Dan Leisman, MD, MSCR @danleisman Twitter profile | Pikagi

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Dan Leisman, MD, MSCR

@danleisman

2,737

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1,327

Following

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2,009

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PGY5 @harvardpulm ⬅️ @mghmedicine 🔁 @MGHanesthesia . Cynical New Yorker. Aspiring intensivist. Sepsis, statistics, physiology, & all things ICU.

Boston, MA

Joined October 2011

Don't wanna be here? Send us removal request.

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@danleisman

Dan Leisman, MD, MSCR

5 years

(1/ )Summaries of the average high impact trial by field: #EBM #medtwitter #epitwitter #FOAMed #Cardiology :We enrolled the entire population of Europe in a trial to detect a composite endpoint occurring in 3% of patients. The relative risk reduction was 20%. The NNT is 12,000

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@danleisman

Dan Leisman, MD, MSCR

3 years

Anesthesia should rebrand itself as interventional pharmacology

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@danleisman

Dan Leisman, MD, MSCR

3 years

The best way to start drama at the hospital is to consult Renal and Cardiology on the same patient.

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@danleisman

Dan Leisman, MD, MSCR

3 years

People say things like, “are you anesthesia?” and it makes me laugh every time. Like imagine going up to a cardiology fellow like, “Hey, are you diuretics?”

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@danleisman

Dan Leisman, MD, MSCR

4 years

Hyperkalemia is not a contraindication to Ringers Hyperkalemia is not a contraindication to Ringers Hyperkalemia is not a contraindication to Ringers Hyperkalemia is not a contraindication to Ringers Hyperkalemia is not a contraindication to Ringers

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@danleisman

Dan Leisman, MD, MSCR

3 years

So uh, intubating on the floor during a code is a little different than intubating in the OR, huh?

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@danleisman

Dan Leisman, MD, MSCR

2 years

Calcium is the most underrated vasopressor

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@danleisman

Dan Leisman, MD, MSCR

3 years

You guys ever look at senior residents and think, “shit, I hope I’m even half this good at my job one day”?

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@danleisman

Dan Leisman, MD, MSCR

2 years

The best part of my day was when one of the interns told me had started a patient on Vanc/Cefepime by saying he ordered them the house wine

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@danleisman

Dan Leisman, MD, MSCR

1 year

Guys, this is literally in the Johns Hopkins Guide to Antibiotics

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@danleisman

Dan Leisman, MD, MSCR

4 years

Inpatient Medicine: If something bad happens to a patient, it better happen with a Mag above 2 and a K above 4.

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@danleisman

Dan Leisman, MD, MSCR

4 years

Intern checklist for taking call with a med student: ☑️They take the early admissions ☑️Make sure they eat dinner - you may need to remind them ☑️Make sure they are caffeinated ☑️Pay for their caffeination - you have a salary, they have tuition ☑️Make sure they get some sleep

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@danleisman

Dan Leisman, MD, MSCR

2 years

I guess it's time to share some news: At the end of next week, I'm leaving the department of anesthesia and transitioning to internal medicine residency at MGH.

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@danleisman

Dan Leisman, MD, MSCR

2 years

It’s come up a lot lately, so I want to talk about large-bore IV (LBIV) access for a sec A big IV can be the difference between life and death for a bleeding or severely volume-down patient But what's "good enough"? Here's some of why LBIVs matter 🧵

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@danleisman

Dan Leisman, MD, MSCR

4 years

Interns, who in the hospital is most likely to bail you out of trouble and why is the answer always the pharmacist?

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@danleisman

Dan Leisman, MD, MSCR

2 years

Me, signing out post-call in the MICU lately: “I have no idea what’s going on with half of these people but everyone who needs to be is lined and tubed”

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@danleisman

Dan Leisman, MD, MSCR

3 years

@sarahmdiamond But… the ABC’s!

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@danleisman

Dan Leisman, MD, MSCR

5 years

(5/) #anesthesia : We asked if gas is good or bad. We are still not sure. Future studies will determine which is cooler: ultrasound or simulation. #InfectiousDisease : We did a trial to see if you can shorten the course of abx. We found you can.

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@danleisman

Dan Leisman, MD, MSCR

6 months

I don’t even know where to start with unpacking the layers of chutzpah in @BrighamWomens emailing me, an MGH resident, asking me to donate to to their hospital today, in honor of “national doctors day”.

