ACPIMPhysicians #IM2023

1. Fluid resusc in pancreatitis: aggress (vs mod) fluids lead to more VOL in mild to mod disease Image 2. Intermediate LMWH for VTE PPX form highest degree of efficacy and lowest bleeding risk
3. Beta-lactam or Vanco first - B-lactam first decreased mortality by 50% per 48h and 7d mortality rate (GN sepsis…)

@ACPIMPhysicians #IM2023