Great breakdown of a great case!

I worked an unexpected overnight last night

This 🧵 is an exhausted, muddy-headed takedown of the historic but continued saddling of medical trainees with ridiculous work hours

There will be no data and I will appeal to emotion a lot

Here we go!

#MedTwitter

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Why domperidone doesn’t cause neurological side effects 😅

Here's a physiology case that *everyone* who touches a ventilator needs to understand:

A 60 yo woman is intubated for hypoxemia from multifocal pneumonia.
She has a SpO2 of 89% on PEEP +12 and 100% FiO2.
PEEP is increased to +16 & her SpO2 drops to 80%!

What happened?

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Case 35-2023: A 38-Year-Old Woman with Waxing and Waning Pulmonary Nodules | NEJM nejm.org/doi/full/10.10…

SAEM Clinical Images Series: More than Skin Deep

The combination of skin rash and shortness of breath may not be as random as first glance would suggest...

Check out this case from New York Presbyterian Queens, Emergency Medicine.

aliem.com/saem-clinical-…

SAEM

4 generations of #EMIM classes at one incredible conference CHEST spanning attending, fellow, and residents of Ohio State Emergency Medicine Residency Ohio State Internal Medicine Residency The Ohio State University Wexner Medical Center 🩻💉🩺🌺🌊🏄🏻 #Chest2023 #criticalcare

The City of Columbus is excited to announce Bike Plus! We want to know more about your experience biking, scooting and skating – however you choose to roll – in the city. Learn more and take the survey at tinyurl.com/BikePlus614

Monday night shift with super colleague ⁦Sarah Dubbs⁩ ⁦U of Maryland Emergency Med⁩ ⁦UMEM Residency⁩ #foamed #WhiteBoardTeaching

A 22 year old G1P1 woman develops headache and confusion 1 week after an uneventful delivery. En route to the ED she has a generalized seizure.

On exam she is somnolent. BP 200/99 mmHg. MRI below (FLAIR⬆️ DWI⬇️). What’s your next step in this #ContinuumCase ???🧵

1/Correlate clinically!

It’s harder than you think in the THALAMUS—where its size is small & but the clinical symptoms are large.

Here’s a #tweetorial to help you remember the main thalamic syndromes & their locations!

#meded #medtwitter #neurotwitter #stroke #radres #FOAMed

A good diagnostician must ask why. It changes trajectory and lives of patients.

Not everyone has done the hard work of asking, so don’t assume

A brief anecdote from the community…

35F admitted to my service for progressive dyspnea and edema. Not new for her, she had HFrEF

What is ignored or neglected by the media -- but will be studied by historians?

Here's the full list of 25 examples:

Napoleon was a master orator

But we would NOT know this without Balzac

In 1838, Balzac went through all of Napoleon speeches

And saved his best insights in a book

10 bangers from the king👇🏻

1/ 'I found the Crown of France lying in the gutter, and picked it up with my sword.'

👴 w Cirrhosis ➡️🏥 with spontaneous bacterial peritonitis and septic shock

After fluid resuscitation, vasopressors and antibiotics shock resolved

However now with oliguria and ⬆️ Na (165 meq/L). Cr 1.0 mg/dl, BUN 30 mg/dl

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EXAMPLE OF Hb-Hct DISCORDANCE

Take a look at the values in the graphic. Without looking ahead in the thread, can you make a diagnosis?

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A 32 yo woman presents with headache and somnolence.

She is febrile to 102.6F.

Exam reveals neck stiffness and this rash…which, when your attending arrives, is absent #hatethat !

A #continuumcase Continuum: Lifelong Learning in Neurology Lyell Jones MD

Congratulations to Patrick Sylvester on winning the Fass Award for outstanding clinical fellow in the The Ohio State University Wexner Medical Center Department of Internal Medicine!

Name this sign and describe the causes.

Immediate Post PCI, ARTERIAL PULSE..
Any specific thing to think or do ?
د . احمد سمان akbar haq Wail AlkashkariFSCAI,FPICSوائل القشقرى🇸🇦🇨🇦🇺🇲 Abdel Almanfi, MD, FACC, FSCAI Ayman Magd Ankur Phatarpekar C. Michael Gibson MD David J. Cohen, MD, MSc Ankush Gupta MIЯVΛƬ #IC Mamas A. Mamas Hany Ragy Dr Imran Hanif Hashmi Lorenzo Azzalini Shahrukh Bakar Dr Shariq Shamim