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@danleisman

Dan Leisman, MD, MSCR

5 years

(4/) #Surgery : These were my last 85 patients and what happened to them. I combined them with 3 of my friends' patients. Then we asked a statistician to propensity-score match, so this was basically a randomized trial. #Nephrology : We tried to do a trial but no one would fund it.

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@danleisman

Dan Leisman, MD, MSCR

4 years

@rubin_allergy 1. Pharmacy 2. Pharmacy 3. Also pharmacy (If being an intern were a specialty)

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@danleisman

Dan Leisman, MD, MSCR

4 years

A little late to the party, but can finally share this meta-analysis in @LancetRespirMed on cytokines in 1,245 pts w/ #COVID19 vs. sepsis, ARDS, & CAR T CRS. I could belabor the details, but the bottom-line is simple: #COVID19 is not a #CytokineStorm .

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Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and...

The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonists. However, direct systematic...

www.thelancet.com

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@danleisman

Dan Leisman, MD, MSCR

5 years

(2/) #CritCare : We powered this trial assuming treatment would reduce mortality by 8000%. The primary outcome was not significant (p=0.06). However post hoc analysis of subgroup X was encouraging. A follow up trial but still inadequately powered trial is planned in this group.

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@danleisman

Dan Leisman, MD, MSCR

2 years

In my happy place

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@danleisman

Dan Leisman, MD, MSCR

5 years

(3/) #Oncology : We conducted a randomized trial of new drug X. The strengths of this study are BiOpLaUsiBiLitY. It was limited by a short-term surrogate primary outcome and lack of a control group. All authors have COI w/ drug manufacturer. The test article is now FDA approved.

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@danleisman

Dan Leisman, MD, MSCR

3 years

July PGY1 was like this is the most utterly incompetent you will ever feel at work and then July CA1 really said hold my beer.

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@danleisman

Dan Leisman, MD, MSCR

10 months

Update: Nine years after realizing this is what I was meant to do with my life, I am finally going to be an ICU doctor. I’m so excited to start this next part of my training at @MGH_PCCM @PCCSM_BIDMC and immensely grateful to everyone who has helped me along the way to get here.

@HarvardPulm

Harvard Pulmonary & Critical Care Fellowship

10 months

We are absolutely delighted to welcome this amazing class of new fellows to the MGH/BIDMC Pulmonary and Critical Care Medicine Fellowship in July 2024! @MGH_PCCM @PCCSM_BIDMC

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@danleisman

Dan Leisman, MD, MSCR

10 months

Me in college: “I like numbers because numbers don’t lie.” Me, after 10 years of clinical and translational research: “Listen, numbers are straight up the most dishonest, scheming, untrustworthy, duplicitous MFs out there.”

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@danleisman

Dan Leisman, MD, MSCR

4 years

I was just chatting with a new admission on our floor, ICU downgrade in his 30s. The last time I saw him he was in the ICU with COVID ARDS, proned, paralyzed, on iNO and being considered for ECMO. So today is a pretty good day.

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@danleisman

Dan Leisman, MD, MSCR

3 years

Why is radial arterial line placement a sterile procedure when peripheral IV placement is not?

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@danleisman

Dan Leisman, MD, MSCR

4 years

After 2+ years of work, pre-proofs of my first basic science paper on Angiotensin-II in the pathophysiology of #sepsis induced #AKI are up. I'm obvi biased, but I think it's pretty cool! Here's why... 🧵(1/n) #FOAMcc #PCCM #nephjc #askrenal @mghmedres

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@danleisman

Dan Leisman, MD, MSCR

4 years

First ED shift in late October I saw only 1 COVID+ patient. Today I had only 2 patients who were not COVID+.

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@danleisman

Dan Leisman, MD, MSCR

3 years

Ok so big bleeding in the ICU is a lot less chill than big bleeding in the OR

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@danleisman

Dan Leisman, MD, MSCR

2 years

There is absolutely no reason to go through and through with an ultrasound guided radial art line and you shouldn’t do it. Thank you for coming to my TED talk.

