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Most recents (24)
Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).
Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.
So what to do?
A 🍄🧵
#FOAMed #FoamCC #MedEd
Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.
So what to do?
A 🍄🧵
#FOAMed #FoamCC #MedEd
If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.
Since we almost never have that we usually rely on history and symptoms
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Randomised clinical trials in cardiogenic shock in the PCI era 
Treatment considerations for patients with AMI-cardiogenic shock
Enrolment data for major randomised cardiogenic shock trials (EuroIntervention 2021; 17: 451-65)
1a) Welcome to a 🆕#accredited #tweetorial on the importance of time in range #TIR in #diabetes . . . with additional emphases on #primarycare and on practice in 🇨🇦.
#FOAMed #endotwitter #MedEd @MedTweetorials #nephtwitter #cardiotwitter
#FOAMed #endotwitter #MedEd @MedTweetorials #nephtwitter #cardiotwitter
1b) Hence we welcome2⃣ expert faculty from Canada: Ilana Halperin @ilanajhalperin, academic endocrinologist at @Sunnybrook and @uoftmedicine, and Noah Ivers @NoahIvers, #familydoc & researcher at Women's College Hospital @UofT
2) Earn 0.75hr 🆓CE/#CME by following this🧵! This program is supported by an unrestricted educational grant from Sanofi Canada and is intended for #HCPs. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/.
And so we begin . . .
And so we begin . . .
🧠 The NEW Consensus statement on concussion in sport: the 6th International Conference on #Concussion in Sport from the Amsterdam, October 2022 interdisciplinary meeting is OFFICIALLY out via @BJSM_BMJ 📄
🧵 Here are the key takeaways summarized by the article:
#FOAMed
🧵 Here are the key takeaways summarized by the article:
#FOAMed
Individuals with persisting symptoms (ie, symptom duration >4 weeks) should be evaluated with a MULTIMODAL CLINICAL ASSESSMENT including the use of standardized and validated symptom rating scales. 2/
The potential long-term effects of Sports Related Concussion & repetitive head impacts (RHI) are areas of ongoing public health interest and concern among both healthcare professionals and the general public. 3/
1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling? Does it seem to have as many openings as letters in its name?
Let this #tweetorial on PPF #anatomy help you out
#meded #medtwitter #FOAMed #FOAMrad #neurosurgery #neurology #neurorad #neurotwitter #radres
Let this #tweetorial on PPF #anatomy help you out
#meded #medtwitter #FOAMed #FOAMrad #neurosurgery #neurology #neurorad #neurotwitter #radres
2/The PPF is a crossroads between the skullbase & the extracranial head and neck. There are 4 main regions that meet here. The skullbase itself posteriorly, the nasal cavity medially, the infratemporal fossa laterally, and the orbit anteriorly.
3/At its most basic, you can think of the PPF as a room with 4 doors opening to each of these regions: one posteriorly to the skullbase, one medially to the nasal cavity, one laterally to the infratemporal fossa, and one anteriorly to the orbit
A patient living with HIV with undetectable viral loads for many years asks you if they can stop their antiretroviral therapy (ART). What is the right answer and what is the underlying reason?
🧵🧵🧵👇(1/n)
#MedEd #MedTwitter #FOAMed #IDTwitter
🧵🧵🧵👇(1/n)
#MedEd #MedTwitter #FOAMed #IDTwitter
The answer is straight-forward: DO NOT STOP!
HIV is notorious for establishing a latent infection in a wide range of cell populations inside body. The lymphoid tissue is the major reservoir. (2/n)
HIV is notorious for establishing a latent infection in a wide range of cell populations inside body. The lymphoid tissue is the major reservoir. (2/n)
As a result, there is a rebound viremia following the discontinuation of the ART originating from these reservoirs. (3/n)
ICU stories (common): Middle-aged pt w hx of COPD was brought to the ED by EMS after SOB x 2 days. No fever or chest pain. Very quickly after ED arrival, he was intubated. CXR showed hyperinflated, “COPD” lungs. Here depicted in two images:
Post-intubation ABGs showed:
BP dropped post-intubation to 55/40; propofol was started & then discontinued due to hypotension. iv fluids (2L Lactate Ringer's) were started & patient was brought to the ICU w SBP in upper 80s. Re-institution of propofol led again to hypotension. What would be the next step?
We're seeing more consult questions for this, and it's also garnering national attention, so let's take a brief moment in #tweetorial format to talk about:
XYLAZINE SKIN ULCERS!
#xylazine #MedEd #FOAMEd #dermtwitter #medtwitter
1/
XYLAZINE SKIN ULCERS!
