Looks adorable.
But in the event of a frontal collision and subsequent airbag deployment, the infant's skull would be accelerated at ~320km/hr 6-8 inches into the man's thoracic cage, killing both instantly.
Indian parents need a harsh reality check.
@abbygov
"My dear, religion is like a penis. It's a perfectly fine thing for one to have and take pride in, but when one takes it out and waves it in my face we have a problem."
Quick, basic primer🧵- Decompressing a tension pneumothorax
A tension pneumothorax is a life-threatening emergency which will lead to death without immediate intervention. Understanding and recognizing one is vital to time dependent intervention.
(1/n)
At 4am this morning, a house surgeon was stabbed multiple times with a scissors in her neck by a patient she was providing care for. She died of her injuries a short while earlier.
She had been my medical student & yet another victim of random, senseless violence towards doctors.
Shared with permission:
This is the sort of abnormal postural variation of heart rate due to
#Dysautonomia
in
#POTS
.
This previously athletic, fit and healthy young man has been suffering with these symptoms ever since his
#LongCovid
set in nearly 8 months ago, with no respite.
So, during my residency there was this "VVIP" celebrity patient who required a lumbar puncture. As is usual norm in such cases, she demanded that the Head of Medicine perform it.
Our HOD obliged, cleaned and draped, took the LP needle in his hand, smiled and said...
(1/3)
VIP patient
#Medtwitter
stories
Pleural tap today.
Me: "I'm going to give the local anaesthesia. This may sting a bit"
Patient: "Doctor wait, I don't want the local thing, please use some high quality injection. Don't worry about the cost."
Me: 😳
With videos like this in circulation, we are going to have an epidemic of random uncles suddenly jumping on another's chests for no reason.
CPR isn't to be performed on a responsive person who is breathing. Improper technique may be harmful (1/2)
@thephysicsgirl
ER doc with experience managing ME/CFS crashes here.
Get her triaged, have her vitals checked. Provide a concise history. Have a doctor perform a physical. ECG, basic bloods and VBG/lactate levels. Minimize shifts, transfers amd ambulation.
(1/2)
...Now, are you still absolutely sure you want me to proceed?"
Celebrity madam now gave a very foolish smile & sheepishly gestured from her lateral recumbent knee-chest position, as my professor grinned, asked me to glove up and walked out after handing the LP needle to me.
(3/3)
(1/n) Thread: Epi-immuno-pathogenesis of
#BlackFungus
, misnormer for
#Mucormycosis
.
As of 26th of May 2021, India had noted close to 12,000 cases of Mucor along with the
#COVIDSecondWave
.
The centre has advised it a notifiable disease under Epidemic act.
"I think this is the spot. You know, it's been 30 years since I've done this, so my techniques' a bit rusty. Thank you for personally "requesting" that I do it, rather than my registrars & interns who I'm sure get to do many LPs routinely in a day. Hope I've still got it...
(2/3)
@thephysicsgirl
Get her on a flat bed with the head end lowered. ER beds can be tilted to the tredelenburg position.
Convince the team to get her on IV fluids while waiting for the bloodworkup. If nauseous ondansetron may help.
(2/2)
Check this as well:
@anujtiwari11
This X-ray has a lot going on:
Left pneumo, right hydro-pneumo + fissural effusion, the thin walled cavity on the left mid zone, bilateral parenchymal infiltrates with destructive bronchiectasis and tractional volume loss.😔
I'm sure that this dad loves his daughter dearly, and I really wish to believe that this dangerous indulgence of child endangerment was a singular lapse of his better judgement. Hoping he & other parents can realise the potential dangers involved in such practices, and do better.
17 year girl with history of recurrent brief fainting episodes (> 8) preceded by palpitations & "anxiety". Normal vitals + physical exam on arrival at the ED.
Dismissed as panic attacks by multiple doctors, her first ever ECG.
Would you diagnose the same?
#MedTwitter
Consent ✅
It's been about six months since we've had to intubate a patient with acute
#COVID19
respiratory failure in our busy emergency department.
The virus hasn't gone anywhere, but bloody hell - the freakin' vaccines work!!! 💉💪🏽
Rounds in the ED discussing a patient with a head injury: What's the patient's GCS?
