Vamsi Aribindi @aribindi Twitter profile

Pinned Tweet

Vamsi Aribindi

@aribindi

5 years

Pinned Tweet: Links to my tweetorials!

Vamsi Aribindi

@aribindi

5 years

Hello #MedTwitter ! Inspired by @tony_breu , this is a tweetorial on feeding tube indications, a technique for placement, and how to read the post film. Credit goes to Dr. @AvoArtinyanMD who taught me this technique @BCM_Surgery ! @RASACS #FOAMed #Tweetorial @BehindTheKnife

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Vamsi Aribindi

@aribindi

4 years

Perhaps unpopular opinion- it's time to bring back visitors in hospitals for all non-COVID+ patients. Have them wear masks and eye protection, and be screened like everyone else. But pts simply do so much worse without their loved ones to support them through their worst times.

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Vamsi Aribindi

@aribindi

5 years

Latest tweetorial: ICU vent management for dummies. #FOAMed #medtwitter @RASACS In light of all the corona-craziness, lets talk about the basics of how to manage a vent for ARDS patients.

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Vamsi Aribindi

@aribindi

4 years

Applying for my Texas Medical License now, and seriously, why can't we just have one national medical license application again? This is absurd...

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Vamsi Aribindi

@aribindi

2 years

@debarghya_das The IIT entrance exam and Indian/Asian test taking system as a whole is very good at selecting for determination, hard work, and some kinds of intelligence. But it is actually terrible at selecting for "genius", because it actively selects against curiosity, wonder, and passion.

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Vamsi Aribindi

@aribindi

3 months

@urcervix_ Knowing anatomy and being able to apply it when you're under stress on clerkships, being questioned and evaluated, are two very different things. I never judged my med students for not knowing something- I only asked that they work hard and hide their desire to be anywhere else.

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Vamsi Aribindi

@aribindi

9 months

@ArmandDoma Harvard Extension isn't a scam- I went to MIT, added on pre-med my junior year, so I took some biology requirements through Harvard Extension over the summer. The classes were thorough and good. Maybe people are taking it for the prestige, but the product isn't inherently bad.

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Vamsi Aribindi

@aribindi

4 years

I know a LOT of MS4s out there need honest match advice, especially in this era. So time for some of the MOST honest advice I can give for General Surgery Applicants. (Full disclosure, I'm a proud @BCM_Surgery resident, and will shamelessly plug my program.) #MedTwitter

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Vamsi Aribindi

@aribindi

9 months

Something that many med students don't really consider when applying to specialties is whether their future job will require them to shape their life around the job, or whether it will let them shape a job into their life. #MedTwitter

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Vamsi Aribindi

@aribindi

2 years

Congratulations to all the newly matched medical students going into general surgery! You truly are joining the best field in medicine. (Integrated CT is cool too😎) Here's my advice on how to set yourselves up for success in residency.

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Vamsi Aribindi

@aribindi

2 years

Happy to say that I matched at @UCSDsurgery for my Cardiothoracic Fellowship in 2023! (Because General Surgery wasn't painful or long enough for me) Grateful for all my mentors and training @BCM_Surgery and @Texas_Heart , and looking forward to a few years back on the West Coast-

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Vamsi Aribindi

@aribindi

9 months

My mom used to tell me how every Dec 25th the hallways in American hospitals were filled with Hindu and Muslim doctors earnestly wishing Merry Christmas to bemused Jewish ones. Much of what is great about this country is found in that IMO-

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Vamsi Aribindi

@aribindi

2 years

@debarghya_das Would Steve Jobs ever have arisen out of IIT? Would a passion for calligraphy been encouraged? There is a lot the US gets wrong, but our education system's focus on creativity, understanding, and critical thinking over rote memorization is a strength

Why Steve Jobs's Passion for Calligraphy Is an Important Example for You

By intentionally exercising your creative muscle, new opportunities naturally follow.

