Richard Moon

Why do most deaths during triathlons occur during the swimming portion, despite it being the first and shortest of all three legs? The answer might surprise you. #tweetorial #triathlete #triathlon

A good summary of carbon monoxide risks, especially in this cold season: msn.com/en-us/health/w…

@AnilMakam VBG is likely to be unhelpful, as PvO2 in a peripheral vein depends on limb blood flow, tourniquet use, etc. PvO2 in a normally oxygenated person may be extremely low.

Be skeptical of pulse oximetry in minorities since it may under recognize hypoxemia Consider a VBG or ABG if decisions hinge on oxygen levels Occurs in not just black patients, but also latinos & asians jamanetwork.com/journals/jamai… bmj.com/content/378/bm… twitter.com/AnilMakam/stat…

It’s that time of year Here are my top 12 studies from 2022 in no particular order that influence Hospital Medicine I avoided: -only abstracts (sorry SABATO & TRANSFORM-HF) -COVID since the disease as we once knew it is uncommon -Subspecialty or critical care only implications

@RyanMDJD Nice paper!

🦠Delirium is prevalent in COVID patients in ICU. 🦠However, after adjustment for covariates (critical illness, benzo/opioid exposure, age), our paper suggests that COVID is not an independent risk factor for delirium.  pubmed.ncbi.nlm.nih.gov/35845128/

I miss her very much. She was the best: physician, friend, mother, wife, role model, human. She brought her bright light and joy to everyone she encountered. ❤️ 💔 ❤️

New New England Journal of Medicine review article on treatment of decompression sickness and arterial gas embolism: nejm.org/doi/full/10.10…. #hyperbaricoxygen #decompression

Immersion-Induced Mitral Regurgitation: A Novel Risk Factor for Swimming-Induced Pulmonary Edema (SIPE) in @journal_CHEST Mitral valve regurgitation at rest can worsen during immersion and represents a novel and measurable risk factor for SIPE sciencedirect.com/science/articl…

@DukeDiveMed Fabulous review of inner ear decompression sickness vs. inner ear barotrauma by Dr. Oskari Lindfors: pubmed.ncbi.nlm.nih.gov/34897597/. This follows his excellent review of inner ear DCS: pubmed.ncbi.nlm.nih.gov/34847303/

Immersion Pulmonary Edema, Swimming-Induced Pulmonary Edema: Shortness of breath of cough during swim or dive? Navy funded study at Duke Medical Center to investigate whether SIPE risk can be reduced by sildenafil (Viagra®). For details click here: #1551294588795-1f3fa7c9-10c9" target="_blank" rel="nofollow noopener">anesthesiology.duke.edu/?page_id=84858…

More interest in lack of emergency hyperbaric care in the US: wms.org/magazine/1320/…

@ProTriathletes SWIMMING-INDUCED PULMONARY EDEMA (SIPE)? Short of breath, coughed up pink sputum or in hospital for pulmonary edema after a swim or dive? Doctors at Duke University are doing a study to determine if sildenafil prevents it. Click here: #1551294588795-1f3fa7c9-10c9" target="_blank" rel="nofollow noopener">anesthesiology.duke.edu/?page_id=84858…

Hyperbaric oxygen therapy for perianal Crohn’s: positive outcomes. Corine Lansdorp and colleagues: Alimentary Pharmacology & Therapeutics, December 16, 2020. pubmed.ncbi.nlm.nih.gov/33326623/

I am incredibly grateful to the @AASLDFoundation and all its donors during this #WeekofThanks!

@tony_breu Best drug to treat postop shivering: magnesium. It’s cheap, not controlled and has few side effects.

1/5 Why is meperidine (Demerol) particularly good at treating rigors? This is another association I learned early in training without hearing a potential mechanism. For the second installment in my fevers, chills, and rigors tweetorial follow-up, let's have a brief look.

@4hrEmergencyDoc Brigade

22yr male doing 30 min HIIT session fainted for 30 seconds. Previously fit & well. BP170/80 HR 55 GCS 15 ?cause #EDCases

@4hrEmergencyDoc If this is necrotizing fasciitis or clostridial myonecrosis consider adjunctive hyperbaric oxygen.

22yr old gardener with rose thorn scratch 3/7 ago. Started on oral Abx for cellulitis. Today collapsed with ? Seizure or ?Prolonged Rigor. HR 109 BP 100/80 BM 15.2 T39.9 ?Cause ?ED Mx #EDCases

@AndrewMMoon @IanARowe @EleanorBarnesOx @CovidHep @lucavalenti75 @Alexfornergon @EASLedu @EASLnews @mcolombo46 @jturnesv @JMPawlotsky @RuiCastroHD @BritSocGastro @ma5RN Strong leadership to promote international cooperation to work on an important problem!

@IanARowe @EleanorBarnesOx @CovidHep @lucavalenti75 @Alexfornergon @EASLedu @EASLnews @mcolombo46 @jturnesv @JMPawlotsky @RuiCastroHD @BritSocGastro @ma5RN We had a call today to discuss collaboration between the SECURE-CIRRHOSIS and Covid-Hep projects. We are working to harmonize case report forms so we can pool data and increase our impact.

New registry for patients with liver disease and COVID19 co-ordinated by @EleanorBarnesOx and colleagues @CovidHep covid-hep.net Similar to covidcirrhosis.web.unc.edu being coordinated by @AndrewMMoon Register your cases and we all can learn together #Covid_19

@tony_breu As long as sodium and chloride are excreted in approximately equal amounts, alkalosis will be maintained.

@RichardEMoon Does this provide an explanation for how the alkalosis is maintained?

1/14 How do diuretics lead to metabolic alkalosis? I often invoke "contraction alkalosis", typically as a hand-wave explanation as patients' bicarbonate increases with diuresis. Should I continue to wave my hands?

@vincristine @tony_breu @AvrahamCooperMD @Duke_Anesthesia @accpchest @DukePulmFellows @PulmonaryNews @DukeDiveMed @TriathleteMag @IRONMANtri @220Triathlon Salt water inhalation unnecessary: SIPE occurs in fresh water as well, and can be experienced in lab settings with immersed exercise on a stationary cycle ergometer.

@RichardEMoon @tony_breu @AvrahamCooperMD @Duke_Anesthesia @accpchest @DukePulmFellows @PulmonaryNews @DukeDiveMed @TriathleteMag @IRONMANtri @220Triathlon No saline inhalation bronchospasm component?

Why do most deaths during triathlons occur during the swimming portion, despite it being the first and shortest of all three legs? The answer might surprise you. #tweetorial #triathlete #triathlon

@vincristine @tony_breu @AvrahamCooperMD @Duke_Anesthesia @accpchest @DukePulmFellows @PulmonaryNews @DukeDiveMed @TriathleteMag @IRONMANtri @220Triathlon CAD is a risk factor for SIPE, but several cases of Takotsubo have been reported.

@RichardEMoon @tony_breu @AvrahamCooperMD @Duke_Anesthesia @accpchest @DukePulmFellows @PulmonaryNews @DukeDiveMed @TriathleteMag @IRONMANtri @220Triathlon Patient of mine had MI in the swim last year . Thought Takotsubo