Puneet Singh

525 posts

Puneet Singh

Puneet Singh

@thePuneetSquare

PulmCCM fellow. Prior Neuroscience Hospitalist. POCUS enthusiast.

Houston, TX Beigetreten Temmuz 2018
252 Folgt140 Follower
Puneet Singh
Puneet Singh@thePuneetSquare·
@PulmCrit @akatzzzzz Is there solid evidence that this benefits compared to AC in any patient centered outcome? Everything I’ve read is based on RV/LV. I refer patients who are very symptomatic with new large clots but my feeling is we are overdoing MT.
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𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊@PulmCrit·
Fresh blog: STRATIFY trial for PE Peripheral tPA infusion is EQUALLY EFFECTIVE as compared to ultrasound-assisted thrombolysis Catheter-directed thrombolysis for PE is dead We can get the same benefits with peripheral tPA infusions (w/o procedural costs & complications)...#1/2
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 tweet media
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Puneet Singh
Puneet Singh@thePuneetSquare·
@emcrit @PulmCrit For the first 24 hours in patients who come in with acidosis that’s primarily driven by renal failure. Still not indication your lactic acid of 20 patient in septic shock.
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the EMCrit Crew
the EMCrit Crew@emcrit·
EMCrit 414 - HyperCRITical - @PulmCrit on BICARICU-2 and EVERDAC. -Should we be treating acidosis with BICARB? -Are a-lines dead?
the EMCrit Crew tweet media
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Puneet Singh
Puneet Singh@thePuneetSquare·
@SeeFisch Is it still a leader in the current environment?
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Conrad Fischer
Conrad Fischer@SeeFisch·
Congratulations Sebastian. This is a wonderful accomplishment however, I would disagree with the phrase "one of" and say it is THE world's leading center for biomedical research
Sebastian Arruarana, MD@sebas_arruarana

I’m incredibly proud to announce that I #MATCHED and over the next years and will be completing my Endocrinology fellowship at the @NIH — The National Institutes of Health This is one of the world’s leading centers for biomedical research, and I’m deeply grateful for the opportunity to train, learn, and grow there. During my time at the NIH, I’ll also be pursuing a Master’s degree offered by the program, an additional opportunity they offered that will allow me to strengthen my skills as a clinician, researcher, and leader. Being so close to Washington, D.C. means I’ll also be able to continue expanding my work in health policy, advocacy, and leadership, and keep empowering the next generation of physicians — especially the international medical graduate community that has defined so much of my journey. @ProjectImg Thank you to everyone who believed in me, supported me, and walked with me on this path. Let’s keep building bridges and creating opportunities for others. The best is yet to come. 🚀

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Puneet Singh retweetet
Joel M. Topf, MD FACP
Joel M. Topf, MD FACP@kidney_boy·
this guy invented/discovered the anion gap. It was a long time before I realized the anion gap was invented/discovered. I thought it just always existed like gravity or time.
David A. Cohen@DavidACohen3

Virtual Grand Rounds this Friday @ Lankenau with #MichaelEmmett MD the Lord of Acid Base. @BrownJHM @JHospMedicine @COREIMpodcast @ACPIMPhysicians @thecurbsiders @AcidBaseIO @aniongapman @ISNkidneycare @kidney_boy