www.entrepreneur.com

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Vamsi Aribindi

@aribindi

2 years

At least one ortho program requires a handwritten personal statement, mailed, which I just find hilarious. Do they judge applicants' personality based on handwriting? @jbcarmody

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Vamsi Aribindi

@aribindi

2 years

🌶️take: surgeons often are criticized for being arrogant, stubborn, aggressive, "malignant", etc. But I'm going to talk about why the same traits that give rise to those stereotypes can be valuable, why the field is changing, and why all trainees should consider it #MedTwitter

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Vamsi Aribindi

@aribindi

4 years

@londyloo This is typically grounds for expulsion in most medical schools, or at least being banned from that hospital ever again. It will hopefully be reflected in tje MSPE, and that student will have a hard time matching...

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd Wrong condition. This is pregnancy induced cardiomyopathy. I am speaking of pre-existing cardiomyopathy from congenital cardiac disease worsened by pregnancy. Your google searching is not a medical degree. Please stop confusing the two.

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Vamsi Aribindi

@aribindi

7 months

Seeing all the match posts has me reflecting on mine. It was not a surprise but for a very different reason than the SOAP: I became hoarse and was diagnosed with lymphoma in January. I would be on chemo through June. I informed all of my programs, including my #1 choice @BCMGSRes

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Vamsi Aribindi

@aribindi

4 years

#MedTwitter #surgtwitter My intern convinced me to do anti-gravity rounds this morning, "to get a workout in". Foolishly, I agreed.

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Vamsi Aribindi

@aribindi

3 years

@gorskon @NateSilver538 A vaccinated teen? Her risk of significant covid is the same as her risk from measles or myocarditis. These kids won't get these years and this time back. IMO @NateSilver538 called this one right- its not rational to say no to activities like these unless you have med conditions.

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Vamsi Aribindi

@aribindi

10 months

#tweetorial #medtwitter For all medical students, interns, and junior residents: how to round on general surgery patients. There are two "tracks" to consider: the disease/surgery, and general surgical principles. Let's talk about general rounding on surgery first

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd You are engaged in magical thinking. You are effectively hoping that after the headman's ax starts to fall, that the patient's neck will develop kevlar skin.

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Vamsi Aribindi

@aribindi

4 years

And what's more, the most vulnerable patients- patients with limited english proficiency, with mild cognitive dysfunction, or comorbid psychiatric disease- NEED family or friends there to advocate for them to reveive appropriate care, and to help make hard decisions.

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Vamsi Aribindi

@aribindi

3 years

In retrospect, getting motivated and doing my first leg day in a month the day before a whipple was an error in judgement.

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Vamsi Aribindi

@aribindi

2 years

The only thing wrong with this photo is that it doesn't include Stanford's Preliminary Residents. They're part of your family and legacy too, and deserve your public support and pride as they try to match again. Otherwise, congrats on a great group of residents!

Stanford Surgery

@StanfordSurgery

2 years

ICYMI: Meet the newest additions to the Stanford Surgery Family! #match2023

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Vamsi Aribindi

@aribindi

3 months

Time for a post-call spicy take. General Ob/Gyns- are not surgeons. They are the ONLY modern surgeon-primary care physician hybrids, a fact which contributes significantly to poor quality control in the field, which then leads to negative perceptions.

Lindsay, DO

@l_deliberto

3 months

!!!! THIS the next time someone tries to say this, i am simply going to refer them to the american college of surgeons. OB/GYNs are surgeons - it is not an opinion, it is a fact.

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Vamsi Aribindi

@aribindi

3 months

Letters of Recommendation in Medicine are a ludicrous system for determining residency and fellowship. This thread is decent advice, but it just illustrates the arbitrariness of thr entire process.

Less-Is-More Cardiologist

@DavidLBrownMD

3 months

A note on asking for letters of recommendation for fellowship (or anything else for that matter). 1. Always ask if a potential letter writer if they can write you a strong letter, not just a letter. Damning with faint praise is going to hurt you.