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@danleisman

Dan Leisman, MD, MSCR

2 years

@coachsadji Bacterial pneumonia Post-partum hemorrhage Tuberculosis Syphilis Gallstones Lyme Disease Hepatitis C Malaria Tension pneumothorax Hodgkins Lymphoma Many leukemias Many breast cancers Endometrial cancer Bacterial meningitis Shall I keep going?

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@danleisman

Dan Leisman, MD, MSCR

2 years

Suppose pt in shock from brisk venous bleed that began 3h ago. They've lost 3L & still bleeding If IV flows are ideal: 🔴20g barely keeps up w/ losses & won’t fix deficit (or shock) 🔴18g keeps up but takes a long time to restore perfusion 🟢16g or 14g get the job done quickly

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@danleisman

Dan Leisman, MD, MSCR

3 years

Most important thing I’ve learned from anesthesia residency so far: by touching your chin to your chest before you swallow, you can avoid immediately aspirating when eat/drink lying on your couch without having to sit up

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@danleisman

Dan Leisman, MD, MSCR

5 years

Man, I hate “those” codes. The ones that everyone sees coming a mile away, with the outcome all but certain, and yet there you are chugging away, feeling 90 year old ribs cracking under your compressions, and you walk away sure only that you definitely did not help anyone

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@danleisman

Dan Leisman, MD, MSCR

2 years

I am still ICU bound. The practice and science of critical care medicine are still my life's calling. I am just taking a different road to my destination.

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@danleisman

Dan Leisman, MD, MSCR

2 years

🔑Point 1: Large bore pIV = 16g or 14g Here's why - Access must be sufficient to BOTH keep up w/ ongoing losses AND correct the existing deficit Max flow rates (to gravity) for different IVs under *ideal conditions*: 20g: 60mL/min 18g: 100mL/min 16g: 210mL/min 14g: 345mL/min

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@danleisman

Dan Leisman, MD, MSCR

4 years

(1/) I want to bounce around a disease model for #COVID19 . This is hypothesis, some parts are hand-wavy, but I'd like to think a lot is also based on evidence. I'll try to clearly distinguish knowns from assumptions as we go... #COVID2019 #SARSCoV2 #medtwitter #FOAMcc #FOAMed

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@danleisman

Dan Leisman, MD, MSCR

2 years

It's bittersweet. I'm sad to leave the OR community that has been my home this year. But I am excited to come back to @mghmedres and to see what the next chapter will bring.

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@danleisman

Dan Leisman, MD, MSCR

3 years

In internal medicine we say, “the patient aspirated”, and in anesthesiology we say “the patient had a vagal/sympathetic response”, when we mean, “I have no idea why they looked so bad for a hot sec there”.

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@danleisman

Dan Leisman, MD, MSCR

2 years

Guys! Did you know a stethoscope can be used for more than checking to see if you mainstemed the endotracheal tube!? I can’t think of anything specific, (I think I used to know once?), but everyone else in clinic seems to use them all the time

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@danleisman

Dan Leisman, MD, MSCR

2 years

If your takeaway from the INTUBE study was that propofol use is the single biggest predictor of peri-intubation cardiovascular instability, I might encourage you to read this letter by Jay Crowley and I Don’t blame the drug - pay attention to the patient

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@danleisman

Dan Leisman, MD, MSCR

2 years

I messaged our CA1 group chat about something extra stupid I did this morning and the chat immediately turned into a thread of all the dumb things everyone did today and basically I have the best co-residents @MGHanesthesia

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@danleisman

Dan Leisman, MD, MSCR

2 years

After a month of cardiac anesthesia and I’ve never been so simultaneously relieved and bummed to finish a rotation It’s been exhausting, humbling, and challenging, but I’ve never learned so much in such a short time. And my barometer for “sick patient” has totally changed

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@danleisman

Dan Leisman, MD, MSCR

2 years

This was, and still is, a really difficult decision but it's one I know is ultimately right for me. It's been made even harder by how unbelievably supportive everyone in the DACCPM, especially @DanSaddawi , has been.

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@danleisman

Dan Leisman, MD, MSCR

2 years

In sum - for bleeding and/or hypovolemic shock: 🩸Yes, you need large bore access 🩸Large bore = 16g or 14g pIV (or a venous sheath) 🩸 20g and 18g don’t cut it 🩸Central lines, PICCs, or other long catheters don’t cut it either 🩸No claves or connectors!