#xylazine #MedEd #FOAMEd #dermtwitter #medtwitter
1/
What is Xylazine? It was created in the 70s as a veterinary anesthetic. As an analog of clonidine, it has similar effects as an alpha-2 agonist, leading to sedation, anesthesia, and euphoria in the CNS.
2/
2/
Recently, Xylazine has entered the drug supply, moreso in certain cities, but increasingly everywhere. It is often mixed with fentanyl as a cutting agent, and can also be used on its own. It may be called Tranq, Zombie Drug, or anestesia de caballo (horse anesthetic).
3/
3/
1/Remembering spinal fracture classifications is back breaking work!
A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:
Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)
Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.
This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!
This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!
A 67-year-old female presents with encephalopathy, ataxia, and this finding on physical exam 👇
What is the diagnosis and what is the pathophysiology of this condition?
A thread 🧵🧵🧵(1/11)
#MedTwitter #MedEd #FOAMed
What is the diagnosis and what is the pathophysiology of this condition?
A thread 🧵🧵🧵(1/11)
#MedTwitter #MedEd #FOAMed
Wernicke encephalopathy (WE) is a known complication of thiamine deficiency first described by Carl Wernicke in 1881 characterized by the classic triad of:
1⃣Acute encephalopathy
2⃣Oculomotor dysfunction
3⃣Gait ataxia
(2/11)
1⃣Acute encephalopathy
2⃣Oculomotor dysfunction
3⃣Gait ataxia
(2/11)
Thiamine (Vitamin B1) is an important cofactor for several enzymes involved in metabolism ➡️ It is more important in areas with high metabolic requirements such as the brain. (3/11)
1a) Welcome to a live-tweeted, #accredited #tweetorial from @nationallipid #NLA23 in #Atlanta on advances in #hyperlipidemia management #LLT. Our expert returning faculty is Pam R. Taub, MD @PamTaubMD #cardiologist from @UCSDHealth
1b) Dr. Taub is a clinician/scientist and is a frequent contributor to our #accredited programs. She is the founding director of the Step Family Foundation Cardiac Rehabilitation and Wellness Center at #UCSD.
#FOAMed #cardiotwitter @MedTweetorials #MedEd #lipids
#FOAMed #cardiotwitter @MedTweetorials #MedEd #lipids
2) This program is supported by an educational grant from Esperion Therapeutics & is intended for #HCPs. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/. Earn 0.75 hr 🆓CE/#CME by following this 🧵!
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A #tweetorial to help you remember cervical radicular pain distributions
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery
A #tweetorial to help you remember cervical radicular pain distributions
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5.
If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5
If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
1) Welcome to a 🆕#accredited #tweetorial from @cardiomet_CE! Earn 0.5hr 🆓 CE/#CME by following this 🧵. Our expert faculty is Sanjiv J Shah MD @HFpEF, Cardiologist & Director, Northwestern HFpEF Program (hfpef.org). Director of Research, @NMCardioVasc
#FOAMed
#FOAMed
1b) .@HFpEF will be sharing the algorithm he uses to treat #HFpEF based on evidence we have thus far and his anecdotal experience treating patients over the past 16 years in the @NMCardioVasc HFpEF Clinic.
#CardioTwitter #MedEd @MedTweetorials #HeartFailure
#CardioTwitter #MedEd @MedTweetorials #HeartFailure
2) CE/#CMEcredit for #physicians #physicianassociates #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺.
Statement of accreditation and faculty disclosures at cardiometabolic-ce.com/disclosures/.
FOLLOW US for accredited programs in #cardiometabolic space delivered wholly on Twitter!
Statement of accreditation and faculty disclosures at cardiometabolic-ce.com/disclosures/.
FOLLOW US for accredited programs in #cardiometabolic space delivered wholly on Twitter!
1/ “Say Aaaaaaah!” I was explaining to my resident how I remember tongue anatomy on imaging & he said, “You have to put it on Twitter!”
So here's a #tweetorial about how to remember tongue anatomy on imaging.
#medtwitter #radres #medstudent #FOAMed #FOAMrad #neurorad #meded
So here's a #tweetorial about how to remember tongue anatomy on imaging.
#medtwitter #radres #medstudent #FOAMed #FOAMrad #neurorad #meded
2/ When you look on the coronal plane at the tongue, the first thing you notice are two column like structures that look like a pair of jeans—genioglossus—or as I like to say “jean-ee-o-glossus.” Genioglossus is latin for jeans of the tongue, right?
3/Right below the jeans are what look like a pair of clown shoes—the geniohyoid. So you see a pair of legs going right into a pair of shoes.
1) Welcome to a 🆕accredited tweetorial from @cardiomet_CE! We welcome back expert faculty @ChristosArgyrop to discuss screening for #CKD in pts w/ #T2D & the role of routine assessment for #microalbuminuria as an effective diagnostic, risk stratification, & patient ed tool.
