Discover and read the best of Twitter Threads about #Anesthesia
Most recents (18)
Board things: Fontan Circulation goals 🧵
Fontan physiology is usually the end-result of palliative procedures (of which there are several variations) for patients born with single-ventricle physiology.
#MedTwitter #MedEd #FOAMEd #Anesthesia #PedsAnes #CardsAnes
Fontan physiology is usually the end-result of palliative procedures (of which there are several variations) for patients born with single-ventricle physiology.
#MedTwitter #MedEd #FOAMEd #Anesthesia #PedsAnes #CardsAnes
Examples of single ventricular physiology:
- Hypoplastic left heart syndrome
- Pulmonary atresia
- Tricuspid atresia
- Ebstein anomaly
- Double outlet RV
Etc.
- Hypoplastic left heart syndrome
- Pulmonary atresia
- Tricuspid atresia
- Ebstein anomaly
- Double outlet RV
Etc.
This is usually completed step wise, starting with a Norwood procedure/Sano shunt hybrid (reconstructs a neoaorta and provides shunt connection from RV to PA), followed by a Glenn (shunt takedown with connection of SVC to PA), then a Fontan (IVC also connected to PA).
A (LONG) thread for patients with #mecfs #longcovid expecting surgery and the #surgeons #anesthesiologists #crnas and #pacunurses caring for them. I'll share my recent perioperative experience. This is neither comprehensive nor medical advice, but I hope it helps. (0)
1. Recovery was a bitch. I've had general anesthetics before, even in the same organ system. This was not the same body undergoing #anesthesia.
2. Set Expectations: Physicians
Expect long lists of meds, allergies, requests, and questions. Listen to and engage with your patient. They may educate you. Anticipate a potentially prolonged and complicated recovery. This is not a fast-track. Respectfully, don't be a Dick.
Expect long lists of meds, allergies, requests, and questions. Listen to and engage with your patient. They may educate you. Anticipate a potentially prolonged and complicated recovery. This is not a fast-track. Respectfully, don't be a Dick.
PSA: You *CANNOT* use a "bougie" or Eschmann Intubating Stylet to do an endotracheal tube exchange. I have seen this mistake twice in the past 6 months. You will lose the airway. A simple look at the length of the bougie and an #ETT will make this clear.
The length of an adult ETT is about 32 cm and the length of the #eschmannstylete is 70 cm. This leaves no room in the center for you to grab it. When you retract the #ETT to the end of the stylet, its distal tip is still in the patient's mouth & entire stylet is covered
To do a tube exchange, you need 2x the length of the ETT and then some additional length to work with, else you risk retracting the exchange device too far and losing the airway. This is why they make an "airway exchange catheter" and its length is 83cm: cookmedical.com/products/cc_ca…
How we implemented specific & tangible #PhysicianWellness recommendations into our national #anesthesia guidelines @CASupdate
🧵of highlights
link.springer.com/article/10.100…
At the end of 2019 the @CASUpdate wellness committee was formed. I had two broad goals for my term as Chair
1/
🧵of highlights
link.springer.com/article/10.100…
At the end of 2019 the @CASUpdate wellness committee was formed. I had two broad goals for my term as Chair
1/
supported by an amazing committee (I didn’t know a 🌎 pandemic ws coming!)
1.Train anesthesiologists 2provide quality evidence based #PeerSupport 2one another,esp after critical events&encourage creation of institutional peer support programs
👀 4more on this another day
2/
1.Train anesthesiologists 2provide quality evidence based #PeerSupport 2one another,esp after critical events&encourage creation of institutional peer support programs
👀 4more on this another day
2/
2. To embed tangible & specific wellness recommendations into our National Guidelines (because healthy physicians are safer physicians and also…urmmm…basic humanity!)
- Appropriate breaks 🚽
- Enough rest 😴
- Skilled help esp after hrs 👩🏽⚕️
- Transparent&equitable policies
3/
- Appropriate breaks 🚽
- Enough rest 😴
- Skilled help esp after hrs 👩🏽⚕️
- Transparent&equitable policies
3/
I wonder whose bright idea it was that if a #vagina managed penetrative #sexual activity, it must be pliable to #insertion of the speculum 😒. Whoever that was definitely disregarded the physiology of sexual #arousal & vaginal changes in the moment that facilitate #penetration.