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Puneet Singh
Puneet Singh@thePuneetSquare·
@IM_Crit_ It’s mostly consolidated lung. It could be necrotizing pneumonia but very little fluid to call it empyema. You surely aren’t going to put a chest tube in there. A bronch might work better.
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IMCrit
IMCrit@IM_Crit_·
ICU - POCUS week: Patient with pneumonia, not improving:
GIF
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Puneet Singh
Puneet Singh@thePuneetSquare·
@IM_Crit_ I can’t tell which vein, whether it’s IVC or a portal vein but large thrombus
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IMCrit
IMCrit@IM_Crit_·
ICU - POCUS week: No context; just "routine" POCUS upon ICU arrival from several years ago 😳
GIF
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Puneet Singh
Puneet Singh@thePuneetSquare·
75 year old female gets transferred to you over night, patient is in shock on levophed with an up trending lactate, elevated probnp and small trop leak. She has bilateral infiltrates. What are next steps? #POCUS #pccm
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Puneet Singh
Puneet Singh@thePuneetSquare·
@MubarakAlhatemi Yes absolutely. Patient was too unstable to complete a CTA and went into refractory shock. Unfortunately wasn’t a candidate for mechanical support 2/2 to above
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Mubarak Alhatemi
Mubarak Alhatemi@MubarakAlhatemi·
@thePuneetSquare Thanks for the update. What’s cause behind the cardiogenic shock? Could the aortic dissection (type B) just be incidental?
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Puneet Singh
Puneet Singh@thePuneetSquare·
Patient gets transferred to you from a standalone ER intubated on max Levo epi and phenyl looking completely mottled. Not much info is sent with the patient. ultrasound shows this. What are your next moves
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Puneet Singh
Puneet Singh@thePuneetSquare·
@MubarakAlhatemi It was cardiogenic shock that got complicated with an aortic dissection that you can see in the other videos making mechanical support not really an option.
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Puneet Singh
Puneet Singh@thePuneetSquare·
@cardiodoc1988 That’s a pleural effusion, there’s no pericardial effusion in this video
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Lung Doc Kumar
Lung Doc Kumar@kumaranupammd·
Our editorial venture “Rare Lung Diseases: A Comprehensive Clinical Guide to Diagnosis and Management” was one of the top sellers in the field for 2023-contributions from an international panel of authors. Thank you all for the suport! amazon.com/Rare-Lung-Dise… @sujith_cherian
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Puneet Singh
Puneet Singh@thePuneetSquare·
Pro tip: if a patient is sent for a CT PE protocol and this much contrast refluxes to the liver…you prob have cardiogenic/obstructive shock
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Puneet Singh
Puneet Singh@thePuneetSquare·
@GrandmaWick Would you do VA ecmo with an aortic dissection though?
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Wick
Wick@GrandmaWick·
@thePuneetSquare Would also already be thinking if this person was an ECMO candidate/what interventions they want.
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Puneet Singh
Puneet Singh@thePuneetSquare·
@critconcepts I agree! That happens to me a lot. There is a flap in the aorta that was consistent with dissection. It’s also seen in the cross sectional view of the aorta
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Critical Concepts
Critical Concepts@critconcepts·
@thePuneetSquare I’m afraid this suffers from “probe in somebody else’s hand/guess what I’m thinking” phenomenon. From these views, it looks like aorta and looks somewhat embedded in echogenic material, so that’s the best I’ve got. Aneurysm doesn’t really fit the rest of the picture.
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Puneet Singh
Puneet Singh@thePuneetSquare·
@critconcepts There are a few other videos in the thread you may not have seen
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Critical Concepts
Critical Concepts@critconcepts·
@thePuneetSquare Hmm. Not very clear but perhaps that’s hematoma around the descending aorta. I don’t see an obvious flap but perhaps dissection. Could go with the reduced function, I guess, if involving the coronaries.
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Puneet Singh
Puneet Singh@thePuneetSquare·
@StefanKornst That’s actually lung in a pleural effusion. Differentiating the two is tricky but a pericardial effusion would extend in between the aorta and the heart
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Stefan K.
Stefan K.@StefanKornst·
@thePuneetSquare Is that a large hematoma/coagulum in that pericardial effusion? That could explain the pressor refractory State
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Puneet Singh
Puneet Singh@thePuneetSquare·
@critconcepts Not sure if you saw the other videos in the reply but there’s definitely a contraindication to mechanical support lurking about
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Critical Concepts
Critical Concepts@critconcepts·
@thePuneetSquare ECG, troponins, involve Cards. Consider echo measurements of CO and/or a PA catheter. See if you can lighten phenyl in favor of epi, dobutamine, or milrinone. Could easily need mechanical support depending on the context.
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