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@danleisman

Dan Leisman, MD, MSCR

5 years

We interrupt your COVID feed to share a brief message: Looks like like I’m shipping back up to Boston next year!! See you soon @MGHMedicine and #MGHanesthesiology !! #MatchDay2020 #Match2020

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@danleisman

Dan Leisman, MD, MSCR

1 year

Someone remind me why the most popular severity tool in ICU trials is still a score that grades shock severity using dopamine dose?

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@danleisman

Dan Leisman, MD, MSCR

3 years

You guys ever think about how blood vessels aren’t rigid pipes, and blood is a colloid with variable viscosity, but we still use hydrodynamics to model the circulatory system anyway?

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@danleisman

Dan Leisman, MD, MSCR

4 years

@DrSamuelBrown I’m reminded of this paper from a few years ago

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@danleisman

Dan Leisman, MD, MSCR

2 years

🔑Point 3: Don’t attach a clave! Claves work by obstructing flow (pic 1). Look at what these devices do to flow rates (pic 2). A clave will turn your 16g or 14g back into an 18g, and turn an 18g into a 20g! Instead, connect IV directly to tubing. Ref:

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@danleisman

Dan Leisman, MD, MSCR

1 year

Get to take my LAST 24-hour call of residency in my happy place

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@danleisman

Dan Leisman, MD, MSCR

4 years

Intern year is great. Like, I’m already exhausted, and I don’t know what day it is, and I feel like an idiot most of the time...but I’ve also had at least 12 other jobs and held one near continuously since I was 14. I‘ve never enjoyed coming to work so much, not even close.

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@danleisman

Dan Leisman, MD, MSCR

2 years

This year has given me immense respect for anesthesiology as a field. I will be forever grateful for what I have learned and the skills I have gained. But I am most grateful for the incredible faculty and co-residents I've been able to work alongside and learn from.

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@danleisman

Dan Leisman, MD, MSCR

2 years

🔑 point 2: Central lines, PICCs, etc. don’t work for volume resuscitation The distal (brown) port of a standard 16cm TLC is the largest, it’s 16g. But it is 11cm longer than a 16g pIV. As a result, it only runs 52mL/min. That’s even slower than a 20g pIV

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@danleisman

Dan Leisman, MD, MSCR

2 years

Today’s teaching point: If you accidentally cannulate a peripheral or femoral artery instead of a vein during a hypotension response, don’t panic, don’t pull the line, hook up pressure tubing and now you have an a-line

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@danleisman

Dan Leisman, MD, MSCR

2 years

@coachsadji Myopia and hyperopia Cataracts Bowel obstruction Peptic Ulcer Disease A wide array of traumatic injuries Osteoarthritis of the hip and knee Heat stroke & hypothermia Leprosy Ascariasis Strongyloidiasis Gonnorhea & chlymydia Chorioamnionitis My dude, I can do this all day long

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@danleisman

Dan Leisman, MD, MSCR

2 years

🔑 Points: 🩸Large bore = 16g or 14g pIV (or a venous sheath). 🩸20g and 18g don’t cut it. 🩸Central lines, PICCs, other long catheters don’t cut it either. 🩸No claves or connectors!

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@danleisman

Dan Leisman, MD, MSCR

3 years

Is it weird I’m not even that mad to be working today?

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@danleisman

Dan Leisman, MD, MSCR

1 year

Crumpling up draft number - I don’t even know, 7? - of the fellowship personal statement and starting to wonder if I should just submit this instead.

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@danleisman

Dan Leisman, MD, MSCR

4 years

Woke up s/p call to see this blew up. I have nothing to promote other than: 1) Statsitical reasoning is clinical reasoning 2) Be nice to your students and trainees: learning doesn’t always require hazing.