@vagina_museum shows that everyone's apparatus is different then how can #Gynecology stick to a one size fits all model? #publichealth should strive to develop minimally invasive self administered #screening tests & #gynaecologist must #research on making procedures comfortable.
researchgate.net/publication/22…
This shows that topical #anesthetic agents reduce #pain and #discomfort during speculum manipulation. Why can't the usage of topical #anesthesia be a #standard process in #Gynecology? Why such blatant disregard for #patient #comfort? 😠 #misogyny much?
This shows that topical #anesthetic agents reduce #pain and #discomfort during speculum manipulation. Why can't the usage of topical #anesthesia be a #standard process in #Gynecology? Why such blatant disregard for #patient #comfort? 😠 #misogyny much?
#NEETPG counseling
First hand College opinion thread
#MedTwitter Please contribute from your experience
First hand College opinion thread
#MedTwitter Please contribute from your experience
General/internal medicine
College & state -
1.academics & research
2.Toxicity
3.Working hours
4.Patient Load
5.Superspecialty Exposure
6. Fees & Pay
College & state -
1.academics & research
2.Toxicity
3.Working hours
4.Patient Load
5.Superspecialty Exposure
6. Fees & Pay
Radiology
1.academics & research
2.Toxicity
3.Working hours
4.Patient Load
5.Modalities avilable
6.Fees & Pay
1.academics & research
2.Toxicity
3.Working hours
4.Patient Load
5.Modalities avilable
6.Fees & Pay
1/ Let’s review pediatric sedation with Dr. Amy Alayari (PGY3)!
Classify the following level of sedation: someone is in a controlled state of depressed consciousness during which airway is maintained. Patient can respond to questions and light touch (e.g. “open your eyes”)
Classify the following level of sedation: someone is in a controlled state of depressed consciousness during which airway is maintained. Patient can respond to questions and light touch (e.g. “open your eyes”)
2/ Think of sedation as a continuum, understand that a patient can go from mild to general anesthesia within seconds! Review the slide here for the answer to the question above
3/ Always be prepared before giving sedation! That includes giving informed consent and making sure you have all materials in the SOAP-ME mnemonic ready
Good afternoon and good evening…thank you all for joining us for this portion of the 2020 @SOAPHQ virtual annual meeting
What's new in #OBAnes - A comprehensive review of the most relevant articles published in 2019
#MedThread #Tweetorial #Ostheimer #SOAPAM2020
What's new in #OBAnes - A comprehensive review of the most relevant articles published in 2019
#MedThread #Tweetorial #Ostheimer #SOAPAM2020
#Halifax would have been amazing - @ruthi_landau and I worked incredibly hard with our amazing management team to bring you an innovative agenda and in many ways we reimagined the way @SOAPHQ delivers an annual meeting #MedThread #Tweetorial #OBAnes #Ostheimer
Most of us have never lived through something like #COVID19 - As we embrace the new normal, remind ourselves of strategies to address our own wellness as physician leaders on the frontline - let's continue to look out for one another! #MedThread #Tweetorial #OBAnes #Ostheimer
This week, we shift our focus and expand our panel and have a more global outlook as we look at the role of #nurse_anesthetists in the era of COVID_19
This panel is an example of what was in store for us at the postponed Pan African Nurses Anesthetists Conference #PANAC (panac.africa) proudly supported by #IFNA, @DiamedicaUK @Safe_4_all #SmileTrain, @AfricaMHF, @VUMCglobalanes and many more
Do you want to know about the global role played by #Nurse_Anesthetists in #SafeAnesthesia?
