Austin Rezigh

Back for the 3rd and final part of this UK #tweetorial. Prior urine electrolyte tweetorials: -UK part 1: rb.gy/hlzgix -UK part 2: rb.gy/z3zh88 -UNa: rb.gy/krd14w -UCl: rb.gy/u7ylai

@ASanchez_PS Might be completely wrong, but first pass instinct was that this represents an early repolarization pattern. Would make sure there is no personal or family history of arrhythmia or sudden cardiac death, but otherwise would search for other cause of the their chest symptoms.

1. What is this ECG pattern? 🤔 2. Next diagnostic moves? 🤔

Great ECG case with @monse_reyeslo today! ⚡️ A young human presented 6 months ago for palpitations, at which time baseline ECG available. 1 month PTA, presented for pleuritic CP, worse when flat/leaning forward → ECG #2 taken → given colchicine ⊕ ibuprofen ⊕ prednisone ...

Allow us to reintroduce ourselves. We are thrilled to welcome our newly matched applicants, categorical and prelim! Congratulations, we are so lucky to have you join our program, and look forward to working together! 🤩🎉👏👏👏 #Match2026 #MedTwitter #MedStudentTwitter

Good post by a good dude.

Afterload 🧵 The physics of circulation part 5 Afterload is tricky to understand. It is not blood pressure. It is not SVR. It is not “how tight the arteries are.” To understand it, we need to separate three things that are routinely blurred.

Critical closing pressure - how it should guide personalised care If CCP is a threshold (not a pressure), the clinical aim is simple: 👉 keep arterioles open 👉 preserve flow continuity from pump → tissue Not chase MAP or SVR in isolation. doi.org/10.3390/jpm160…

This claim keeps circulating no matter how many times it’s debunked, so let’s try again. The Shrestha et al Cleveland Clinic preprint found vaccinated employees had 27% higher flu rates. Sounds damning until you learn vaccinated employees were also tested at 27% higher rates. UPenn biostatistician @jsm2334 showed that when you correct for this testing bias, test positivity was actually ~20% lower in the vaccinated group. The “negative effectiveness” is an artifact of who got swabbed, not who got sick. This is a preprint, not peer-reviewed, from one healthcare workforce in one season. Meanwhile, observational data across millions of people consistently show flu vaccines reduce hospitalizations by 40-60% depending on strain match. And while we’re here: flu shots cannot cause the flu. The injected vaccine contains no live virus. When people say “I got the flu shot and then got sick,” they either caught something else (it’s cold season), experienced a normal immune response (mild fatigue, sore arm), or were already incubating an infection before the vaccine took effect.

🧵 Afterload, resistance, and why the heart isn’t “pushing against” pressure 👇

🧵 What drives blood flow – the heart or the vessels? Eminent physiologists have argued this for decades. The disagreement survives because of imprecise causality. Here’s the resolution 👇

🧵 Inlet impedance: the missing determinant of cardiac output 1/ What really limits cardiac output: the heart or the circulation delivering blood to it? This question has sparked heated arguments between physiologists for decades. To answer it, you first need to understand inlet impedance (Zin).

🚨 FELLOWSHIP MATCH ALERT! 🚨 Our residents absolutely crushed the 2025 match: ❤️ Cardiology 🩸 Heme/Onc 🫁 Pulm/CCM 🦠 ID 🧪 Endocrinology 💩 GI 🤲 Rheumatology 🌟 And more - at some of the most prestigious programs nationwide. So proud. So grateful. So inspired. Let’s GO! 💥

🧵 Albumin in Critical Care: 70 Years, 700 Papers… Zero Benefit 1/ Albumin is the most studied fluid in critical care. Decades of trials. Endless meta-analyses. And yet – not a single clinically meaningful benefit. Here’s why the entire theory collapses once you understand Extended Starling. 👇

🔥Check out our VMR - 11/15/2025​💡Well done @CPSolvers team!!! Huge shout-out to @AjuVaniBabu for an awesome case and program insights from chiefs @abbey1a @lexileea @Rachel_DiLeo5 @mellldiaz, faculty @RezidentMD, & PD @TKapetanos 👏 #MedEd #MedTwitter clinicalproblemsolving.com/virtual-mornin…

#MedTwitter #Match2025 Are you interested in knowing more about residency programs? Tomorrow, we will feature the Allegheny Internal Medicine Residency Program @AHNIMres 🗓️When: Tomorrow ⏲️Time: 9:00 AM PST / 12:00 PM EST 💻Where: Virtual, as always.

Come check us out on the CPS VMR @ 12pm EST tomorrow, 11/15/2025 Featuring a case by @AjuVaniBabu @RezidentMD @TKapetanos @michaelturk6 @lexileea

Ascites management

Octreotide pearls 1. When a patient comes in with upper GI bleeding, you do NOT need a PPI with octreotide because “it may be an ulcer”. Both drugs raise the gastric pH to the same amount 2. Octreotide stops working after 3-6 days.

Ammonia is open to work

🧵 Part 2 — The Venous Return Curve 1️⃣ Last time, we fixed the cardiac function curve. Now let’s look at the other half of the story — venous return — and how the circulation really feeds the heart. #FOAMed #MedX #physiology

🧵 The Cardiac Function Curve — why it misleads (Part 1) 1/ The cardiac function curve is one of the most recognisable images in physiology. Unfortunately, it’s also one of the most misdrawn, mislabelled, and misunderstood. Let’s redraw it — and see what it really tells us about the circulation. #MedX #FOAMed #physiology