Thing I learned today: it can feel daunting to address negative emotions with patients but here's some evidence to inspire more confidence: "When oncologists responded empathically just one time, patients perceived communication more favorably." #tilt ncbi.nlm.nih.gov/pubmed/28993888

Thing I learned today: anemia can be one of the first signs of Crohn seen by PCP (+ growth failure), due to anemia of chronic disease. #tilt #pedigi

Thing I learned today: unlike G-tubes, never rotate GJ-tubes b/c risk of dislodging the J. Tilt2: if a new tube gets dislodged, don't place a red rubber in a fresh tract - it's too firm, go for a foley of the same french size or corpak & call surgery to replace the tube.#tilt

Thing I learned today: patients with constipation should take their medications for 6-12mo before considering weaning off them (though they can wean down doses if stool is too loose). #tilt #pedigi

Thing I learned today: PPI use is the most common cause of SIBO, which is just another reminder that chronic PPI use is not benign! #tilt #pedigi

Thing I learned today: when an adolescent presents with painless rectal bleeding, top of your ddx = hemorrhoids from constipation (remember: rhoids 🚫 seen on DRE in kids). #2 on ddx: proctitis (often painless!). #tilt

Thing I learned today: two situations to always avoid delayed cord clamping are 1) if mother is under GA (anesthetic will cross placenta to baby) and 2) for twin A when twins share a placenta. #tilt

Thing I learned today: always be wary of standing Clonazepam orders because doses can stack and become very deliriogenic! #tilt

Thing I learned tonight: pts with CHF can experience low-grade fevers from their CHF! #tilt #pedicards @DrJamieLim

Thing I learned tonight: sx of guanfacine OD are bradycardia, fluid-responsive hypotension and an opioid toxidrome. With severe OD you can see resp depression but can sometimes avoid intubation with high dose naloxone (think 10mg, much higher than opioid dosing). #Tilt #MedEd

Thing I learned tonight: whenever a trached patient presents with stridor to the ED with resp distress, passing suction through trach should be considered as a part of your airway assessment to determine if trach is patent. #tilt #MedEd

Thing I learned today: you should use absorbable chromic sutures for lip/mucosa because they otherwise dissolve too quickly, but if lac crosses Vermillion border you need fast absorbables so watch your anatomy closely! #tilt #pedied

Thing I learned today #1: always include examining for hair tourniquets on fingers/tongues/male GU when evaluating a fussy baby. Amanda Stewart, MD MPH #tilt #pedied

Thing I learned today #2: you can be fooled by cap refill of the fingers if there's a radial artery injury because of the ulnar collateral. Always check the pulse! #pinkpulselesshand #tilt #pedied Amanda Stewart, MD MPH

Black & Hispanic children make up the majority who develop MIS-C and increased risk appears to extend beyond socioeconomic status. Identifying factors predictive of #MISC susceptibility is necessary to provide equitable care. ja.ma/3qQdpwK JAMA Pediatrics #medtwitter

#Tilt: H&P tips for sudden onset double vision: ask kids if they see two things side by side or on top of each other to determine horizontal vs vertical diplopia; if kid has trouble with finger-to-nose, cover one eye at a time to figure out which eye is the problem.

Things I learned last night 1: when thinking about the diagnosis of mono, you can raise your suspicion for CMV vs EBV based on history/exam bc you are more likely to have diarrhea and less likely to have bad pharyngitis w/ CMV. #tilt #pedied

#tilt2: Clues to look for when trying to make diagnosis of parotitis - does it obscure the angle of the mandible? Gold standard for imaging is US. (Grateful for my very education-minded attending last night!) #pem #tilt