Dr. Jackie Rowles, (@jsrowles), President of the International Federation of Nurse Anesthetists will be share about the global role nurse anesthetists have in this movement
Dr. Jackie Rowles, (@jsrowles), President of the International Federation of Nurse Anesthetists will be share about the global role nurse anesthetists have in this movement
1/ Women in #CriticalCare: #Anesthesia/CC
Four EXPERT MD mentees in our CIBS Center (clockwise top left): Heidi Smith (R01 funded for Mini-MENDS), @kimberlyrengel (studies prehabilitation), @christinahayhu2 (pain after ICU) & Tina Boncyk (FAER awardee).
#medtwitter #heforshe
Four EXPERT MD mentees in our CIBS Center (clockwise top left): Heidi Smith (R01 funded for Mini-MENDS), @kimberlyrengel (studies prehabilitation), @christinahayhu2 (pain after ICU) & Tina Boncyk (FAER awardee).
#medtwitter #heforshe
2/ Women in #CriticalCare: Biostatistics
“Stats-magicians” bring truth from darkness to light at CIBS Center. Our EXPERT is Dr. Rameela Raman (e.g. MIND-USA NEJM). Dr. Ayumi Shintani & @jent103 did stats for CAM-ICU, MENDS & ABC trials & BRAIN-ICU NEJM.
#biostats #epidemiology
“Stats-magicians” bring truth from darkness to light at CIBS Center. Our EXPERT is Dr. Rameela Raman (e.g. MIND-USA NEJM). Dr. Ayumi Shintani & @jent103 did stats for CAM-ICU, MENDS & ABC trials & BRAIN-ICU NEJM.
#biostats #epidemiology
Women in Anesthesiology Statement on Racism in America
Women in Anesthesiology is an independent anesthesiology organization consisting of women of every color. Injustice felt by one of us is felt by all of us.
Women in Anesthesiology is an independent anesthesiology organization consisting of women of every color. Injustice felt by one of us is felt by all of us.
We recognize that our specialty of anesthesiology is not immune to the inequalities experienced by the black community. We recognize that pregnant black women are less likely to receive a labor epidural or to receive the preferred anesthetic for cesarean delivery.
We recognize that black children are less likely to have a parent present at induction of anesthesia or to receive antianxiety medications before surgery. We recognize that black children and adults sometimes receive inferior pain management.
Hi 👋🏽- I have #COVID19.
Isolated at 🏠 away from my healthy & unexposed family.
Seeking ways to help as a research subject (take my serum!) & hope to be back on front lines soon w/my #ICU & #anesthesia colleagues as an🤞🏽immune #COVIDー19 fighter.
Oh & anosmia= 100% REAL. 1/
Isolated at 🏠 away from my healthy & unexposed family.
Seeking ways to help as a research subject (take my serum!) & hope to be back on front lines soon w/my #ICU & #anesthesia colleagues as an🤞🏽immune #COVIDー19 fighter.
Oh & anosmia= 100% REAL. 1/
My #covid19 symptom timeline were:
Day 1: myalgia
Day 2: chills, coughing, malaise
Day 3: coughing continues, exhausted, intermittent nausea, myalgias
Day 4:myalgia, cough, nausea, decreased taste, fatigue
Day 5: myalgia, cough, malaise, ANOSMIA
Symptoms come & go in 🌊 2/
Day 1: myalgia
Day 2: chills, coughing, malaise
Day 3: coughing continues, exhausted, intermittent nausea, myalgias
Day 4:myalgia, cough, nausea, decreased taste, fatigue
Day 5: myalgia, cough, malaise, ANOSMIA
Symptoms come & go in 🌊 2/
Anosmia. The strangest & most fascinating symptom of all. Discovered it when the brand new diffuser wasn’t working despite dumping several drops of strong scented oil in. Then a friend asked “so is that anosmia thing real?” Then it hit me. 3/
1/ I'm my department's disaster preparedness officer. Have had a hectic few days with #COVID19 planning, but the following thought occurred to me - Why you want an anesthesiologist or anesthesia provider on your disaster preparedness team:
2/ We contingency plan every day. This is our normal state of being. What happens if x, then y, then z? How about 1, 2, & 3?