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Vamsi Aribindi

@aribindi

8 months

If you're a trauma patient rolling in at 5AM, you want a fresh team that hasn't been up 24 hours. If you're a trauma patient who came in at 5AM, got an ex-lap, and is now crashing at 3AM, you want the tired team that knows you and your course like the back of their hand.

priscilla💫

@sasstronomical

8 months

I lied, one more thing. As someone has been a trauma patient, who had a surgical complication, the LAST THING I would have wanted is a surgeon on q2 24hr call— exhausted, more likely to make mistakes. The “do it for your patient” is a tired argument. WE DON’T WANT THAT.

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Vamsi Aribindi

@aribindi

4 years

@darakass @WSJ If Dr. Dre and Dr. Phil can run around, the least we can do is call her Dr. Biden.

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Vamsi Aribindi

@aribindi

2 years

@MaggieTugend Med school grading is a joke. I honored only Psych and Neuro, and am about to finish Gen Surg and start CT Surgery fellowship. Everyone knows they are a farce, which is why programs barely even care- step 1 (now 2) was the only objective thing they had, so it's what they used.

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Vamsi Aribindi

@aribindi

10 months

24 hour call makes no sense for most internal medicine residencies. It does make sense for some surgical ones as the least bad option, due to the reality of lower staffing which is dictated by elective and emergency case volume limiting the maximum size of surgical residencies.

Mark D. Siegel

@MarkDSiegel1

10 months

Good-Bye Overnight Call, A #ProgramDirectorsNote to my @TradIMYale residents. @YaleIMed Twenty-eight hour call is ending in our residency, beginning next June.

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Vamsi Aribindi

@aribindi

5 years

Now, when someone is first intubated, you can put them on peep of 5, FiO2 of 100, rate of 14, and tidal volume of 4-6 cc/kg of ideal body weight, a number that comes from the famous ARDSNET study . Key point- it's ideal body weight, not actual body weight.

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Vamsi Aribindi

@aribindi

4 years

We don't think very much of our patients' psychological health. But having had to deliver news of metastatic cancer to a patient alone in a hospital, I don't want to do that to anyone else.

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Vamsi Aribindi

@aribindi

1 year

@RyanMarino I'm sure NYC is full of drug dealers desperate to give away large amounts of their product for free in an attempt to kill random people and bring the entire NYPD down on their heads.

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Vamsi Aribindi

@aribindi

5 years

Hello #MedTwitter ! Inspired by @tony_breu , this is a tweetorial on feeding tube indications, a technique for placement, and how to read the post film. Credit goes to Dr. @AvoArtinyanMD who taught me this technique @BCM_Surgery ! @RASACS #FOAMed #Tweetorial @BehindTheKnife

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Vamsi Aribindi

@aribindi

4 years

My sister (PGY3 IM+Chief R to Be), Cousin (PGY1 IM Prelim->Rads) and me (PGY4 Gen Surg, Research) tried to help our cousin (MS3) with her UWorld Step 1 Qs. We all 100% got this question wrong- and we were 100% sure of the answer lol... @jbcarmody @reverendofdoubt @tnicholsmd

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Vamsi Aribindi

@aribindi

4 years

Highlights include asking if a patient was short of breath while trying to hide the fact that I myself was short of breath, almost twisting my ankle on the way down, and considering this as full justification to order a ton of sichuan food on day call today.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd @tnicholsmd is being entirely honest here. You're the one who has no idea what you are talking about. Abortion can be and often is a life-saving procedure for the mother. In all cases, forcing a woman to carry a pregnancy she doesn't want to is wrong.

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Vamsi Aribindi

@aribindi

3 months

@PROUDKYAMERICAN @RyanMarino ... if someone is able to leave and go to a different ER, they probably don't need to be in an ER.

