QTmeds

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You're right for low risk patients with no other medications that could interact with QT interval or CYP3A4 or electrolytes. But for high risk patients or polymedicated ones, I'd still recommend an EKG Check QTMeds.com, to analyze your prescription against QT prolongation !

🚫If you’re still recommending routine ECGs before starting ciprofloxacin in all patients — please stop. This is outdated practice.🚫 QT risk is low in patients without risk factors, and blanket screening adds no value. ECG should be reserved for high-risk patients after proper risk assessment.

@simplify_drugs Both cover anaerobic germs But some times for deep anaerobic infection you might want to add metronidazole for better penetration

Why combo of piperacillin/tazobactam with metronidazole is usually noted required 🤔

@drsthanus There is a nice Luftsichel sign around aortic knob and a pneumothorax

What are two important findings in this chest radiograph?

@DrAkhilX Osborn wave seen in hypothermia

ECG finding of a homeless man brought into the ED in an unresponsive state. What is it❓️

@NephroP Oh you're right ! I didn't notice the scale was inverted 😂

@QTmedics x.com/NephroP/status…

#POCUS #VExUS quiz Likely interpretation of this portal vein color Doppler? POLL in thread below 👇 #Nephmadness #Nephpearls

@icmteaching Absolutely agree, that's why I also reduce the wall filter to get the clearer signal possible. I might include this in my VExUS simulator, check VExUS.qtmeds.com

This is a really important Doppler physics point that influences how you interpret renal doppler signals in VExUS. What you are seeing here is not a physiological change in renal venous flow. It's a change in Doppler sensitivity. The velocity scale on colour or PW Doppler is essentially the PRF (pulse repetition frequency). When the scale is set high, the system is tuned to detect higher velocities and very slow flow may fall below the detection threshold. When that happens, the slower parts of the venous waveform simply disappear from the display. The result is that only the faster portions of the waveform are visible, which can make flow appear interrupted or pulsatile. If you progressively lower the scale, the machine becomes sensitive to lower velocities and those previously invisible parts of the waveform reappear. The same flow can therefore go from: no visible flow → interrupted flow → continuous flow purely as a function of Doppler settings, not physiology. This matters because renal venous velocities are extremely low (often just a few cm/s), so inappropriate scale settings can easily create pseudo-pulsatility. For renal venous Doppler the scale therefore needs to be reduced until low-velocity venous flow is fully visible (while avoiding noise). Only then can waveform morphology be interpreted. The important implication is that some apparent renal venous “pulsatility” may reflect machine sensitivity rather than true flow interruption. This is something that I have not seen discussed in the VExUS literature. @ThinkingCC @khaycock2 @NephroP @ArgaizR thoughts?

@jrkott27 Great thread 👏 Take a look at VExUS.qtmeds.com, it's a VExUS waveforms simulator, to help people understand how the waves change according to congestion status !

Our patient? 🧪📉 🔴 Portal Vein: >50% Pulsatility 🔴 Intrarenal Vein: Loss of systolic flow This is #VExUS Grade 3! 🚨🌊 Despite being "net even" and having no peripheral edema, the kidneys are congested. This isn't just ATN! It's Congestive Nephropathy.

We dove deep into the data for the #NephMadness POCUS Region this year, but let's talk real-world implementation 👴CKD3b 🫁 Septic shock 💧 3 days in, "net even," no edema. On RA 📉 Cr 3.3 ➡️ 4.5. Easy diagnosis of ATN, right? Fluids? Diuretics? Watch and Wait? or #POCUS! 🧵👇

@nickmmark Yup ! To achieve correct decongestion, one must pee more sodium than ingested. Sodium restriction makes sense perfectly

There’s better evidence for sodium restriction than for fluid restriction…

@DrMedica_13 Synchronised cardioversion

Did u know?

@modernHealthMe HyperK

CKD patient presents with weakness. ECG 👇🏻 Most likely diagnosis? A) VT B) Hyperkalemia C) Atrial flutter D) Torsades

@Mario_Sneh Team B, think ecology !

Are you Team A or Team B?🌚👀

@NephroP Thank you for your valuable input ! You're a reference regarding VExUS exams & will implement this ASAP

Very cool work! It might be worth changing “volume overload” to “congestion” to better reflect congestion from multiple causes. Also, when severe TR is selected, the intrarenal Doppler waveform remains normal, which would be uncommon in real-life scenarios. In addition, elevated intra-abdominal pressure typically produces a dampened, less pulsatile, or flattened hepatic vein Doppler waveform. CC @khaycock2

#nephmadness #POCUS

@simplify_drugs Aspirine !

Which NSAID use is associated with Reye’s syndrome?

@drabdulhameed07 Flumazenil !

Antidote for benzodiazepine overdose? A. Naloxone B. Flumazenil C. Atropine D. Physostigmine

@modernHealthMe I would still go for syncrhonised cardioversion, because id the shock is delivered right at the T wave, the patient will for sure be in Vfib

A patient collapses in emergency room. No pulse felt. ECG 👇🏻 Best next step? A. Synchronized cardioversion B. IV amiodarone C. Immediate defibrillation D. IV adenosine

@simplify_drugs Sulbactam !

Which of the following beta lactamase inhibitor is more likely to have direct effect on Acinetobacter? Clavulanic acid Tazobactam Avibactam Sulbactam

Nice idea ! I also created something similar, a VExUS simulator at VExUS.qtmeds.com, tell me what you think about it !

@IhabFathiSulima Brugada pattern

What is the Lethal ECG Pattern?