Discover and read the best of Twitter Threads about #FoamED
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1/ A long thread on LifeVest. I promise it will be entertaining. If you find any inaccuracies please let me know.
Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself nejm.org/doi/full/10.10…
Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself nejm.org/doi/full/10.10…
2/ In 2001, FDA gave approval to Lifecor for the first WCD. Later Lifecor was acquired by Zoll (2004 agreement, 2006 acquisition). Zoll maintains a registry for prescribed LifeVests. But lets go back to the FDA approval process.
3/ Lifecor presented 2 separate prospective studies to the FDA; WEARIT and BIROAD. FDA asked for both to be combined into 1 study, and each study representing a subgroup. A total of 289 patients were included.
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST
Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri
#POCUS not 🐇🎩, not short #TTE
#Preview for #ASEchoJC 🔜9/4 8pm EST
Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri
#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd
(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills
(2) develop scanning techniques➡️ basic competence
(3) recognize & differentiate b/w normal anatomy & basic pathology
(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills
(2) develop scanning techniques➡️ basic competence
(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching
"priming effect" of preclinical education
Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC
Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
"priming effect" of preclinical education
Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC
Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
Check out this amazing pictorial showing the relative flow rates of various intravenous catheters. The numbers represent how long in minutes it takes for each catheter to deliver one liter of saline under 300 mmHg of pressure!
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So the catheters are positioned above in order from fastest to slowest going left to right.
Here is a chart listing the catheters from fastest to slowest going top to bottom with their respective infusion times to the second.
2/x
Here is a chart listing the catheters from fastest to slowest going top to bottom with their respective infusion times to the second.
2/x
These varying catheter flow rates can all be simply explained by Poiseuille's Law:
The flow(Q) of fluid is related to the viscosity(n) of the fluid, the pressure gradient across the tubing(P), and the length(L) and diameter(r) of the tubing.
3/x
The flow(Q) of fluid is related to the viscosity(n) of the fluid, the pressure gradient across the tubing(P), and the length(L) and diameter(r) of the tubing.
3/x
Hey #medtwitter, it’s time for another #histmed #FOAMed Tweetorial! I’m giving a couple of lectures this fall, and in the spirit of #FOAM I’m going to (try my best) to do a Tweetorial for each, so anyone can benefit/watch me flounder/vehemently disagree with me.
So thank you to @BostonChiefs, and let's talk about semiotics and the development of the physical exam!
First, an opinion poll. Do you think that the physical exam as it is practiced today is useful for care of our patients? When I poll people, I’ve noticed dramatic response differential between training levels.
#FITSurvivalGuide #ACCFIT
Topic - Ventricular Tachycardia!
Agenda:
1- Approach to evaluating #VT
2- Management of #VT
3- Practice Cases
Please share your thoughts & input to this #tweetorial!
@ACCCardioEd @ACCinTouch #FOAMed @MichiganACC
Topic - Ventricular Tachycardia!
Agenda:
1- Approach to evaluating #VT
2- Management of #VT
3- Practice Cases
Please share your thoughts & input to this #tweetorial!
@ACCCardioEd @ACCinTouch #FOAMed @MichiganACC
#FITSurvivalGuide #ACCFIT
1/10 – Ventricular Tachycardia
Simplified approach to evaluate tachycardia:
Rule #1 – If HD unstable ➡️ shock!
If HD stable, sit down & think.
Step # 1 - QRS: wide or narrow?
Step # 2 - Rhythm: regular or irregular?
This will narrow DDx!
1/10 – Ventricular Tachycardia
Simplified approach to evaluate tachycardia:
Rule #1 – If HD unstable ➡️ shock!
If HD stable, sit down & think.
Step # 1 - QRS: wide or narrow?
Step # 2 - Rhythm: regular or irregular?
This will narrow DDx!
#FITSurvivalGuide #ACCFIT
2/10 - Wide complex tachycardia
Always consider clinical Scenario!
Look for history of MI and cardiomyopathy ➡️ strongly favor #VT!
* If structural heart disease is present, you will be correct 9/10 times with diagnosis of VT!
2/10 - Wide complex tachycardia
Always consider clinical Scenario!
Look for history of MI and cardiomyopathy ➡️ strongly favor #VT!
* If structural heart disease is present, you will be correct 9/10 times with diagnosis of VT!
**Arterial Blood Gas Interpretation for Paramedics**
You asked for it so here it is!
Started off last week with a request from my #Paramedic mates wanting to know more..
#CPD
#EmergencyMedicine
#TeamNHS
You asked for it so here it is!
Started off last week with a request from my #Paramedic mates wanting to know more..
#CPD
#EmergencyMedicine
#TeamNHS
2.
3.
1. The rota is tough. I know you’re knackered, you’ve probably not seen your friends and family for ages and the rota is playing havoc with your sleep. Please, tell me if you’re struggling. I would rather know, and support you, rather than you burning out. It’s ok not to be ok
2. Don’t lose your humanity
We’re a battle hardened lot, we’re quirky and sometimes cynical. I’m sorry for that. Empathy is something to be treasured, hold onto it. Being kind is never a weakness.
