1/
Are you an IMG looking for opportunities to grow your clinical skills and strength your CV?

Look no further... 2/The @CPSolvers hosts a daily case-conference (similar to morning report).

These are held for free on Zoom.

Prior videos are uploaded to youtube
youtube.com/@clinicalprobl…

Hypokalemia.

Let's get practical with two sets of 3s.

1. 3 steps before hitting esoteria.

2. And 3 esoteric diagnoses.

<3 @DxRxEdu To anchor ourselves, let's reflect on two other ways to approach hypokalemia from @CPSolvers

bit.ly/2L1xKyl

The first -

A mechanistic one that studies the site of potassium loss.

Kidney
Intracellular
GI tract

A 4-step dance.

But first, a short story.

Breeze
Hop on the ramp
& then whatever you do, DON'T
Wheeze The wind in your lungs brings you oxygen and helps you bid farewell to CO2.

Your muscles, and pleura, listen your brain (respiratory rate) and pull in the breeze (tidal volume)

Carbon dioxide hops on the ramp, and unless you wheeze, say peace to CO2.

Compensation & Hypernatremia

The premise in many disorders, especially acid/base, is that a compensatory change never fully corrects the underlying disorder.

In hypernatremia, it's the exact opposite... A patient with metabolic acidosis, for example, should have respiratory compensation that ALMOST, but not fully, normalizes the pH.

It's the exact opposite with hypernatremia...

1/4
Dizziness...

Keeping it simple.

Let's head to the triage room - we have a patient waiting.

You:
Feeling dizzy?
I am sorry!

Do you mind holding still for a few seconds?
How does that feel? Pt #1: Much better!

You (internal dialogue): Phew. Probably not a stroke.
BBPV vs presyncope?

You: Great!
Does it come back when you move your head?
What about standing up?

Depending on the conversation and exam our toolkit is
1. Vitals
2. Orthostatics
3. Dix-Hallpike
4. EKG

1/
This is a two part story (#RLR)

Each stands alone but their combination is multiplicative #Synergy #Interdependence

Today’s topic: “The sample is hemolyzed” - In vitro vs In vivo 2/
The lab notifies you “the sample is hemolyzed.”

First step in reasoning, did the hemolysis occur in the patient (in vivo) or during collection of the specimen (in vitro “ex vivo”), eg., prolonged application of tourniquet

1/n
fUnKy Inflammation

Yup.
You are reading this right.

fUnKy Inflammation!
A thought exercise...

Who said learning medicine can't quirky and fun?!?

Let's go👊 Wait, what do you mean by inflammation?
So glad you asked.

There are many roads that lead to the conclusion that a syndrome has features of inflammation.

Fever is the most specific, but there are many other paths.

More here - bit.ly/2VXeky0

Teaching Rounds

Diarrhea - Part 1

3 Misleading Mimics
&
2 Key Questions

Join us #medtwitter & #medstudenttwitter Diarrhea = increase in stool water content.

We tend to use the term loosely (Ha! 😉) so your patient may be referring to another change in bowel habits when they say diarrhea.

How do we know?

The Bristol Stool Chart!

bit.ly/2TWeVgS
🙏🙏 @Dietitianbytes

Teaching Rounds Day 5

Thrombocytopenia

Hold your breath.

Schistos?
Heparin?

Breathe!

Join us, #medtwitter & #medstudent twitter! Is there an approach to thrombocytopenia?
I don't think so.

There are just way, way to many possibilities to make progress with just this information alone.

How can we make this a less cognitively challenging task?

Teaching Rounds Day 4

Anemia - Part 2

Slow loss
&
The Bone Marrow Factory

Check out part 1 here -bit.ly/2PJRo18

Join us #medtwitter & #medstudenttwitter

https://twitter.com/rabihmgeha/status/1234840853308264448

Ok, let's get out bearings..

