Rising #MedTwitter #MedX interns, here are my favorite approaches for acute inpatient medicine issues! 🚨

1) Hypoxemia, by Clement Lee, MD, MSc 🫁

Ditch the alveolar gas equation (sorry Pulm PEEPs) & use this practical approach.

x.com/ClementLeeMD/s…

The power of clinical reasoning

Today's morning report highlighted a critical concept in clinical reasoning.

The patient returned from Central America and then developed chronic diarrhea.

It would be a MISTAKE to reflexively blame the travel for the cause of diarrhea despite…

A Scientific Statement From the American Heart Association: Orthostatic Hypotension in Adults With Hypertension

ahajrnls.org/3UMqEzt

Should we start statins for primary prevention in older adults?

2x RCTs are ongoing. In the interim, this propensity score matched analysis found that statins users had lower mortality and MACE independent of frailty status.

#MedTwitter JAGS

agsjournals.onlinelibrary.wiley.com/doi/full/10.11…

Hey #MedTwitter #hospitalmedicine look at this amazing diagram from Journal of Allergy and Clinical Immunology showing a timeline of typical onset of various drug hypersensitivity syndromes. Thanks Kimberly Blumenthal, MD, MSc and team! jacionline.org/article/S0091-…

Well , non Infectious
But.... very common!
Today,my patient with K= 5.8
Internal Medicine team recommended ECG
Things We Do for No Reason: Obtaining an electrocardiogram for managing mild hyperkalemia in hospitalized adults #MEded Robert Centor MD MACP 🇮🇱 Brad Spellberg
…mpublications.onlinelibrary.wiley.com/doi/10.1002/jh…

Interesting view on Advance Care Planning:
Limited value in stating preferences for future hypothetical scenarios More useful for (1) illness education (2) eliciting values/goals to guide current decisions (3) Preparation for future end of life decisions
agsjournals.onlinelibrary.wiley.com/doi/10.1111/jg…

The medical education community on X is unparalleled.

Here are some of my favorite posts and threads related to #meded from 2023!

Each and every one of these exceptional educators deserves a follow!

What posts/threads would you add?

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Lobar anatomy from my new CXR signs online course! 🫁

ANTERIOR CHEST: Horizontal fissure (white line), oblique fissures (white dotted line), R upper lobe (red), R middle lobe (green), R lower lobe (purple), L upper lobe (yellow), L lower lobe (blue).

radiopaedia.org/courses/chest-…

Twitter is free education for those in medicine...

but you have to follow the right people.

Here are my 9 recommendations.

Listening to a recent grand rounds by Tim Anderson on the pitfalls of treating inpatient hypertension got me wondering:

What is the single best justification for routine BP monitoring in all hospitalized patients?

#MedTwitter

#TipsForNewDocs

Know the pitfalls of the tests you order.

Ex:
- Neg D-dimer makes PE unlikely, but pos D-dimer doesn't indicate PE
- Normal uric acid doesn't rule out gout.
- A stress test is neg only if the pt achieves adequate HR.

Share your pitfalls!

#kittlesonrules

I recently gave a COPD boot camp lecture and wanted to share some of the high points. 🫁

#tipsfornewdoctors

Should all hospitalised patients with COPD exacerbations have imaging to exclude VTE?

In this study VTE prevalence was 25% in patients admitted with COPD exacerbations. Two thirds were PEs and two thirds were in large vessels.

#MedTwitter #ImproveDx

t.n.nejm.org/r/?id=h65e4e51…

#UncleBob day 10/39 - we had a pt with multiple problems. One was labelled COPD and he was on appropriate meds. Searching his chart we found PFTs. Normal FEV1/FVC but markedly decreased total lung capacity. Try to not accept dx without confirming. This happens often.

What’s the most Important Bone? Source: deviant art

1/2
Jaundice

How to predict direct (hepatobiliary) vs indirect (hemolysis) before labs?

Dark urine > points to direct b/c direct is water soluble but hemoglobinuria from IV hemolysis fair game

Abd pain > points to direct but indirect from hemolysis and gallstone fair game

Pro tip:

When you see these diagnoses in the chart, try your best to verify on what basis they were made:

Heart failure
CKD
COPD
CAD
Dementia

It can sometimes take a little bit of time, but you will be amazed what a little digging might reveal.

Any others I missed???

'When clinicians, from a position of authority, describe patients with respiratory failure as needing intubation, patients and families presume intubation is what should be done.'

Reconsidering the Language of Serious Illness jamanetwork.com/journals/jama/…