Resident: GCS couldn't be assessed as the patient was drowsy.
Me (thinking to myself): Wow! That's a new one.
Me (out loud): That's EXACTLY the situation the Glasgow Coma Scale was designed for 🤷🏾♂️
Breaking news: Curd apparently blocks the action potential of the α1 subunit on selectively permeable voltage-gated calcium channel on the cell membrane.
@vijayanpinarayi
@just1doctorwala
Absolutely brilliant stuff from Kerala health care services. And you sir, are a legend with this tweet sticking it up where the sun don't shine. Respect!
#POTS
or Postural Orthostatic Tachycardia Syndrome is a form of Orthostatic Intolerance (OI).
Due to abnormal autonomic function, a dramatic and sustained increase in heart rate occurs with postural change, without a significant fall in blood pressure.
24 hour holter also shown.
@Chinmayi
Opportunistic perversion seems to be the default setting in the Indian male. And then you have those who take it up a tier to create the opportunity, particularly using positions of power and disgustingly so.
It almost seems one needs willing restraint to maintain basic decency.
Monkeypox is currently in a multi-country outbreak and has currently been classified as a "Public health emergency of international concern" by the
@WHO
One pager infographic on mpox
The patient's heart rate shoots up from a resting rate of 70-80/ minute to 130-140/minute within moments of getting up to standing from a supine position, as shown in the video before gradually decelerating.
The holter shows regular such spikes in heart rate throughout the day.
@BrownHospMed
@dr_skaggs
Asymmetrical superficial abdominal reflexes.
If noted in a patient with scoliosis, would image to rule out a lower throacic syringomyelia (syrinx)
@theliverdr
Dropping this superb infographic from
@bmj_latest
on a clinical syndrome pattern recognition + lab/serological diagnostic approach to Acute Undifferentiated Febrile Illness (AUFI without localising symptomatology) in tropical regions.
This romanticism of servitude to the cause of nobility is harmful to the medical fraternity and ends with us getting us beaten up in the long term.
It's a profession, not a vocation.
#MedTwitter
🇮🇳
She is a Co junior Resident doctor in my hospital working for patients with a “IV Saline Paracetamol Drip in her Hand” as she had fever & severe weakness .
When I asked her why don’t you take rest she replied “My patient is in Sick condition , I will be fine if patient will be
#CoughSyrup
Because if you thought
#BigPharma
was a despicable ill-motivated industry, wait till you meet it's unregulated Indian cousins: The malicious and deadlier Small & Medium Pharma.
P.S. Some food for thought. Lot of comments pertaining to non-existent Indian road ethics.
But how is it that the individuals who blatantly flout road rules in India, follow them to the dot in the west?
Better overall civic sense, or is it better enforcement & harsher penalties?
"Our aim is to train you to be the physicians who we'd want to be treated by, if we have taken ill."
- Dr. Anand Zachariah,
Past HOD, Department of Internal Medicine,
CMC Vellore, India.
From his address to Y1 Internal Medicine residents circa 2013
@OffCMCVellore
#MedTwitter
14 years since I passed out of med school and I'm sorry to say that I'm also equally "inexperienced" and inadept with the nuances of unarmed defensive physical combat against an armed assailant.
Shame on me.
Take the time, make the effort to learn how to perform CPR. Hopefully it's a skill you will never have to use.
You may never know when, and on whom you have to use it. It may be a loved one or a stranger. But when it comes to that, their lives could be in your hands.
#CPR
#BLS
For those who understand Malayalam, the conversation as it took place in the vernacular.
Me: "Sirae, local injection aanae; ith alppam vedhana undakum"
Patient: "Local item onnum venda. Koodiya sathanam mathi. Doctor ethinu chelav onnum nokanda"
Approach to hypoglycemia in the ED:
1. Doctor did it (iatrogenic)
2. Patient did it (OD/inadequate meal)
3. Drug not eliminated (worsened renal fn)
4. Body's glucose factory kaput (liver dysfn)
5. Body demands more glucose (sepsis, etc)
6. Weird causes (🤙🏽
#EndoTwitter
)
#FOAMed
80 yr old man brought to casualty with severe hypoglycemia despite IV dextrose.
Not a known diabetic.
RBS 45.
Insulin and C-peptide sent during episode of hypoglycemia.