#10ThingsToKnow
We’re a battle hardened lot, we’re quirky and sometimes cynical. I’m sorry for that. Empathy is something to be treasured, hold onto it. Being kind is never a weakness.
#10ThingsToKnow
3. Take a break
Thank you, for trying to help me when you’ve been working 8 hours without a break, and you don’t feel able to leave me and the shop floor with a 5 hour wait. You’re amazing. But please, take a break. You’ll be safer, and more productive for it.
#10ThingsToKnow
Thank you, for trying to help me when you’ve been working 8 hours without a break, and you don’t feel able to leave me and the shop floor with a 5 hour wait. You’re amazing. But please, take a break. You’ll be safer, and more productive for it.
#10ThingsToKnow
Been thinking a bit about what I’ve learnt in the two years since I qualified as a doctor & what (hopefully, helpful and honest) advice I’d give to brand new medics on the cusp of a career in the NHS - a thread #TipsForNewDocs
1. Being a doctor is the best job in the world. Some days it will feel like the worst, but 95% of the time it’s the best and most rewarding career. I adore the NHS. Be proud of yourself, you’ve worked damn hard to get here.
2. Remembering to say “thank you” on a busy ward at 2pm can earn you a cup of tea at 4am. A sincere “thank you” with eye contact might even get you a cup of tea *and* some magical NHS biscuits on your night shift (the holy grail is NHS toast). Nurses are all-seeing superheroes.
1/
Let’s continue with Day 7 of the cardiology #FITSurvivalGuide #tweetorial! Today we will talk about basics of stress testing for diagnosing CAD.
#ACCFIT #CardioMedEd #FOAMed @ACCinTouch @ACCCardioEd
Let’s continue with Day 7 of the cardiology #FITSurvivalGuide #tweetorial! Today we will talk about basics of stress testing for diagnosing CAD.
#ACCFIT #CardioMedEd #FOAMed @ACCinTouch @ACCCardioEd
2/
Let’s start with a case: 55 y/o woman with CV risk factors presents to clinic with mild CP for 3 months. What is the next test if you want to diagnose significant CAD?
Let’s start with a case: 55 y/o woman with CV risk factors presents to clinic with mild CP for 3 months. What is the next test if you want to diagnose significant CAD?
3/
Not enough info. History/physical critical. Starting meds ok but get a diagnosis if case not clear cut. Exercise testing is better but not appropriate for every patient. Cath first if you believe unstable/high-risk disease or if symptomatic + high-pretest probability.
Not enough info. History/physical critical. Starting meds ok but get a diagnosis if case not clear cut. Exercise testing is better but not appropriate for every patient. Cath first if you believe unstable/high-risk disease or if symptomatic + high-pretest probability.
How to make your
correlations correlate.
Even if they don't.
==============
A practical tweetorial for aspiring research fraudsters, cardiology fellows doing research, and others in need of a strong association when there isn't one.
#meded #foamed
Please retweet to fellows.
correlations correlate.
Even if they don't.
==============
A practical tweetorial for aspiring research fraudsters, cardiology fellows doing research, and others in need of a strong association when there isn't one.
#meded #foamed
Please retweet to fellows.
Thank you to @rallamee for loaning me the use of her garden and boating lake to do a few demonstrations in this weekend's tweetorial.
Thank you also to a colleague, for sending me this just now. It is enlightening and I am genuinely sorry.
Risk Ratio, Odds Ratio, Hazard Ratio
========================
2nd and final part of the tweetorial, from ORBITA-HQ!
Fun, easy and informative [*]
#MedEd #FOAMed #cardiology #cardiotwitter
[*] Results may vary and are not guaranteed. See small print.
========================
2nd and final part of the tweetorial, from ORBITA-HQ!
Fun, easy and informative [*]
#MedEd #FOAMed #cardiology #cardiotwitter
[*] Results may vary and are not guaranteed. See small print.
Not all fears are alike.
* Some fears are one-and-done:
I get a cold which progresses to pneumonia. Will I die, or recover?
* Other things hang over us for much longer, perhaps all your life.
Will you get hit by a bus?
Get a heart attack?
There's no "sell by" date on the fear.
* Some fears are one-and-done:
I get a cold which progresses to pneumonia. Will I die, or recover?
* Other things hang over us for much longer, perhaps all your life.
Will you get hit by a bus?
Get a heart attack?
There's no "sell by" date on the fear.
Practice Qs
You are walking through Hyde park, minding your own business.
Hardly causing any trouble at all.
Perhaps the odd humorous tweet.
You get a Direct Message:
"Enough of ur abuse!
You will be hearing form my agent shortly.
kthxbai
AJ Kirtane"
You see the agent:
You are walking through Hyde park, minding your own business.
Hardly causing any trouble at all.
Perhaps the odd humorous tweet.