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@danleisman

Dan Leisman, MD, MSCR

3 years

PGY-1 ✅

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@danleisman

Dan Leisman, MD, MSCR

1 year

All of the anesthesiologists while listening to the presentation on whether peripheral levophed or peripheral vasopressin is safe

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@danleisman

Dan Leisman, MD, MSCR

4 years

@Poietic_Justice @rubin_allergy Sometimes in the “instructions for pharmacy” box on the order - I literally just write “I don’t have any idea how to dose this, please help”

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@danleisman

Dan Leisman, MD, MSCR

1 year

When I’m on service anywhere that isn’t an ICU

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@danleisman

Dan Leisman, MD, MSCR

3 years

@JamiePrivratsky Lol rounding 3x in a single stretch of daylight hours sounds like it’d be a great way to comprehensively discuss all the work you don’t have time to get done

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@danleisman

Dan Leisman, MD, MSCR

2 years

Why is this the case? Hagen-Poiseuille's Law says that increasing the radius of the catheter increases fluid flow by a *power* of 4! The law also says that an increase in either catheter length or fluid viscosity will reduce flows 8-fold. Brings us to point 2…

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@danleisman

Dan Leisman, MD, MSCR

3 years

Someone told me this week to remember that when wrestling with a decision, “delaying a decision to the point of not making one is itself a decision” and I feel like that is very true of both clinical medicine and life in general

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@danleisman

Dan Leisman, MD, MSCR

3 years

Our work exploring the dynamics of alveolar, epithelial, & organ injury markers in severe #COVID19 just published online in @ATSBlueEditor (sad that this is even still relevant ) There's a lot to unpack so I'll try to hit some highlights 🧵

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@danleisman

Dan Leisman, MD, MSCR

3 years

Pretty cool and a little intimidating to share the virtual stage with these rockstars at @MGHMedicine Grand Rounds today. Grateful for mentors @CDMD62 & collaborators @JamiePrivratsky @MattDTaylorMD1 but especially my JAR @Natasha_Merali for covering my list so I could present

@KathleenCoreyMD

Kathleen Corey

@KathleenCoreyMD

3 years

Congratulations to the winning abstract authors for @mghmedres Scholarship Day! @zmemel @eemoin @andrewbsong & @danleisman Fantastic @MGHMedicine Grand Rounds talks today! @mghmedres @jmvyasmdphd @MassGeneralNews @katrinarmstrong

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@danleisman

Dan Leisman, MD, MSCR

2 years

Off-service rotations are great not just because of what you learn but also because you get to see how hard another specialty’s job is. Continually have so much respect for emergency medicine clinicians.

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@danleisman

Dan Leisman, MD, MSCR

3 years

@WApplefeld I thought you guys don’t like salt

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@danleisman

Dan Leisman, MD, MSCR

1 year

2 week vacation with no travel plans, Day 1: “I am going to apply to fellowship, resubmit 2 papers, learn a new programming language, discover the mechanism of anesthetics, and solve the Reimann Hypothesis.” Day 7: “Look, at least I finally made it to the gym today.”

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@danleisman

Dan Leisman, MD, MSCR

4 years

I would work 80h/week and give up research for the rest of my career if you if you told me that was the only way I could be an intensivist. (Luckily it isn't, but still). Like I'm bummed about starting a vacation block b/c I can't stay on in the unit. This feels pathologic.

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@danleisman

Dan Leisman, MD, MSCR

3 years

One of the highest positive predictive values for badness in the hospital

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@danleisman

Dan Leisman, MD, MSCR

2 years

Even outside the OR, sometimes the best option is just to put a pIV in the foot

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@danleisman

Dan Leisman, MD, MSCR

4 years

Dear Administrators, I don’t know of a nice way to say this, so I’ll just say it. If your email is longer than 500 words, there is a near zero percent chance I am going to read it.

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@danleisman

Dan Leisman, MD, MSCR

1 year

Looks like we will be changing up the house wine Pragmatic RCT finds Zosyn ⬇️ delirium/coma vs Cefepime without ⬆️ adverse renal events (or mortality) = enough to change my practice But I do wonder if generalizes to (eg, onc) pts w/ baseline cytopenias

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@danleisman

Dan Leisman, MD, MSCR

2 years

The best part of my day was when one of the interns told me had started a patient on Vanc/Cefepime by saying he ordered them the house wine

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@danleisman

Dan Leisman, MD, MSCR

4 years

My signout this morning was election-themed in that: -it was incomplete -key results are pending -no one really knows what’s going on -there is no plan -overnight events bode poorly -its clear we could and should’ve done a better job

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@danleisman

Dan Leisman, MD, MSCR

3 years

Hypovolemic shock and positive pressure ventilation really mix about as well as 💩 on velcro

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@danleisman

Dan Leisman, MD, MSCR

4 years

I tried out a Peloton today and I would describe my rider style as fulminant VQ-mismatch

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@danleisman

Dan Leisman, MD, MSCR

3 years

Friends don’t let friends write the Response to Reviewers’ Comments while hungry.

