choskiMD

@smarter411 Amazing

@northwoods1980 It works. Ancillary staff have to come down with the pt, no exceptions. Ordered like a routine exam and I fortunately don’t get called about it. Is it ok that radiology does them all? No.

@ChoskiMD What do you think of this process?

Radiology now appears to be the default service for lumbar punctures. Setting that aside, what are other groups doing for ICU intubated patients? For normal or smaller patients, is there a requirement that a bedside attempt be made before mobilizing the patient, nursing, RT, and equipment to Radiology? Or are requests accepted w/o that step? No questions asked? No policy?

@KyleCooperMD @SIR_ECS @SIRRFS Worsened dizziness and ataxia with upper extremity exercises!

@ChoskiMD @SIR_ECS @SIRRFS Classic steal case! What were the patients symptoms?

Diagnosis? @SIR_ECS @SIRRFS

Post intervention

@KyleCooperMD @myliuMD @IRDocFuji @RadioJin07

Complete cut off. "Percutaneous Extra anatomic needle crossover"

@cantonmeow What do you think about $ALAB?

When I bought a small position in $WULF at $2 and again at around $5-6, I thought it'd take more time to get to 0.786 log fib, and that it'll take time to push through 0.786 rather than on its first try. Consolidation is reasonable and is healthy.

@theblanketdog Unfortunately even some urban hospitals have completely given up on doing bedside LP and directly consult radiology. I’ve had neurologists tell me they are “not credentialed” to do an LP. Neurology.

Maybe doctors are partially to blame for the cost of Healthcare. I am at a rural site. I was called last night by another rural site and was asked to transfer a patient with possible meningitis to get an LP. I asked if they had tried bedside? No. Will you be trying bedside? No. Well, I'm not accepting this unless you try. The indication for image guided LP is failure of bedside LP. To transfer a patient with possible meningitis because you don't want to try an LP is insane. When I was an intern, we did these all the time. Now, I wonder how often this is happening on a daily basis? Even if it's 5 times across the country at 3k per transfer, that cost adds up.

@smbracewell @SIRRFS @SIR_ECS Great point. Always have to be conscious of the sheath position as well.

Yes, the angles are helpful. However, the problem is ergonomics , laying out a 260 cm wire from the neck, you essentially have to flip the patient upside down on the table. I did tips like this and training, while awkward, it was nice to not have to work with your hands floating in the air. @ChengaziMD @IRtmke @t_intheleadcoat

Internal jugular vein always an option if access to the groins are unavailable. Sometimes the angles getting into the pulmonary arteries are more favorable from above. #irad @SIRRFS @SIR_ECS

@ChengaziMD @smbracewell @SIRRFS @SIR_ECS I use a 6 Fr 90 degree angled pigtail. Also have used a 45 angled pigtail with backend of a curved Bentson for support. Admittedly I have not used Flash from the jugular. Although I find Triever24 to be very smooth. Added support with curved T20 for tighter angles

@smbracewell @ChoskiMD @SIRRFS @SIR_ECS Agree, although could go with 80 cm flash here. I still go groin,I find that I have more torquability and control without the 270 deg turn @ChoskiMD how do you cross the heart when going jugular?

Radiation exposure is definitely an issue in IR. There are ways to mitigate the risk, but even with the approaches many of us are taught, it’s still a problem and one we need to pay more attention to. The effects are real.

When the ECMO team on standby in the room GASP with the first clot haul, vitals return to normal 5 min later, and the CT surgeon says “looks like you don’t need me anymore” you know you’re doing something right. This right heart was on the brink of failure. Another life saved!

@myliuMD @KyleCooperMD Thanks, appreciate you!!

@ChoskiMD @KyleCooperMD My man! Strong work 🙏🏻

Recanalization of left sided SVC due to malignant obstruction. Grateful for all the lessons @KyleCooperMD 🙏. Hard work pays off in the end. #irad

@yuejianing @KyleCooperMD Abre!

@ChoskiMD @KyleCooperMD nice! what stent？

@koh1050 @dramrmaged @KyleCooperMD Thank you!

@ChoskiMD @dramrmaged @KyleCooperMD great job

@DHidlayVIR @KyleCooperMD Thank you!