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Vamsi Aribindi

@aribindi

2 years

I try to teach because it makes me a better doctor, and because I want to honor my grandparents- retired teachers who moved from India and helped bring me up. I was their last student, and they were my first teachers- the best I could have asked for.

BCM General Surgery Residency

@BCMGSRes

2 years

Couldn’t be clapping any harder for our incredible residents, @CenturaAnbarasu , @aribindi , @CT_RyanMD , and Nader Zamani! Way to go y’all 👏👏👏

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Vamsi Aribindi

@aribindi

5 years

@theblondeMD I would tend to agree, except that this creates a massive incentive on the part of programs to secretly discriminate against anyone they think might commit suicide/fire people at high risk of commiting suicide so they don't do it while part of the program.

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Vamsi Aribindi

@aribindi

17 days

Time for a spicy take. There are bad EHRs. But most of the lost time from decent EMRs like Epic, Cerner, and AthenaHealth is mostly due to: 1) Increased safety measures 2) Attempts to increase billing 3) The reality that medicine is simply harder than it was in the pre-EHR era

Real Doc Speaks

@realdocspeaks

17 days

Judy Faulkner is the billionaire founder of Epic Systems, and a recent study by Dr. Christine Sinsky reveals the following time spent on Epic per 8 hours seeing patients: • Infectious Disease 8.4 Hours • Endocrinology 7.7 Hours • Nephrology 7.5 Hours • Primary Care 7.3 Hours

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd Imminent? Every day that passes the mother's heart failure grows worse and worse. At a certain point, it becomes irrecoverable, and even if we abort the patient will die anyway. Is that day tomorrow? You can't know that it isn't.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd The collective experience of the entire pediatric cardiology department of a hospital that shall remain unnamed.

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Vamsi Aribindi

@aribindi

4 years

@domsisti @eemoin @Sarah_Mojarad Why? Its not in the hospital, not demeaning to patients at all. It may not mean much to the general public, but to physicians it's hilarious.

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Vamsi Aribindi

@aribindi

7 months

@DrJenGunter Crohn's typically doesn't get a temporary ileostomy- they get stricturoplasties, or small bowel resections. It's ulcerative colitis that gets the 3 stage total abd colectomy w/colostomy-> ileal pouch anal anastamosis w/diverting loop -> ileostomy take down.

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Vamsi Aribindi

@aribindi

3 months

@jjfitzgeraldMD That's... not at all what I said. I deeply respect my ob/gyn colleagues, almost went into the field, and went out of my way to teach Ob/gyn interested MS3s suturing and camera skills. My thread is about how referrals from PCPs are an important tool to improve quality.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd Do you understand that everytime we put someone with heart failure under anesthesia, we risk their life? Anesthesia depresses cardiac function- and when the heart is already damaged, that can have lethal consequences. Offering her surgery would be malpractice.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd What are you talking about? If we wait until imminent, life-threatening cardiac arrest the mom is dead no matter what we do. Have you ever seen dilated cardiomyopathy? The way to stop that patient from dying is to stop the woman's body from signaling to inc cardiac output

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd C-section of what? Patients have increased cardiac output requirements of 30-40% in the first trimester alone. You can't do a c-section on a 1st trimester pregnancy, and even if you could you'd be subjecting the patient to a massive surgery for no benefit to anyone.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd Says who? You with your extensive training in pediatric cardiology? We saw her ventricles starting to dilate dangerously at 6 weeks, and we knew what would happen if we didn't intervene urgently and abort. Those medicinal treatments work if the heart failure is 3rd trimester.

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Vamsi Aribindi

@aribindi

1 year

@DrCasteelEM Kids pay attention to who you are, not what you say. If parents work relatively fulfilling jobs, are somewhat happy, make a good living, and have a fair bit of prestige in the community, it tends to draw a crowd-

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd Yes, it is to reduce risk from 100% mortality to something less than that, depending on how severe the heart failure is. As for imminent, most people consider dying within a few months to be imminent.

