Discover and read the best of Twitter Threads about #NoonConference
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A brief refresher about #Antibiotic-associated #Encephalopathy #Twittorial #Tweetorial #AMS
Inspired from today's #NoonConference topic
#MedTwitter #MedStudentTwitter #NeuroTwitter #NeurotwitterNetwork #MedEd @MedTweetorials #NeurologyResident #Neurology #RITEReview
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Inspired from today's #NoonConference topic
#MedTwitter #MedStudentTwitter #NeuroTwitter #NeurotwitterNetwork #MedEd @MedTweetorials #NeurologyResident #Neurology #RITEReview
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Antibiotics are commonly prescribed medications in the inpatient and outpatient setting and it's important to recognize #AdverseEvents, including idiosyncratic reactions, such as #encephalopathy.
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Antibitiotics associated with #Encephalopathy:
- Beta lactams
- #Cephalosporins (#Cefepime is the most common,
Ceftazidime)
- Imipenem
- #Penicillin procaine
- Fluoroquinolones
- Macrolides (clarithromycin)
- TMP-SMX
- #Metronidazole
- Isoniazid
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- Beta lactams
- #Cephalosporins (#Cefepime is the most common,
Ceftazidime)
- Imipenem
- #Penicillin procaine
- Fluoroquinolones
- Macrolides (clarithromycin)
- TMP-SMX
- #Metronidazole
- Isoniazid
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Catching up on some awesome recent #ChiefResident blog posts from #NoonConferences and #WOTW #winoftheweek's!
first up, FUO? What a giant differential! Is there a role for PET?
imrespdx.com/imrespdx-blog/…
first up, FUO? What a giant differential! Is there a role for PET?
imrespdx.com/imrespdx-blog/…
#NoonConference
how to look at art with Dr. Lam!
including samples of some of the art work on campus
imrespdx.com/imrespdx-blog/…
how to look at art with Dr. Lam!
including samples of some of the art work on campus
imrespdx.com/imrespdx-blog/…
Special #NoonConference surgical curbsiders style with Dr. @katewat4141 from @OHSUsurgery (sorry @thecurbsiders ...)
INCLUDING clinical pearls AND systems-based practice including their call cycle/structure and team structures (color coded by subspecialty)
imrespdx.com/imrespdx-blog/…
INCLUDING clinical pearls AND systems-based practice including their call cycle/structure and team structures (color coded by subspecialty)
imrespdx.com/imrespdx-blog/…
Showing off our beautiful campus
“Love where you work and the work you do there” (ht @PDX_Tom) @aoglasser @jungleland @Gurpreet2015
“Love where you work and the work you do there” (ht @PDX_Tom) @aoglasser @jungleland @Gurpreet2015
Noble Wiley Jones lectureship committee residents at lunch. #NoonConference with challenging cases next!
#NoonConference resident bake off!
Getting plates ready for the judges...or flunking the mini cog exam and clock draw...
Resident bake off
#noonconference today is resident bake off! It’s going to be...
Because our residents have mad skills!
And we will bring a blend of medical knowledge and cooking?? #NoonConference
#ChiefResident blog
we love seeing residents being innovative educators esp when giving case-report style #NoonConference!
Dr Huber did a one-two punch: exciting medical case & expose into the challenges of providing med advice to our family members...
imrespdx.com/imrespdx-blog/…
we love seeing residents being innovative educators esp when giving case-report style #NoonConference!
Dr Huber did a one-two punch: exciting medical case & expose into the challenges of providing med advice to our family members...
imrespdx.com/imrespdx-blog/…
Dr Huber shared with the permission of his family member, & the work/management of this case was through his eyes, by proxy through another family member, over phone calls and text messages, complicated by the fact that the patient did not have insurance initially #NoonConference
and check out this @AnnalsofIM article including OHSU faculty authors! annals.org/aim/fullarticl…
There may not have been 525,600 #medtwitter moments, but 2018 was quite the year to learn, connect, and share the joy of practicing internal medicine and caring for patients, ourselves, and each other. Here’s our 2018 #medtwitter highlights real! 1/n
We drove, walked, ran, and biked to work (the unicycle commuter isn't a resident, alas...), even during the long winter nights, taking in the sunrise while pre-rounding or rounding 2/n
We came together to learn, with the input and involvement from each other, fellows, and faculty 3/n
#ChiefResident blog #NoonConference Dr. Eddie Maldonado's case highlighting care facets when a patient is incarcerated! imrespdx.com/imrespdx-blog/…
#NoonConference #meded this was a fascinating case that touched on multiple medicolegal and social themes encountered on the wards--We were also joined by two representatives from our wonderful OHSU social work team @OHSUSOM @OHSUNews
Incarcerated patients, when admitted, have certain considerations, rules, and legal protections that we should keep in mind. Remember, implicit and explicit biases by the entire care team must be carefully considered while administering treatment for this vulnerable populartion,
It’s an #InterviewDay and R2 Francis Phan is shaking it up with #NoonConference in a different format!