1. Is there an approach to anemia?
I don't think so - we need a time course.

2. If you don't have a prior HgB, use the clues below to tease out between acute and chronic anemia.

3. Acute anemia =
Bleeding
Hemolysis or
Acute marrow disease

Teaching Rounds Day 3

Anemia - Part 1

Neighbors and Time Zones...

Join us #medtwitter & #medstudenttwitter Claim:
It's nearly impossible to have an approach to anemia.

Yup, impossible.

It's as tough as having an approach to altered mental status?

Wait, what?

Wasn't that the VERY first @cpsovlers episode?
And...what about this schema??

Teaching Rounds Day 1/15

Venn Diagrams from a practical lens...
(or "VAN" diagrams as @DxRxEdu calls them!)

How do we actually use them?

Join us #medtwitter & #medstudenttwitter If you are in a position to use a Venn Diagram, that probably means you've crystalized the fundamental aspects of your patient's condition.

In other words, your problem representation is fairly advanced and you've identified the salient features.

Nice job!!👊👊👊

February Teaching Rounds - Recap

Part 1 of 2.

Because #spacedlearning is an endless journey...

Join us #medtwitter & #medstudenttwitter Day 2 - Upper GI bleed

1. 4 common pathways to a working Dx of an overt upper GI bleed

2. 3 common diagnosis...

3. 2 KEY questions!

More here -
bit.ly/2V9pboc

Teaching Rounds Day 11/15

Hypoxemia...

Beyond the Mechanism & Back to the Bedside

Join us, #medtwitter & #medstudenttwitter I fondly remember learning about hypoxemia in medical school and breaking it down by mechanism

1. Low FiO2
2. Hypoventilation
3. Impaired diffusion
4. Shunt
5. V/Q mismatch - the go-to answer every time!

Teaching Rounds Day 10/15

Weight Loss

2 Key Steps

2 Common Pitfalls

...and 1 intriguing question. Not all weight loss is concerning.

>5% loss over several months should get us thinking about an underlying cause.

Teaching Rounds Day 8/15

Cellular lysis...

Not all cells are equal.

Join us, #medtwitter & #medstudenttwitter "Why you do always start your talks with a vague statement and not actual learning objectives, Rabih?" - a dear friend

🤣🤣
I think it's more fun this way AND
75% of teaching is making sure everyone is having fun.

When it comes to learning

Climate > Content

Teaching Rounds Day 5/15

Fever.

The Journey to a Diagnosis…

Part 2 - Base Rate & The Spotlight

Join us, #medtwitter & #medstudenttwitter Check out part 1


Key points:
1. Fever is specific to "inflammation", but not sensitive enough.
An afebrile patient could be inflamed

2. Most, but not all, elevated temperatures represent a fever.
Consider hyperthermia early.
It could be life saving.bit.ly/2OuQsNo

Teaching Rounds Day 4/15

Fever.

The Journey to a Diagnosis...

Part 1

Join us, #medtwitter & #medstudenttwitter Let's zoom out.

The core problem we are often solving isn't fever.

It's "inflammation".

Teaching Rounds Day 3/15

H2O toxicity...

Say what?

Yes...
H2O toxicity.

The Story and The Schema.
Join us, #medtwitter & #medstudenttwitter The Story...

What is H20 toxicity?
It’s when the blood has too much H2O.

What exactly is too much?
Enough that neurons swell and
don't work well.

1/The base rate…a double-edged sword.

A mini-tweetorial on this crucial concept in clinical reasoning. 2/What is it?

The base rate is the relative frequency of a diagnosis within a clinical context.

Example:
In the emergency room, what % of patients with dyspnea have a pulmonary embolism?

1/What other complications of EtOH do you think of, #medtwitter?
Would you organize this differently?
Teaser courtesy of @ArsalanMedEd:
+ EtOH level without any EtOH exposure (oral intake or otherwise)??? 2/Check out this @CPSolvers case with @hdx and @HannahRAbrams for a fascinating case that discussed the "mast cell complications"
#FOAMed
clinicalproblemsolving.com/2019/02/21/epi…