You get a Direct Message:
"Enough of ur abuse!
You will be hearing form my agent shortly.
kthxbai
AJ Kirtane"
You see the agent:
RELATIVE RISK, ODDS RATIO, HAZARD RATIO
=============================
What are they?
Why do we need 3 of the damn things?
Which should I use?
Are they the same, or different, or a bit samey?
An #ORBITA-HQ #tweetorial.
#Meded #FOAMed
=============================
What are they?
Why do we need 3 of the damn things?
Which should I use?
Are they the same, or different, or a bit samey?
An #ORBITA-HQ #tweetorial.
#Meded #FOAMed
All 3 of these are about comparing the scale of dangerousness of one thing AGAINST ANOTHER.
Suppose you are walking through an unfamiliar forest and the road comes to a fork: you have to choose one path.
As you stand, uncertain, a troll pops out of the ground.
Suppose you are walking through an unfamiliar forest and the road comes to a fork: you have to choose one path.
As you stand, uncertain, a troll pops out of the ground.
You ask for advice on which path is safer.
As always, the advice he offers is scrupulously correct, but not necessarily instantly interpretable to the layperson.
As always, the advice he offers is scrupulously correct, but not necessarily instantly interpretable to the layperson.
What does a P value mean?
==================
A microtweetorial because I have been watching @anupampom and @JohnTuckerPhD chase each other like this for the last hour, which is distracting me from doing work.
Answer this and save them from circular argument.
#foamed #meded
==================
A microtweetorial because I have been watching @anupampom and @JohnTuckerPhD chase each other like this for the last hour, which is distracting me from doing work.
Answer this and save them from circular argument.
#foamed #meded
Francisomycin, my new natural anti-atherosclerotic antibiotic, has now been published in NEJM to reduce atherosclerosis by 173 arbitrary units (p=0.03).
I am really, really pleased with the result and the fact that I have the patent on this magical stuff.
I am really, really pleased with the result and the fact that I have the patent on this magical stuff.
What does p=0.03 mean?
A. 3% of pts had reduced atherosclerosis?
B. 97% of pts had reduced atherosclerosis?
C. If a drug is ineffective, 3% chance that it produces an effect this extreme.
D. 3% probability that THIS drug is ineffective, i.e. that these results occurred by chance
A. 3% of pts had reduced atherosclerosis?
B. 97% of pts had reduced atherosclerosis?
C. If a drug is ineffective, 3% chance that it produces an effect this extreme.
D. 3% probability that THIS drug is ineffective, i.e. that these results occurred by chance
Intention To Tweet
============
1. Why is intention-to-treat the ONLY right way to interpret trial results?
2. Why are these fine gentlemen wasting their prayers?
Tweetorial for cardiology fellows from ORBITA-HQ
#cardiology #meded #foamed
============
1. Why is intention-to-treat the ONLY right way to interpret trial results?
2. Why are these fine gentlemen wasting their prayers?
Tweetorial for cardiology fellows from ORBITA-HQ
#cardiology #meded #foamed
Thank you to Ali Jazayeri for suggesting this subject on the highly secret DM contact address (@ProfDFrancis).
At first I hesitated over whether this was truly needed amongst such an elite body of scienntific minds as we have reading this thread.
But Pascal Meier insisted that it was.
He said he was watching a whole session dedicated to not understanding this at a conference. Sent a pic!
But Pascal Meier insisted that it was.
He said he was watching a whole session dedicated to not understanding this at a conference. Sent a pic!
Like a blog you’ve thrown together at the last minute to maintain you’re public profile, it’s #NHSthisweek :
Protests against the GMC continue, including one suggestion to rip up GMC registration certificates outside their London offices. On a Saturday.
Which leads to the philosophical question, if a man rips up a certificate and no ones there to see it (cos it’s a Saturday) does it make or sound, or even an impact?
It’s Saturday, it’s poorly written, it’s #NHSthisweek:
The health secretary hailed Microsoft Excel with the cells shaded in a threatening red colour as “great technology”
Meanwhile, here at BAM! we too devised a new way of using technology to see the state of the health service in your region
It’s Saturday it’s #NHSthisweek on twitter:
64 emergency medicine doctors write to the PM over the #nhscrisis, meaning 64 bed managers will be angrily demanding to know why the PM hasn’t accepted the referral in 4 hours time...
Meanwhile 64 med regs have been told that they need to chase the result of the letter
MYOCARDIAL VIABILITY
================
Lazarus revisited
[Tweetorial from ORBITA-hq: "Making cardiologists think again"(TM)]
Please retweet to cardiology fellows or anyone who might be interested to practice data interpretation.
================
Lazarus revisited
[Tweetorial from ORBITA-hq: "Making cardiologists think again"(TM)]
Please retweet to cardiology fellows or anyone who might be interested to practice data interpretation.
Let's start our story here, when I was first informed that viability testing saves lives.
A few weeks later, a decisive meta-analysis.
3000 patients
3000 patients