Cortisol level sent at the time 19
Thoughts?
Repeat after me: Cough is a physiological response to a pathology (such as suppuration or spasm) in the airway which facilitates it's clearance.
Hence it must not be suppressed unless the cough itself causes harm or significant discomfort / pain.
Treat the cause, not the cough.
This moron, through regular irresponsible feeding has created a pack of stray dogs sensitised to assemble & anticipate food.
What happens when the moron doesn't turn up? The hungry dogs turn on whoever is passing by expecting to be fed. And when that doesn't happen, they attack
Shame on you
@HimalayaIndia
You are exposing yourself and your unscientific double standards
Rest assured netizens will leave no stone unturned till you regret the day you ever thought taking
@theliverdr
to court was a good idea...
#BoycottHimalaya
As many have mentioned, dismissal by their health care provider has been a common unpleasant experience, often labelled anxiety and pychosomatic, further gaslighting the orderal.
However, many have found great guidance, counsel, therapy and learnt to cope.
Also mentioning the role of wrist worn fitness trackers, availability of finger pulsoxymeters, etc have made patients realise that their discomfort was associated with variations in heart rate, thus allowing approach to medical care with evidence to show.
@EM_RESUS
Right pneumothorax 🟠
Left massive hemothorax 🟢
Rib fractures with flail collapse Left 1st - 4th rib🔵
Scapular fracture with acromio-clavicular dislocation 🔴
Tube device (cyan blue) left lateral chest wall.
(Or)
Old left complete pneumectomy with a hyperinflated right lung 🤡
If someone suddenly collapses and isn't breathing, place them on a flat surface & begin chest compressions as demonstrated here.
Get trained from proper sources.
Also, avoid photos/video graphy & sharing of an extremely disturbing moment to the person & their loved ones. (2/2)
Thank you to all who choose to share here, their own story of living with and dealing with POTS, those who care for individuals suffering from POTS and those who advocate for it.
Despite the disease being around forever, it was orphaned by medical research and needs awareness.
An ECG costs less than $2 where I work.
A walk-in consult (24x7) with primary doc: $1. An out of hours referral to emergency department consultant: $1.50
An appointment with the cardiologist the very next day: $3.
And people still complain about healthcare costs & waiting times.
My primary care doc bills my insurance $100 when he does an EKG in-office.
He wanted another, I said could I go to my local hospital to get one? "Yes."
I went by, they said would do it. I asked how much--
$1,200!
I said no thank you.
My doc did it.
Time for uniform pricing in US.
Seeing a sharp upturn in COVID19 cases presenting to the ED since yesterday. This is following a lull during the past two months.
The cases coming in are mostly community acquired, with no significant travel or contact history.
All are breakthrough infections in 2x vaccinated.
If you are alive today > 90 days since taking the vaccine (when the chances of any such complication is impossibly small), you need not worry, nor take any of these tests.
You and the community have benefited from the vaccine.
Sincerely,
A doctor who deals with COVID & VAE/AEFI.
Had 3 patients this week with clinical leptospirosis. IgM serological tests negative in all. Sent lepto PCRs, all 3 of which were positive.
Instead of being proud & smug, I'm kicking myself for sending expensive investigations instead of trusting my clinical judgement.
Thoughts?
To all those who spat out their curd, I'm sorry. This is a satirical misleading post calling out yet another misleading post from a 'doctor'.
Please continue to enjoy as much heated curd, cold curd, curd rice, lassi, chaach, buttermilk as you like, anytime of the day or night.
@anzypanzywanzy
*Senior nurse with 40 years of peripheral IV cannulation experience watches, on as the patient's veins are repeatedly counterpunctured by the attending*
@Olivemadsci
Patient: This is the worst headache of my life.
Narrator: No it wasn't. Our patient was merely experiencing their first hangover after having turned 30.
@GargiRawat
Poor judgement, risk assessment and hazard awareness.
This is what happens when stupidity, combines with ignorance of road safety and lack of enforcement of traffic rules.
64y lady (HTN,off Rx) who collapsed at home was brought unresponsive to the ED.
🫀54'
⏲️200/110
🫁8', gasping, airway ❌
🧠E1VAM1
This finding was noted during prep for intubation & site of lesion clinically neuro-localized prior to the CT.
