Discover and read the best of Twitter Threads about #midwesthospmed
Most recents (3)
(Thread) Another week and another @MedTwitThisWeek #medthread. As a reminder, this is not all inclusive. It's a jumping off point. A continuation of the discussions from the week that I found interesting including conferences, #Tweetiorials and tributes. #medttw #FOAMed
2/ Conference Bonanza! Since last week, several amazing conferences took place (or just started). Each conference has their own hashtags and flavors of #SoMe. Here are some highlights...
3/ @jenreadlynn was at #midwesthospmed and did a great job of distilling @MelBreggs' talk on inpatient management of alcohol withdrawal.
Tried to channel my inner @tony_breu when presenting 3 hospitalist controversies yesterday:
- Normal saline vs Lactated Ringer's
- Risk of contrast-associated nephropathy?
- Routine K+ supplementation
GIANT THREAD (& poem).... #medtwitter @midwesthospmed #midwesthospmed 1/
- Normal saline vs Lactated Ringer's
- Risk of contrast-associated nephropathy?
- Routine K+ supplementation
GIANT THREAD (& poem).... #medtwitter @midwesthospmed #midwesthospmed 1/
NS vs Balanced IVF (e.g. usu LR as cheaper):
FYI LR has lactate, not lactic acid. quickly metabolized by liver to HCO3. caveat - cirrhosis pts can't metabolize as effectively so measured serum lactate can ⬆️(not harmful, not lactic acid). Can use D5W+3ampNaHCO3 if want buffer./2
FYI LR has lactate, not lactic acid. quickly metabolized by liver to HCO3. caveat - cirrhosis pts can't metabolize as effectively so measured serum lactate can ⬆️(not harmful, not lactic acid). Can use D5W+3ampNaHCO3 if want buffer./2
NS vs LR: the SALT-ED and SMART ICU trials:
- ⬇️rate of major adverse kidney events (persistent renal dysfxn, new dialysis, death) with LR/plasmalyte. NNT around 100 for both floor and ICU pts
- Trend towards ⬇️ inpatient mortality in ICU with LR
- avoid LR in TBI 3/
- ⬇️rate of major adverse kidney events (persistent renal dysfxn, new dialysis, death) with LR/plasmalyte. NNT around 100 for both floor and ICU pts
- Trend towards ⬇️ inpatient mortality in ICU with LR
- avoid LR in TBI 3/
@MelBreggs reminds us not to document stigmatizing language in our notes:
✅risky/unhealthy use vs alcohol use disorder
❌alcohol abuse or dependence
#midwesthospmed
✅risky/unhealthy use vs alcohol use disorder
❌alcohol abuse or dependence
#midwesthospmed
-Uncomplicated withdrawal does not require treatment
-Complicated (seizures, hallucinosis, DTs) does require treatment and can be screened for using PAWSS
-PAWSS = 10 question survey, positive if 4 or higher
-specificity 99.5%, sensitivity 93%
-Complicated (seizures, hallucinosis, DTs) does require treatment and can be screened for using PAWSS
-PAWSS = 10 question survey, positive if 4 or higher
-specificity 99.5%, sensitivity 93%
-Symptom-triggered treatment > fixed schedule
-Monitoring is not perfect but AWSS better than CIWA
-Look for other complications of alcohol use disorder
-Don’t forget to check Mg (low levels make withdrawal worse) and give thiamine!
-Monitoring is not perfect but AWSS better than CIWA
-Look for other complications of alcohol use disorder
-Don’t forget to check Mg (low levels make withdrawal worse) and give thiamine!