(Do you remember the last time he presented when he brought tons of BP cuffs and did hands on pulsus paradoxus testing incl breathing through straws?!)
(Do you remember the last time he presented when he brought tons of BP cuffs and did hands on pulsus paradoxus testing incl breathing through straws?!)
This is revealing itself to be an incredible systems-based and ethics case!
Don’t forget the difference between capacity and competency!
#ChiefResident blog #NoonConference #meded Flozin down that river of knowledge: a wild case of undifferentiated shock! THanks to Dr. Levin for this "choose your own adventure" case! imrespdx.com/imrespdx-blog/…
HT @thecurbsiders and @kidney_boy for providing a framework for our discussion on dissecting the acid-base distubances in this case!
ultimately this patient had euglycemic DKA from an SGLT-2 inhibitor!
#ChiefResident blog #NoonConference #Meded Noon Report: Hyponatremia Review w HT @thecurbsiders @kidney_boy for the hyponatremia algorithm discussed on the podcast! imrespdx.com/imrespdx-blog/…
Here's the link to the "Hyponatremia Deconstructed" episode
thecurbsiders.com/medical-educat…
thecurbsiders.com/medical-educat…
#NoonConference #meded Dr. Horton brought a great PICO question about hyponatremia as a prognostic marker for in-hospital mortality, using this article as part of the discussion--each ⬇️serum Na by 3mEq <140 was associated w increased risk mortality sciencedirect.com/science/articl…
#ChiefResident blog #NoonConference #meded Thanks to Dr. Nelson for a non-conventional case exploring capacity and ethics! "Tips to not feeling incapacitated by capacity assessments" imrespdx.com/imrespdx-blog/…
The questions were raised:
--Does this patient have capacity to make this decision?
--How does her underlying schizophrenia affect her capacity?
--What do you do when the patient’s wishes don’t align with your own or those of the patient’s family members?
--Does this patient have capacity to make this decision?
--How does her underlying schizophrenia affect her capacity?
--What do you do when the patient’s wishes don’t align with your own or those of the patient’s family members?
this is a great @NEJM article on assessing capacity
and remember, have confidence with capacity: This is not only something we can and should assess, it is something that the primary team is BEST suited to do.
nejm.org/doi/full/10.10…
and remember, have confidence with capacity: This is not only something we can and should assess, it is something that the primary team is BEST suited to do.
nejm.org/doi/full/10.10…
#ChiefResident blog #NoonConference #meded
even a seemingly "bread and butter" case can provide excellent learning--
"Be Still My Heart... A Case of Type I NSTEMI" imrespdx.com/imrespdx-blog/…
even a seemingly "bread and butter" case can provide excellent learning--
"Be Still My Heart... A Case of Type I NSTEMI" imrespdx.com/imrespdx-blog/…
don't forget the spectrum of ACS, including unstable angina, NSTEMI, and STEMI! #NoonConference #meded
Pearls from Dr. Hegarty: STE in aVR with diffuse ST depressions is a pattern we should recognize! #NoonConference #meded
#ChiefResident blog #NoonConference #meded yearning for more after yesterday's awesome session involving dynamic pulsus paradoxus testing?? Here's the blog post about it! "Go Forth and PULSUS!" imrespdx.com/imrespdx-blog/…
In the age of echocardiography, it is easy to lose our pulsus paradoxus skills, but this is an important maneuver that should stay in our physical exam repertoire! #NoonConference #meded
Pulsus paradoxus is a phenomenon that was first described in 1873 by German physician Dr. Adolf Kussmaul (yes, the same Kussmaul as Kussmaul’s sign with JVP and Kussmaul breathing in DKA) #NoonConference #meded
en.wikipedia.org/wiki/Adolph_Ku…
en.wikipedia.org/wiki/Adolph_Ku…
#ChiefResident blog #NoonConference #meded Echinococcal Cyst? No! Chronic Cavitary Pulmonary AspergillOSIs! imrespdx.com/imrespdx-blog/…
we had a fantastic discussion re the differential for peripheral eosinophilia, which includes allergic, infectious, neoplastic, and immunologic etiologies. check out this great review article #NoonConference #meded imrespdx.com/s/Eosinophilia…
here's another great article that came up during our discussion, re diagnosis and treatment of pulmonary aspergillosis syndromes #meded #NoonConference static1.squarespace.com/static/54ebbf4…
#ChiefResident blog #NoonConference #meded irAEs-ing (I'm raising) Awareness: Immune checkpoint inhibitors imrespdx.com/imrespdx-blog/…
check out this great @NEJM review "Immune-Related Adverse Events Associated
with Immune Checkpoint Blockade" nejm.org/doi/pdf/10.105…
with Immune Checkpoint Blockade" nejm.org/doi/pdf/10.105…
Immunotherapy for cancer and specifically immune check point inhibitors are being used and their side effects can be thought of as all the “itises”. Have a HIGH index of suspicion for their side effects when a patient presents with an inflammatory picture #NoonConference #meded
#ChiefResident blog #NoonConference #Meded Pulmonary Complications Following Stem Cell Transplant --> diffuse alveolar hemorrhage (DAH) in this case imrespdx.com/imrespdx-blog/…
see the awesome blog post to help you structure your differential based on pre-engraftment period (days 0-30), early post-engraftment (engraftment day-100days post engraftment), and post-engraftment (> 100 days) #NoonConference #meded
Here's one of the articles that helped our discussion #NoonConference #meded
static1.squarespace.com/static/54ebbf4…
static1.squarespace.com/static/54ebbf4…
#ChiefResident blog #NoonConference #meded #medtwitter Thy(whoa)ma!