#neurotwitter
Qn: Location of the ICH?
Despite all the bad press, anyone who says that practicing medicine is a thankless profession is out of line.
No other vocation grants the privilege to 𝘢𝘧𝘧𝘦𝘤𝘵 so many fellow human lives in an average week; than the average person does in their entire lifetime.
#MedTwitter
@BrownHospMed
Frontal inhibition release sign - Snout reflex.
Tapping or percussion of the lateral aspect of upper lip region causes a pouting or puckering of the lips making a snout.
Two sons, two systems of justice, but one message for Indians: Fall in line
My latest on Aryan Khan and Ashish Mishra. A crucial piece for the Washington Post
Dear public,
Who have chosen to interpret the word MILDER.
Milder doesn't mean chilling at home with hot chocolate, nice books and movies.
Milder means not having multiple pipes & tubes shoved in you & being connected to a bunch of 'alarming' machines in an ICU.
Okay thanks.
To everyone who propagated that Omicron is mild, you didn’t understand that scientists said it’s MILDER than Delta, which translates to LESS LETHAL. It’s still Covid. People who were already not following public health measures had their belief of near zero threat reaffirmed.
50 year old fisherman (local equivalent of the American farmer), brought against his will to the ER: Hey look doc, it's nothing. Just this funny feeling in my chest since yesterday.
Me: Say no more.
@EM_RESUS
If you want to find the best doctors in a hospital, ask the nurses there who they'd consult should they or their loved one fall ill.
You'll be right 100% of the time
#MedTwitter
@Lap_surgeon
What really had me confused initially were these.
It took me a while to recognise that it was actually just the reflection of the phone camera.
@BrownHospMed
@grepmeded
When the meninges are inflammed, stretch on the dura by passive flexion of the neck causes meningeal irrigation and pain.
To releive the stretch, there is involuntary flexion of the hip + knee thus relaxing the stretch on the meninges.
High specificity for meningeal inflammation
@YouAreLobbyLud
The single most effective way to prevent
#LongCovid
is to prevent getting infected with the SARS-CoV-2 virus in the first place. Vaccination + boosters, masking, ventillation, distancing etc remain the cornerstones of prevention of COVID, and must be what's pursued.
Her ECG shows short PR intervals with slurred upstroke on the QRS complexes: Delta waves - signifying the presence of an accessory pathway which may lead to aberrant conduction & electrical "short circuits"
This is NOT a panic attack.
This is Wolff-Parkinson-White syndrome (WPW).
@PallaviPareek
@RuchiAngrish
@ManipalHealth
ER & IM doc, here. The line of recommendations put forward was correct. Rabies is a disease you don't want to take a chance.
For a category III bite, immunoglobulin therapy is indicated at the earliest in all except those who have completed vaccination schedule previously.
(1/2)
@BrownHospMed
Epidemiology and pathogenesis of mucormycosis.
A relatively rare disease which we saw waging a mini pandemic of it's own in India during the COVID19 delta wave.
(1/n) Thread: Epi-immuno-pathogenesis of
#BlackFungus
, misnormer for
#Mucormycosis
.
As of 26th of May 2021, India had noted close to 12,000 cases of Mucor along with the
#COVIDSecondWave
.
The centre has advised it a notifiable disease under Epidemic act.
Confirmation: Tension pneumothorax is a CLINICAL diagnosis!!!
Confirm with
#POCUS
signs of a pneumothorax if available at the bedside. Undue delays to obtain X-ray or CT imaging MUST NOT delay your intervention, as progression may cause your patient to further deteriorate.
As promised, let's go...
Breaking this X-ray down systematically (armed with hindsight and ofcourse me peeking at her cross sectional CT imaging sequences)
We have a scary looking X-ray of a 78 year old lady:
AP view, reasonably well centred and exposed.
(1/n)
1. Your immune system needs no boosting - it doesn't work that way and, a hyper active immune system will kill you.
2. Your liver needs no detox, your liver detoxes you.
Im a liver diseases specialist trained in hard-core basic science hepatology, active in research/practice of clinical hepatology, routinely caring for most advanced liver failure patients
& I assure you
Liver detox, specific foods for liver health/immunity are absolute hoaxes.