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Vamsi Aribindi

@aribindi

1 year

@AlanaKinrich Lolz. I know an anesthesiologist who induces and intubates sitting down. She uses to do her central lines sitting down to, until someone reported her for not being sterile enough lol.

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Vamsi Aribindi

@aribindi

2 years

@ryan_barnicle I want the model of the CT machine that was used.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd That is 100% of cases that we knew of- perfectly honest. The liklihood of worsening heart failure and death also aligned with our knowledge of physiology and pathology. She would have died unless we aborted.

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Vamsi Aribindi

@aribindi

7 months

I will be eternally grateful for my program's response, before I was even their resident, standing by me despite a ~5-10% chance of relapse. Best wishes to all who match today, and I hope their program supports them when it counts the most, as mine did. #Match2024

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Vamsi Aribindi

@aribindi

5 years

@arghavan_salles I mean, the dates themselves are odd. I grew up without a smartphone till about halfway through college. I'm a PGY 3 now- no time off. Nobody who is in surgical residency really had a lot of smartphone time growing up.

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Vamsi Aribindi

@aribindi

5 years

Lets break this down then again into oxygenation and ventilation. For ARDS, when it oxygenation, the key is higher PEEP, lower FiO2, using this handy dandy table from the ARDSNET. Higher PEEP = Ptx risk. Watch out for sudden rises in peak/plateau pressures on the vent!

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Vamsi Aribindi

@aribindi

2 years

@akscsfba People not wanting to cook meat with dishes is not a caste based thing. Jewish people have similar practices with Kosher. It's a choice. Speaking an enthusiastic meat eater, this is a religious/cultural choice that should be respected, not a caste based thing in any way.

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Vamsi Aribindi

@aribindi

4 years

@KurteL10 @j_thePA That's okay. It takes someone with vision.

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Vamsi Aribindi

@aribindi

4 years

Congratulations to all who matched today! This thread is the most honest advice I can give to help guide some of those who did not receive such happy news- particularly those who applied surgery or a surg subspecialty, and are considering a prelim year. #MedTwitter #surgtwitter .

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Vamsi Aribindi

@aribindi

5 years

@peter_masiakos I understand what you are going for, but its worth noting that current guidance to doctors is to continue working despite positive contacts if they are asymptomatic. As in I am expected to work if I wear only a surgical mask (or nothing) and have contact with a patient who tests+

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd Over a million kids with the condition. You don't hear about them because doctors are pretty damn good about making sure the patients at the highest risk never get pregnant. And that is NOT the recommended treatment for this condition.

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Vamsi Aribindi

@aribindi

4 years

@missiwimberly If your husband is a nursing home director, have you considered that you may get it asymptomatically, pass it to your husband, who then passes it to his patients who are far more vulnerable?

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Vamsi Aribindi

@aribindi

3 years

@tnicholsmd @DGlaucomflecken Its a false choice though. Also, Canadian salaries can exceed US ones for hours worked, as can Swiss and even UK salaries at the consultant level. Costs are not high because of doctors' salaries, they are high due to admin overhead in a for-profit system.

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Vamsi Aribindi

@aribindi

9 months

@ArmandDoma Sure, but that's just marketing. To be a scam means they are selling something that's it not. Fundamentally, they are real classes with educational rigor and value.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd 100% of young women with pre-existing heart failure whose heart function we see getting worse early in pregnancy have died in the past if we didn't abort.

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Vamsi Aribindi

@aribindi

1 year

@allisonoconn No more horrifying than rectal and pelvic exams, poring over pictures of horrific conditions, watching parents fall apart after being told their child is dead, sticking your hands inside someone for hours retracting in surgery, and so much more? It's part of becoming a doctor?

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd ... this is a pointless sideshow. let's assume like any sane patient she refuses the surgery.

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Vamsi Aribindi

@aribindi

3 years

@AmyGDalaMD Heh, every year my anesthesiologist mom would take my sister and my halloween loot, and take it to the hospital for "all the sick patients and hard working nurses". I learned years later that she just kept it in her car and would eat it over the next month. The betrayal...

