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🧵#askingautistics I am planning an educational session for my team about perioperative care for autistic children (and adults) particularly for anaesthesia and recovery but happy to include pain management and intensive care. There’s literature and personal experience but 1/4

@TennesseeDx @Mr_Husky1 Not sure- in young females people use CT scans much more sparingly because of not wanting to damage their ovaries. I know many cases of missed appendicitis in young women because “it’s gynaecological” or “sh’s being hysteric”

@Mr_Husky1 I call bullshit on this story. She would have had 9 CT scans during those 4 visits. But if true it’s egregious malpractice.

Can death be prevented? Yesterday, a 17-year-old patient died from complicated appendicitis. Yes, from appendicitis. A teenager who, over approximately 10 days, visited four different health centers. She arrived with abdominal pain, distension, and a yellowish, foul-smelling vaginal discharge. She was sexually active, and at some point, she was likely treated as a gynecological case. But it was an acute abdomen. When she arrived at our center, she was in shock. Tests were performed, but before the complete results were available, her condition deteriorated. She was taken to the ICU, stabilized, and then transferred to the operating room. During surgery, approximately 3,000 cc of pus were found in her abdominal cavity. A perforated appendix. Sepsis. Two days later, she died. And this is where reality hits me. I believe that death, as the final destination, is inevitable. We are born, and one day we die. But what I do believe is that some causes of death can be prevented. Appendicitis shouldn't kill a 17-year-old patient. Abdominal pain, fever, nausea, vomiting, diarrhea in a previously healthy teenager. That diagnosis isn't complex. It doesn't require being a surgeon. It requires clinical suspicion. We surgeons operate on appendicitis. But it should be diagnosed by all clinicians. This patient sought help. Her family sought help. She was turned away time and time again. She arrived without a referral. She arrived when sepsis had already set in. And yes, perhaps her death was inevitable that same day. But it didn't have to be from appendicitis. That's what hurts. That's what shocks me. That's what shouldn't happen. Because when the diagnosis is delayed, it's not just a mistake. It's a lost opportunity to save a life.

@WilliamAird4 s.c. B12 works as well

Patient on apixaban with severe, symptomatic B12 deficiency. What do you do?

@MoraliaMaxima Dabei würde sich Techno anbieten- hat eh den gleichen Beat wie die Röhre

Wählen Sie aus und sagen Sie uns Bescheid

@wkcmd @ThinkingCC Sometimes when you consider Dobutamin+Norepi the answer might be Epi- even if you don’t want tachycardia and you don’t want to increase O2 consumption of the myocardium. It might still be the answer- low low low continuous dose

@ThinkingCC Pure inotropes like dobutamine and milrinone, while effective in some cases, may not reliably augment profoundly depressed aortic pressure and can worsen hypotension by failing to increase LV preload.

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

@IM_Crit_ Thank you! I preach this as well but it doesn’t seem to change the practice- it probably takes a generation of doctors to change a dogma like this!

At least once a week a colleague tells me that he gave fluids to a patient w a struggling RV (this week it was a patient w intermediate (very) high-risk PE) in an attempt to force the RV to generate better forward flow Thanks for participating in the discussion! #foamed #foamcc

Right ventricular (RV) involvement complicates >30% of acute inferior STEMIs, though hemodynamically significant RV infarction occurs in ~10–15% of cases. The classic teaching is that when a patient w inferior STEMI becomes hypotensive & has clear🫁on physical exam, the treatment

@The_Nanashi_O @IM_Crit_ This! I‘ve seen so many patients in RV fairure who deteriorated rapidly with IVF bolus

@IM_Crit_ Should go back to the lab as RV marginals may be blocked off — having this degree of RV failure after successful PCI raises that question. IVF bolus might be the "best next step" for boards but would probably worsen haemodynamics. Option C + systemic vasoconstriction ± MCS.

ICU - Board Review Qs: 60 yo pt admitted to the ICU because of inferior STEMI. Emergency cath: 100% proximal RCA occlusion treated successfully with stenting One hour post-PCI: dyspnea/anxiety - BP: 94/70, HR: 60/min (sinus). Phys exam: JVD (+), clear lungs, cool extremities

@AllenGreenMD1 @HMhnuey Yeah- but if it was OTC and there‘s how many pills in one pack? That’s why

@HMhnuey It’s been several years since I’ve looked this up, but it takes something like 32mg in an IV push to cause significant QT prolongation.

The gang learns about Torsades de Pointes

@DrEenfeldt I can tell you- no- eggs do NOT have the same effect neither does fiber. Sincerely, someone who tried both.

Ozempic users are eating less junk food and spending less on groceries. That's a satiety effect. GLP-1 drugs suppress appetite. But so does eating 30g of protein at breakfast. So does fiber. So does choosing whole foods over processed ones. The difference? One costs $1,000/month. The other costs $3 in eggs. We've medicalized what used to be common sense: eat food that fills you up.

@FilmUpdates This only makes the news in the rare event that they have to blow the bomb of if someone gets hurt… ir maybe if they have to evacuate a hospital- otherwise it’s just a commuting inconvenience

Exclusive new look at Theo James in David Mackenzie's 'FUZE.' An unexploded WWII bomb is discovered on a busy construction site in the centre of London. Chaos ensues as the military and police begin a mass evacuation against a ticking clock. In theaters April 24.

@GWaldmensch Großartig! Ich war auch schon im Regenwald und man versteht erstmal was „Wald“ eigentlich bedeutet wenn es kein „Forst“ ist- es ist verrückt wie ein Ökosystem ohne Menschlichen Einfluß aussieht! Ich freue mich dass du diese Erfahrung machen konntest!