2) Christos Argyropoulos MD, PhD @ChristosArgyrop is Division Chief, Nephrology @UNMHSC. #CKD is chronic #kidneydisease, #ESKD is end-stage kidney disease.
#FOAMed #nephtwitter #cardiotwitter @MedTweetorials @NephUCommunity @ISNkidneycare @KidneyDiseaseFm
#FOAMed #nephtwitter #cardiotwitter @MedTweetorials @NephUCommunity @ISNkidneycare @KidneyDiseaseFm
3) This program is intended for #HCPs and is supported by an unrestricted educational grant from Bayer. Statement of accreditation & faculty disclosures at cardiometabolic-ce.com/disclosures/.
FOLLOW US for more expert-authored #tweetorials and earn #MedEd
FOLLOW US for more expert-authored #tweetorials and earn #MedEd
PICC line 🧵 #medicine
1/
A central device (i.e in the SVC) placed via a peripheral venous access
.
#irad #vascular #MedTwitter #FOAMed #hematology #Tweetorials @nihardesai7 @MedTweetorials #Cardiology #MedEd #oncology #internalmedicine @BrownJHM #MedStudentTwitter #cardiotwitter
1/
A central device (i.e in the SVC) placed via a peripheral venous access
.
#irad #vascular #MedTwitter #FOAMed #hematology #Tweetorials @nihardesai7 @MedTweetorials #Cardiology #MedEd #oncology #internalmedicine @BrownJHM #MedStudentTwitter #cardiotwitter
2/
Classically placed in the arm
May be placed in the leg (eg in #pediatrics /neonates – which may then terminate in the infrarenal IVC/iliacs)
.
#criticalcare #cardiovascular
Classically placed in the arm
May be placed in the leg (eg in #pediatrics /neonates – which may then terminate in the infrarenal IVC/iliacs)
.
#criticalcare #cardiovascular
3/
Advantages:
- Lower infection rate then central lines
- Used in the outpatient setting
- Can be used for several weeks to months
- Duration of PICC lines may be from 4 weeks to 6 months
(although they have been known to be functional for more than 300 days)
Advantages:
- Lower infection rate then central lines
- Used in the outpatient setting
- Can be used for several weeks to months
- Duration of PICC lines may be from 4 weeks to 6 months
(although they have been known to be functional for more than 300 days)
ICU pictorials: A patient was admitted for "weakness". Unimpressive vitals / phys exam / labs. A few days later because of temp 101 F, a fever w/u was initiated. Due to "SOB", a CT chest angio was done:
👆Massive saddle PE extending in both sides w evidence of R heart strain
Echo findings:
INTRAVENOUS THROMBOLYSIS (fibrinolytic therapy) can be successfull if given
A. Within 30minutes to 12 hrs in STEMI
B. Within 3-4.5 hrs in Acute ischemic stroke
C. Within 14 days in Pulmonary embolism
Choose the ✅️correct statement/s among the above.
#Medtwitter #MedEd
A. Within 30minutes to 12 hrs in STEMI
B. Within 3-4.5 hrs in Acute ischemic stroke
C. Within 14 days in Pulmonary embolism
Choose the ✅️correct statement/s among the above.
#Medtwitter #MedEd
✅️TRUE statement/s among the above three
Fibrinolytic agents are plasminogen activators(PA) that act by converting plasminogen to plasmin. Plasmin then degrades the fibrin matrix of thrombi and produces soluble fibrin degradation products resulting in clot lysis.
ICU Quizzes:
What is the most common electrolyte abnormality seen in the hospital?
What is the most common electrolyte abnormality seen in the hospital?
👆 C.
In what time frame of development, is a hyponatremic episode considered acute?
In what time frame of development, is a hyponatremic episode considered acute?
👆 C.
If the onset of hyponatremia is unknown, it should be managed as:
If the onset of hyponatremia is unknown, it should be managed as:
I was checking again today about DKA/HHS in a very modern & easy to read textbook and I saw this about the Na correction:
The Katz correction factor is 1.6 mEq/L for every 100 mg/dL that the serum Glu exceeds 100 mg/dL & the Hillier correction factor is 2.4 mEq/L
amjmed.com/article/S0002-…
amjmed.com/article/S0002-…
It seems that the textbook 👆 uses a sodium correction factor of < 1.0 mEq/L for every 100 mg/dL of Glu above 100 or applies the correction starting from a higher Glu level (probably 200 mg/dL?)
1/Time is brain! So you don’t have time to struggle w/that stroke alert head CT.
Here’s a #tweetorial to help you with the CT findings in acute stroke.