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Vamsi Aribindi

@aribindi

11 months

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Vamsi Aribindi

@aribindi

3 months

@SlickTweetsSC That's... just not true. Your chance of matching into specialties is based on your test scores, and higher paying specialties are more desirable to many. But brilliant people go into peds all day long. Peds cardiologists are some of the smartest docs there are- I work with them

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Vamsi Aribindi

@aribindi

4 years

The fact that I already have a full California medical license (for moonlighting and patient research work during my research fellowship) that is completely unblemished actually makes applying for a Texas one MORE complicated and expensive. WTF.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd A mother with compensated heart failure, after congenital cardiac repair. The increased cardiac output required to support a pregnancy would lead to decompensation of that heart failure and death.

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Vamsi Aribindi

@aribindi

3 years

@jfitzgeraldMD This sentiment was proven to be true in general surgery- research analyzing referral patterns showed that female surgeons who have complications get much fewer subsequent referrals from PCPs than male surgeons that have similar complications.

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Vamsi Aribindi

@aribindi

1 year

A story of coming full circle as I finish residency. When I was an MS3 on Ob/Gyn, I did a post-op check in clinic. Patient was doing great, but I didn't check the pathology. The Ob/Gyn Chief Res I presented to told me "you could have killed this woman by not checking the path"

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Vamsi Aribindi

@aribindi

7 months

Random thoughts for surgery interns/junior residents: #MedTwitter I remember feeling intensely frustrated when different attendings would give me diametrically opposite instructions for how to operate. This is common, painful, but will make you a better surgeon.

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Vamsi Aribindi

@aribindi

3 years

Step 1 studying saved my patient's life. @jbcarmody take note. My intern was trying to order vitamin K on a completely stable patient. They found Vitamin A, several Bs, C, E, and D, but not K. I told her to try "phyto-something" Phytonadione popped up. LIFE SAVED.

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Vamsi Aribindi

@aribindi

5 years

@KBrookeGolisch Yup! And the guy who pioneered the system was Halsted, a cocaine addict, which in retrospect explains a lot.

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Vamsi Aribindi

@aribindi

5 months

@DrLongissimus As someone about to start my 9th year of post-medical school training, and finishing up 72 hours straight on call... I think the average nurse is much smarter and made better life choices than the average doctor.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd The recommended treatment for a patient with pre-existing heart failure who gets pregnant is often an abortion, depending of course on a variety of factors. Any other course and both mom and baby die.

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Vamsi Aribindi

@aribindi

2 years

@coffeeandblades Total proctocolectomy, entrectomy, gastrectomy, esophagectomy with spit fistula. Small bowl transplant referral. Specimen sent to the desert to be nuked from orbit. It's the only way to be sure.

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Vamsi Aribindi

@aribindi

2 years

There are few more rewarding things in medicine than walking out after a surgery and telling the family everything went well.

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Vamsi Aribindi

@aribindi

6 months

It's quite insane to me just how bad the evidence base is in Cardiac Surgery. In CABG, we have no clue to this day how many targets to bypass or where to put it. If the PDA and PL are blocked should we bypass both or only one? If there are 2 blockages, how distal do you go?

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Vamsi Aribindi

@aribindi

5 months

Time for a thread on malignancy in surgical residency, inspired by the current #medtwitter drama which features an anonymous residency review website targeting my residency, @BCMGSRes which I consider one of the best in the country

Review My Residency

@residencyreview

5 months

Baylor College of Medicine General Surgery Residency - @BCMGSRes

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Vamsi Aribindi

@aribindi

4 years

@KurteL10 Bad doctors are rare. Mediocre (which is to say excellent but not outstanding) doctors are far more common. To me, the more interesting question is, what if the #MedTwitter doctor you hate is an outstanding doctor in real life?