🙏🏼 Eine Woche im Amazonas. 🥾 Rund um Manaus unterwegs gewesen, mit einem indigenen Guide aus dem Volk der Wapixana. Kein Empfang, keine Wege, keine Infrastruktur. Nur echte, wilde Natur. 🌱 Was dort schnell klar wird: Das ist nicht das, was wir normalerweise unter „Natur“ verstehen. Kein gestalteter Raum, keine Planung, keine Pflege und Gestaltung. Kurz: Keine Kulturlandschaft. Sondern ein System, das funktioniert, auch ohne uns. 🫨 Mit jemandem unterwegs zu sein, der dort aufgewachsen ist, ändert den Blick auf Natur, und auch das Leben, komplett. 💭 Für mich war das eine ziemlich intensive Erfahrung. Vor allem die Erkenntnis, was Natur eigentlich ist… und wie weit weg wir davon sind. Das, was wir oft als Natur bezeichnen, hat mit echter Natur nur mehr wenig zu tun. 🙇🏻‍♂️ Eine Woche und Gespräche, die hängen bleiben. Und über die ich noch lange nachdenken werde.

I took the German or Autistic diagnostic. Results: probably autistic. Wittgenstein would have gotten the same result. german.millermanschool.com Which is funny- because I’m German and probably autistic

@drkeithsiau @Ironman014 @pamchenko2 @Mota55em @grok This! In primary care I believe with proper selection of patients it’s a valuable tool to detect cancers (not only gi but also prostate) - plus spinal injury. Once in a hospital…. The donut of truth and scope will tell a different story

@Ironman014 @pamchenko2 @Mota55em @grok Not at all. In primary care, it’s still a good tool for anorectal pathology. In hospitals, eg acute medicine / surgery, its role is highly debatable.

It’s 2026. What’s your view on this?

@psypharmacopeia I would test for it when suspecting insulinoma

All these doctors out there saying you have to get a fasting insulin level, what exactly do you do with that information? Like if it’s high, but they are clearly not diabetic by any medical standard, what do you actually do with that information? What treatment does that prompt?

@mitodoc @dpaessler Das hatte ich missverstanden, ich war von Hypovolämie als therapeutischem Effekt ausgegangen! Dehydriert zu tauchen kann das Risiko für DCS erhöhen, allerdings gibt es sicherlich zu relativer Hypovolämie keine Daten- frage mich ob der Effekt trotzdem eher von der Kompression ist

@MusstduD @dpaessler Es geht um die relative Hypovolämie bei ME/CFS, wobei Tauchen (kurzfristig) anscheinend hilfreich zu sein scheint.

Zum dritten Mal Tauchurlaub mit Long COVID. Zum dritten Mal passiert das Gleiche: Nach wenigen Tagen mit täglichen Tauchgängen auf 20–30 Meter Tiefe verschwinden meine PEM-Symptome fast vollständig.

@MartinKnopp1 @dpaessler Wäre auch meine Vermutung- für Immersion reicht aber eigentlich auch das Schwimmbad- 30cm Wassersäule- fände es interessant ob 1h Aquagymnastik einen ähnlichen Effekt hat?

@dpaessler Wirkt wohl wie Ganzkörperkompressionsstrümpfe plus vielleicht bessere Sauerstoffversorgung? Kompressionsstrümpfe für die Beine alleine reduzieren ja auch PEM bzw. erhöhen den Level den man ohne crash machen kann. Und Sauerstofftherapie hilft ja auch manchen ...

@mitodoc @dpaessler Wieso Hypovolämie? Im Wasser wird zunächst primär die Vorlast erhöht (Immersionseffekt)- Hypovolämie wäre höchstens nach dem Tauchgang, wenn das Kapillarbett sich wieder füllt, sollte keine ausreichende Trinkmenge eingehalten werden

Danke für den interessanten Erfahrungsbericht! Ich kann mir vorstellen, dass es eine relative Hypovolämie ist, weil durch reduzierte (periphere) Sympathikusfunktion der Gefässtonus reduziert ist und so das Blut „wegsackt“ ähnlich einer POTS Symptomatik, was schlussendlich zu einer hypoperfusion von Gehirn und Organen führt mit PEM Symptomatik. Würde auch erklären, warum HBOT den Effekt nicht ganz erreichen kann, den sie im tiefen Wasser erfahren. Ich würde gerne mal Messungen der Gewebsperfusion ggf. mit sowas wie den MOXY Geräten sehen bei Menschen PEM vs non-PEM.

@MEFreake @dpaessler Nein die Rationale ist der erhöhte Sauerstoffpartialdruck im Blut und damit eine zellunabhängige Gewebeoxygenierung durch Diffusion

@PSHolstein @dpaessler @Gmwetz Ja

@dpaessler @Gmwetz Gibt es eigentlich Studien zu Druckkammer und LongCovid?

@nickmmark And you need to immobilize the arm on that position ir it might dislodge, at leadt that‘s hiw we‘re taught

Gotta inwardly rotate the arm when placing humeral IOs otherwise you risk damaging the biceps tendon. Tip: place the hand behind the persons back

@dysclinic @SpineNeuro CT or even xray isn’t harmless- unless the radiologist uses ultrasound …

@SpineNeuro As technology evolves, so should procedures: you don't need to go in blindly if you can get exact location with visualization. It's safer for the patient.

Why did lumbar puncture go from being a med student procedure (bc it is extremely low risk) to a procedure that can only be done by an interventional radiologist?