What a case-- jam-packed with items ripe for differential making! Petechial rash! Pancytopenia! Mediastinal Mass! imrespdx.com/imrespdx-blog/…
What a case-- jam-packed with items ripe for differential making! Petechial rash! Pancytopenia! Mediastinal Mass! imrespdx.com/imrespdx-blog/…
remember “the cartoon network” or “that crazy Neukam” (@sneukam) or “totally cool Nikes” or any mnemonic for the letters “TCN” to help you remember the differential for anterior, middle and posterior mediastinal masses #medtwitter #meded #NoonConference
the paraneoplastic syndromes associated w thymic neoplasm are many and can present in myriad ways. So the lesson is, if you see a mediastinal mass and well… any other symptom!... think thymoma and it’s attendant paraneoplastic syndromes #meded #medtwitter #NoonConfernece
#ChiefResident blog #NoonConference #meded ALS Presenting as Hypercarbic Respiratory Failure imrespdx.com/imrespdx-blog/…
#NoonConference #Meded
One way to think about the elimination of carbon dioxide is:
"won't breath" - CNS
"can't breath" - PNS, respiratory muscles, chest wall, pleura, upper airway
"can't breath enough" - lungs
One way to think about the elimination of carbon dioxide is:
"won't breath" - CNS
"can't breath" - PNS, respiratory muscles, chest wall, pleura, upper airway
"can't breath enough" - lungs
#NoonConference #meded A recent review article highlights that two large trials (EMPOWER, BENEFIT-ALS) and the ALS trial database (PRO-ACT) found that the rate of decline in FVC predicts the liklihood of death. tandfonline.com/doi/full/10.10…
#ChiefResident blog #NoonConference #meded Evidence-based cardiac exam, dyspnea triangle --> cardiac tamponade physiology from a likely hemorrhagic cardiac effusion from a supratherapeutic INR imrespdx.com/imrespdx-blog/…
A pulsus paradoxus of >10-12 mmHg has a +LR of ~3.3 and -LR of 0.03 which is the best diagnostic test we have for tamponade physiology. Here is a great @StanfordMed25 page to review how to perform a pulsus #NoonConference #meded stanfordmedicine25.stanford.edu/the25/bppp.html
Things to do immediately for a pt with tamponade physiology include considering the following: hemodynamic stability (consulting the ICU), IV access, coagulation status (reversal if indicated), fluids to support preload, other consultants (cardiology/ cardiothoracic surgery)
#NoonConference #meded thanks to Dr. Adam Obley for sharing this and the following article on yield of obtaining both ESR and CRP jpeds.com/article/S0022-…
#ChiefResident blog #NoonConference curious as to what the discussion was about? Check out this follow-up post about aortic dissections! imrespdx.com/imrespdx-blog/…
#NoonConference #meded Certain symptoms have a high positive likelihood ratio of thoracic aortic dissection including tearing/ ripping pain (LR+ 1.2-10.8) pulse deficits (LR+ 2.4-47) and focal neurologic deficits (LR+ 6.6-33) @JAMA_current ncbi.nlm.nih.gov/pubmed/11980527
#NoonConference #meded We discussed the utility of a D-dimer in diagnosis of aortic dissection. If < 500 ng/mL it has an excellent negative likelihood ratio (LR- 0.06) but not a good positive LR in a meta analysis ncbi.nlm.nih.gov/pubmed/21296332
#NoonConference #meded The PICO question: whether pts receiving therapeutic heparin v prophy SQ heparin had higher incidence of HIT. @accpchest 2007 article found 0.76% incidence w therapeutic heparin v < 0.1% incidence w prophylactic dosing sciencedirect.com/science/articl…
#NoonConference #meded Similarly, in a 2011 article in British Journal of Hematology found that full dose anticoagulation with unfractionated heparin had a RR 3.66 (CI 1.98-6.75) compared to prophylactic dosing onlinelibrary.wiley.com/doi/abs/10.111…
