Coati

@JonW1993 Sometimes I hear colleagues take pride in their performance with a certain set of skills (physical exam, landmark lines, DL), implying they are good or great without tech and therefore don’t “need” it, but I think they’d just be even better with it

@JonW1993 I wonder how much of discourse about this.. and related topics such as US for vascular access, VL for intubation, is about struggling with the discomfort of not having ready access (or time for) modalities that have an intuitive and literature proven benefit

Classic auscultation signs really have limited utility in high resource health care settings. Important to combine pocus with traditional physical exam and clinical reasoning. Have seen countless patients with VTIs of 5, low CI but ok cap refill and adequate organ function

@aribindi @ThinkingCC @fersaurin I’m sure you’re plenty familiar with cardiogenic shock patients who decompensated despite best efforts, in which I’m not sure what exactly is to blame. I think the question is in aggregate does POCUS add any diagnostic/management accuracy, not is it perfect.

@aribindi @ThinkingCC @fersaurin a critical failure. Or misplaced confidence in a POCUS judgement leading someone not to course correct if possible. But outside of anchoring, I still think the POCUS should be judged against the decision that would be made in its absence, which could be the exact same one.

It is terrifying that 33% gave fluid to a struggling RV with an underfilled LV. Terrifying.

@aribindi @ThinkingCC @fersaurin Likely to benefit from a fluid load given some degree of right sided dysfunction on Echo. And then POCUS could inform a post test probability of fluids vs inotropes.

@aribindi @ThinkingCC @fersaurin For that ‘average doc in practice’ some guidance on making the decision about whether a particular patient would benefit from fluids could reasonably come from some POCUS. Reasonable minds could disagree on the exact parameters and the pre-test % of patients likely to benefit.

@Inamanotherapy @khaycock2 @NephroP @ThinkingCC Whether or not you feel there are cost, time or diagnostic yield or decision making reasons to POCUS someone or not is between you and the patient as it is any time you perform a maneuver or procedure or order a test.

@Inamanotherapy @khaycock2 @NephroP @ThinkingCC This is a false dilemma, it’s not either or, you can consider POCUS to be a component of or extension of the physical, not necessarily a replacement of it. That would be like saying getting imaging or labwork of any kind is pointless because the clinical exam is sufficient.

For the Specialist not trained in the Gen Med here is an important but overlooked tip for your patient's Creatinine problems: If the BUN/Creatinine ratio is >20- Give Fluids. The Creatinine will normalize after 24 hours If the BUN/Creatinine ratio is <20- Call the nephrologist. This is not your patinet to treat !

@jackdeliuc @PulmCrit Curious your thoughts @PulmCrit

@jackdeliuc @PulmCrit But I think some more discussion of the medicolegal landscape and the true diagnostic yield improvement of contrast outside of obvious vascular concerns on differential would be useful. Just saying the clinical risk is overblown/has changed isn’t enough at this stage IMO

modern IV contrast dye for CT scans isn’t neprotoxic. definitive imaging saves lives. this is so simple but people & journals & textbooks keep on messing it up.

@PerformativeM How do you even find this stuff if you don’t follow anyone

This shit is fucking A+ stuff. You can’t even make it up.

@PerformativeM Lol can I DM you or are you a public square only kinda guy

Yeah. Go outside or your little academic shit hole. You’ll be told to suck a dick moron. Because nurses can do your job. But go ahead. Do the winky face out in practice. Or you’ll be the cock suck that hides in academics forever.

@DrRazi4 @RobertHermanMD @PMcardioApp Does RCA being non dominant imply that LCX is supplying that inferior territory? Normally that would be RCA if RCA dominant?

@DrRazi4 @RobertHermanMD @PMcardioApp Nice thanks

77 y.o old lady treated with chest pain; treated as NSTEMI Delayed angiography after 24hours Great performance by @PMcardioApp #ECG #Cardiology #Medicalstudent