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Vamsi Aribindi

@aribindi

3 years

@ATLmurse SCDs don't function by mechanically breaking up clots. They function by increasing nitric oxide release which then acts systemically- so an SCD applied to an arm will prevent clots in the leg, and vice versa. This patient, if immobile, may still benefit from an SCD on the arm.

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Vamsi Aribindi

@aribindi

3 years

@richienrg I mean... attractive as this theory is for me, chess is fundamentally different as a domain than, say, medicine. "Winning" at chess is far different than telling a patient "your pain is nothing" and having it turn out to be cancer. The latter happens all the time.

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Vamsi Aribindi

@aribindi

3 years

@DGlaucomflecken This actually happened-

Police arrest doctor after fight with another physician at St. Elizabeth in Boardman

Police arrested a doctor after a fight with another physician turned physical at St. Elizabeth in Boardman.

www.wytv.com

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Vamsi Aribindi

@aribindi

3 years

@SAGES_Updates what is this insanity? Per FUSE, I'm supposed to use the cut setting to coagulate a blood vessel? Literally no one I know does this, in 7 years of working with surgeons across a dozen hospitals. @dsmd06 @Zea_Rodrigo @DrArsalanAmin

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd 100%

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Vamsi Aribindi

@aribindi

5 years

Now lets talk about the vent machine itself. There are a gazillion different modes and options, but at the core, you need to know only one: volume assist control. No studies have ever shown superiority of any other vent mode to this one.

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Vamsi Aribindi

@aribindi

5 years

@McPheMommy @tnicholsmd ?? 18 year old girl, had hypoplastic left heart s/p several repairs, has heart failure, eventually will need a transplant. Didn't take her pills, IUD fell out, whatever, she is now pregnant. She is at 6 weeks when discovered. If she continues, she will die. Is it okay to abort?

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Vamsi Aribindi

@aribindi

5 years

There are 2 key things ventilators do- ventilation (removal of CO2) and oxygenation (addition of O2). For simplicity, these can be modeled/thought of as completely separate processes.

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Vamsi Aribindi

@aribindi

1 year

We need an open and honest conversation as a profession to define what our country's needs are in terms of physician training. Interventional cardiologists need to be trained to function at 2AM, night after night if needed. Endocrinologists? Not so much. #MedTwitter

Justin Bullock

@jbullockruns

1 year

It is F*CKING crazy that residency programs would rather LET GO of a trainee rather than exempt them from doing night shifts. Like is it easier to replace 12 months of a human than it is four weeks of nights??

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Vamsi Aribindi

@aribindi

5 years

For ventilation, the name of the game is permissive hypercapnea, meaning we let patients have higher pCO2s and lower pHs in exchange for plateau pressures less than 30, down to pHs of 7.2-7.25. Below this, we get concerned. But, here's where acid-base comes in.

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Vamsi Aribindi

@aribindi

6 years

@theblondeMD Now, no one ever sleeps overnight. People are also far, far sicker taking many more medications, because they survive with more comorbidities. This all adds up to something people are calling increased work intensity, and it's something I really want to study.

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Vamsi Aribindi

@aribindi

5 years

@tnicholsmd I agree that if you're doing it to teach a lesson, that's abominable. All patients deserve respect and compassion. I've sometimes drained small abscesses without lido only b/c trying to inject lidocaine into thin, acidotic skin often causes more pain that a single, quick cut.

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Vamsi Aribindi

@aribindi

5 years

Volume assist/control (VAC) means this: you set a rate and a tidal volume (Vt). The ventilator will force that amount of air into the patient's lungs, at the rate set at minimum. If the patient takes extra breaths, they will get extra support to make that breath the set Vt.

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Vamsi Aribindi

@aribindi

1 year

I'm convinced that if hospitals stopped trying to charge for every bandage and tape and just negotiated some flat fee for all patients, it would free up 20% of nurse's time and vastly improve just about every metric of care. Basic supplies behind a pyxis is moronic.

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