3/ We start with the worst case scenario and work backwards. How do I know that all my patients *don't* have #COVID19? What if there is no oxygen? What if we run out of hospital beds?
Engaging and inspiring grand rounds from @EMARIANOMD today @HSSAnesthesia about biggest threats to #anesthesiology —concerns and solutions- classic Ed. Too much good info to share so excuse the string 1/8
Loss of identity.
-anesthesia is safe. We have enabled remarkable surgeries to happen and make it look easy
-we are sometimes invisible. We have a “ambivalence toward recognition”
-loss of identity ➡️ #burnout 2/8
-anesthesia is safe. We have enabled remarkable surgeries to happen and make it look easy
-we are sometimes invisible. We have a “ambivalence toward recognition”
-loss of identity ➡️ #burnout 2/8
SOLUTION to loss of identity
- We need to consider our brand
- #anesthesiology can lead in #PrecisionMedicine
- Take a “victory lap” and talk to families after #anesthesia
- Know when to take the mask off. Lead committees, contribute to the hospital, community impact 3/8
- We need to consider our brand
- #anesthesiology can lead in #PrecisionMedicine
- Take a “victory lap” and talk to families after #anesthesia
- Know when to take the mask off. Lead committees, contribute to the hospital, community impact 3/8
1/Lesson #5: Pressure Regulated Volume Control (PRVC)
#WeVentWednesdays #WaveformsMatter
@CritCareMed @Crit_Care @emcrit @somedocs @ATSMedEd
#pccm #EMCritCare #CriticalCare @AnesthCritCare #pulmcc #medtwitter
Resource: bit.ly/2MImYv3 by @emireles_c et al
#WeVentWednesdays #WaveformsMatter
@CritCareMed @Crit_Care @emcrit @somedocs @ATSMedEd
#pccm #EMCritCare #CriticalCare @AnesthCritCare #pulmcc #medtwitter
Resource: bit.ly/2MImYv3 by @emireles_c et al
2/ PRVC = Continuous Mandatory Ventilation, Pressure Limited, Time Cycled with Adaptive Targeting.
SETTINGS: Tidal volume, Insp Time, Fio2, PEEP, RR
Breath to Breath feedback of exhaled TV, compared to target with adjustment of subsequent insp pressure to lead to steady TV
SETTINGS: Tidal volume, Insp Time, Fio2, PEEP, RR
Breath to Breath feedback of exhaled TV, compared to target with adjustment of subsequent insp pressure to lead to steady TV
3/ ALSO KNOWN AS #AKA...
PRVC - Marquet Servo i
Autoflow - Drager
Adaptive Pressure Ventilation - Hamilton Galileo
Volume Control + - Puritan Bennett
Volume Targeted Pressure Control, Pressure Controlled Volume Guaranteed - Engstrom
PRVC - Marquet Servo i
Autoflow - Drager
Adaptive Pressure Ventilation - Hamilton Galileo
Volume Control + - Puritan Bennett
Volume Targeted Pressure Control, Pressure Controlled Volume Guaranteed - Engstrom
It began with the forging of the Great Rings.
Three were given to the Elves, immortal, wisest, fairest of all beings.
Three were given to the Elves, immortal, wisest, fairest of all beings.
Seven to the Dwarf Lords, great miners and craftsmen of the mountain halls.
And Nine rings were gifted to the race of Men who, above all else, desire power.
Every summer my heart is heavy with memories of a time when I even came close to leaving #medicine-when career & motherhood collided and I didn’t ask for help.
I want to share that story in case it helps even 1 person.(Thread) #medtwitter #meded #womeninmedicine #TipsForNewDocs
I want to share that story in case it helps even 1 person.(Thread) #medtwitter #meded #womeninmedicine #TipsForNewDocs
I share this now because July is full of #tipsfornewdocs but August comes & we all get swallowed up in the hustle & bustle of heavy clinical loads- when orientation ends and the real work begins.
I had just finished #pediatric residency and started #anesthesia residency with a 6 month old baby. Orientation was over & we were deployed to do our first cases in the OR without an attending always in the room with us.
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,
- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
