Hospitalist via @gtown_medres & @PCOMGeorgia - #MedEd ; clinical/diagnostic reasoning, patient communication/education & transitions of care. Tweets/RT my own.
Nashville, TN
Joined May 2012
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The amount of speculation based off lay media reporting regarding Jalen Hurts is wild. Yall probably just need to stop talking at this point because we clearly do not have the whole story and I bet half of what we’ve been told is incorrect.
I am going to start documenting “Medical futility” as a problem and tell families I will honor their wishes and continue torturing their loved one indefinitely at their request.
This country has a real problem with how it approaches death and dying.
I’d love to talk to a physician when placing a consult on a sick inpatient. Asking too much, I guess, in the year of profits, 2026.
If the patient actually has a UTI and you make the correct diagnosis, don’t just reflex to Ceftriaxone.
Have they had recent abx exposures, catheterization/instrumentation, recent urine cultures, immunosuppressants?
If yes, broaden the coverage if they are sick!!
I think one of the most important aspects of training residents as a hospitalist is demonstrating yourself how to expertly and efficiently coordinate care in complex patients. Call, text, email, obtain records, access additional EMRs, fax, chat in person, etc.
Kevin Hageman retweeted
💡 One of the most important findings in delirium research in recent years, and I think it's still not widely enough known.
The DECIDE study (Richardson et al, Age and Ageing 2021) followed 305 older adults from the population-based CFAS II-Newcastle cohort.
They compared cognitive trajectories in three groups: hospitalised with delirium, hospitalised without delirium, and a matched group who weren't admitted to hospital at all.
The hospitalised patients who didn't develop delirium had essentially the same cognitive trajectory as those who were never admitted. No significant difference.
But those who developed delirium during their admission showed a 2.2-point MMSE decline at one year compared to the no-delirium group (P<0.001). Neither the number of admissions nor total length of stay were significant predictors.
For years we've assumed that hospital admission itself is bad for the brain. This study suggests the real culprit is delirium. And delirium is something we can detect and, at least partly, prevent.
That makes it potentially a modifiable risk factor for dementia - at least it means that we need to look into this more and explore the potential benefits of early detection and aggressive treatment aimed at protecting the brain.
#medtwitter #dementia
Nice article for internists to peruse!
Drugs that may cause toxic myopathy, presenting as muscle dysfunction w/ weakness and elevated muscle enzymes and possibly confused w/ idiopathic inflammatory myopathies (IIM) - full read review of mimickers of myositis. buff.ly/TpgCwrX
Kevin Hageman retweeted
ARISE-FLUIDS has arrived and it's awesome 🥳
For over a decade, the Surviving Sepsis Guidelines recommended that septic patients get at least 30 cc/kg fluid. In the United States, these guidelines were weaponized into performance metrics, pressuring clinicians to prescribe arbitrary volumes to every patient.
Evidence-based clinicians have LONG known that this guideline lacked evidentiary support. For example, I've attached a picture of a blog I wrote about this back in 2017. Despite the lack of evidentiary support and some evidence of harm, the Surviving Sepsis Guidelines INSISTED on perpetually recommending 30 cc/kg fluid resuscitation.
We finally have a prospective RCT demonstrating that mandating early administration of 30 cc/kg fluid (as compared to early vasopressors) doesn't help and may actually cause harm.
It's important to note that all of the hard endpoints in this trial were neutral (e.g., mortality, days free of organ support).
I still think that 30 cc/kg fluid is a pretty reasonable volume of fluid for *most* patients. But the study does suggest that giving too much fluid may promote edema - so we should be *thoughtful* about this intervention rather than mandating it for every septic patient.
Based on the subgroup analysis, the fluid-conservative strategy may have helped the subgroup of pneumonia patients the most. This is statistically nonsignificant but aligns with my expectation. ARDSy patients often don't respond well to fluid. (In contrast, I really doubt that a liter of fluids in either direction matters for most urosepsis patients.)
This is a great example of the over-reach of guidelines and protocoled medicine. People get all upset about practice variation, so sometimes they try to stomp it out using guidelines and protocols. But these guidelines are highly fallible, so what may occur is that you standardize care in a way that harms everyone equally. 🤦♂️
omg thank you for letting me know this didn’t come up once in 16 years of med school or residency or practice or cme
RFK Jr. isn’t forcing anyone off psych meds. That’s insane. If anything he’s alerting physicians to the fact that sudden cessation, or even missing a few days, can put people in acute withdrawal. He’s educating doctors that 2-4 week tapers can cause neurological damage, sometimes permanent.
The pushback is so insane it boggles the mind.
This isn’t a political issue.
1/6 people are on meds that are more dependency forming and cause more neuro adaptation than classically addictive drugs. It’s a complete catastrophe.
Anybody who wants to be on one can stay on it but they should know if they miss a few days after 2+ years of treatment it could trigger a neurological nightmare.
They should know they might have to take them for life.
They should know that new psych symptoms might be neurological damage from the medications.
They should know the serotonin imbalance is a myth.
They should know the ketogenic diet is more effective and treats the metabolic underlying issue.
And even more importantly, so should their doctors.
What’s the consensus on initial oral vanc taper v fixed duration for first episode C diff (it’s a real colitis I promise)? @BradSpellberg @ABsteward @DrToddLee
The GI pathogen PCR panel must be the most expensive over-ordered reflexive test there is. No thought behind it and a $1500 charge to your patient. I’d rather someone order 10 useless UAs than this test 🤦🏼♂️😩😤
The amount of people kept on full dose DOAC after a remote thrombotic event blows my mind —- is this just a big knowledge gap?