#medtwitter #FOAMed #FOAMrad #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter
Here’s a #tweetorial to help you with the CT findings in acute stroke.
#medtwitter #FOAMed #FOAMrad #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter
2/CT in acute stroke has 2 main purposes—(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke. However, that doesn’t mean you can’t see other findings that can help you diagnosis a stroke.
3/Infarct appearance depends on timing. In first 12 hrs, the most common imaging finding is…a normal head CT. However, in some, you see a hyperdense artery or basal ganglia obscuration. Later in the acute period, you see loss of gray white differentiation & sulcal effacement
1/
Second day of @Smart_Meeting_M
Professor @giovannilandoni talking about management of #anticoagulant in #perioperative patients 💉
✅You surely all know how to deal with #antithrombotic and #regionalanesthesia, here the guidelines:
pubmed.ncbi.nlm.nih.gov/34980845/
#FOAMed #FOAMcc
Second day of @Smart_Meeting_M
Professor @giovannilandoni talking about management of #anticoagulant in #perioperative patients 💉
✅You surely all know how to deal with #antithrombotic and #regionalanesthesia, here the guidelines:
pubmed.ncbi.nlm.nih.gov/34980845/
#FOAMed #FOAMcc
2/
💡Let's focus on perioperative #DOAC /#NOAC / #TSOAC
➡️Consider both #surgical blood loss risk and #patient characteristics.
⚠️Remember NOT to bridge with #LMWH or #UFH.
pubmed.ncbi.nlm.nih.gov/33895845/
💡Let's focus on perioperative #DOAC /#NOAC / #TSOAC
➡️Consider both #surgical blood loss risk and #patient characteristics.
⚠️Remember NOT to bridge with #LMWH or #UFH.
pubmed.ncbi.nlm.nih.gov/33895845/
3/
What if it's not an elective patient??
Use #reversal agents when needed❗
🔹#Idarucizumab for #dabigatran
🔹#Andexanet for #apixaban and #rivaroxaban
💡#Prothrombin complex concentrates in addiction
pubmed.ncbi.nlm.nih.gov/36988142/
What if it's not an elective patient??
Use #reversal agents when needed❗
🔹#Idarucizumab for #dabigatran
🔹#Andexanet for #apixaban and #rivaroxaban
💡#Prothrombin complex concentrates in addiction
pubmed.ncbi.nlm.nih.gov/36988142/
ICU stories (last night): A patient had been admitted w pneumonia / intubated / on norepi 0.12. At 01:00 am, the nurse notifies you that urine output is 5-10 cc/hr for the previous 3 hours. BP is 99/44, HR 90, CRT 3 sec. You take the US in patient's room to see what's happening.
What POCUS finding(s) is/are likely to explain the oligo-anuria in the shortest amount of time?
If you (and the patient) are lucky, you may find this:
1/
🎬 Now on stage Professor @giovannilandoni talking about what we DON'T KNOW about #cardiocirculatory drugs
✅ #Norepineprhine is the most used vasoactive drug in the guidelines for:
🔹 #sepsis
🔹#cardiogenic shock❗(Scandinavian)
BUT...
@Smart_Meeting_M @SRAnesthesiaICU
🎬 Now on stage Professor @giovannilandoni talking about what we DON'T KNOW about #cardiocirculatory drugs
✅ #Norepineprhine is the most used vasoactive drug in the guidelines for:
🔹 #sepsis
🔹#cardiogenic shock❗(Scandinavian)
BUT...
@Smart_Meeting_M @SRAnesthesiaICU
2/
BUT... #Norepineprhine (base) does not exist❗
🚫 base is not soluble, unstable and unable to reach target receptors
💡 Let's make it a salt!
🤔 But which one?
⚠️ Available Norepineprhine salts has different #dilution
⚠️ Sometimes with misleading #labeling
BUT... #Norepineprhine (base) does not exist❗
🚫 base is not soluble, unstable and unable to reach target receptors
💡 Let's make it a salt!
🤔 But which one?
⚠️ Available Norepineprhine salts has different #dilution
⚠️ Sometimes with misleading #labeling
3/
➡️ Please do not change you're clinical practice for this ⬅️
But consider the possible implications on:
🔹Second line drugs initiation
🔹Co- administration of other vasopressors
❗Comunication of your results!!!
pubmed.ncbi.nlm.nih.gov/36978126/
#FOAMed #FOAMcc
➡️ Please do not change you're clinical practice for this ⬅️
But consider the possible implications on:
🔹Second line drugs initiation
🔹Co- administration of other vasopressors
❗Comunication of your results!!!
pubmed.ncbi.nlm.nih.gov/36978126/
#FOAMed #FOAMcc