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@danleisman

Dan Leisman, MD, MSCR

2 years

The greatest lie we tell in medicine is, “I should be home by [whatever time]”

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@danleisman

Dan Leisman, MD, MSCR

3 years

Anesthesia notes will be like: Number of intubation attempts - 16 Assists Used - Laryngeal manipulation, bougie, cricothyrotomy. Was the Patient a Difficult Airway - No

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@danleisman

Dan Leisman, MD, MSCR

3 years

An anesthesiologist told me as a med student that a CA1 is the most dangerous intern in the hospital because of how oblivious they can be when they’re close to the edge and I am starting to understand that and frankly agree.

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@danleisman

Dan Leisman, MD, MSCR

5 years

@holympus Krebs cycle has saved lives before

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@danleisman

Dan Leisman, MD, MSCR

4 years

Guys! In 5 days I start 4 weeks in the MICU and I. AM. SO! excited! What should I read about!? What should I read!?

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@danleisman

Dan Leisman, MD, MSCR

9 months

This was a fun one Post-hoc look at ATHOS-3 trial patients who had ARDS at enrollment Contrary to what I’d guessed we would find, Ang-II group had significantly improved oxygenation by Hour-48 vs placebo

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Angiotensin II treatment is associated with improved oxygenation in ARDS patients with refractory...

Background The physiological effects of renin-angiotensin system modulation in acute respiratory distress syndrome (ARDS) remain controversial and have not been investigated in randomized trials. We...

annalsofintensivecare.springeropen.com

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@danleisman

Dan Leisman, MD, MSCR

4 years

No one is having a worse week than Tocilizumab

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@danleisman

Dan Leisman, MD, MSCR

3 years

Surgeons who’ve never seen a COVID pt IRL talking about how vaccine mandates for hospital employees are bullshit testing my self restraint again.

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@danleisman

Dan Leisman, MD, MSCR

4 years

@gueromedico Speak for yourself, I graduated with no inklings

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@danleisman

Dan Leisman, MD, MSCR

2 years

Epic doesn’t hesitate to say what it really thinks about me

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@danleisman

Dan Leisman, MD, MSCR

3 years

#anesthesiology textbooks really be like: Chapter 1 - Here is some fluffy narrative about the history of #anesthesia Chapter 2 - Here is the Newtonian basis for medical gas delivery systems

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@danleisman

Dan Leisman, MD, MSCR

2 years

Last, a fair counterpoint: “An 18g in the 💪 is >> than a 14g in the ☣️🗑” AGREE! If inexperienced w/ LB or tough stick,reasonable to 1st get small IV, then LBIV. Can have 2 ppl work on opposite arms to parallel process But in true hemorrhage/hypovolemic shock, <16g = too slow

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@danleisman

Dan Leisman, MD, MSCR

3 years

Or consider learning from the first phase of the pandemic, and not doing this.

@cameronks

Cameron Kyle-Sidell, MD

3 years

To Indian doctors: Consider administering CYPROHEPTADINE (PERIACTIN) 8mg TID to patients with severe COVID illness (hypoxemic and tachypneic) There is good physiologic rationale to support the use of this inexpensive medication 👇 @isccmsociety

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@danleisman

Dan Leisman, MD, MSCR

2 years

❓Is Angiotensin-II an immuno-modulator? ❓Does it promote bacterial defense? Check out this years-long team science effort in @PNASNews 🧵 @JamiePrivratsky @MGoldbergLab @mghmedres @MGH_PCCM @mgh_id @MGHMedicine @MGHanesthesia #FOAM #FOAMcc #FOAMed

Tweet card media

Angiotensin II enhances bacterial clearance via myeloid signaling in a murine sepsis model | PNAS

Sepsis, defined as organ dysfunction caused by a dysregulated host-response to infection, is characterized by immunosuppression. The vasopressor no...

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@danleisman

Dan Leisman, MD, MSCR

5 years

(1/ ) Let's do a thread on this. Great question that lets us speak a lot of what is and is not known about #sepsis . Let's start with some of the assumptions in the way this is asked, since some of them may not hold up. #medtwitter #FOAMed

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