Daniel Feuer, MD

Eager to announce that I’ll be coming back home to Miami to pursue my Pulmonary and Critical Care fellowship at the @UMiamiHealth! 🌴☀️

Had a great time at ATS in San Francisco this year! #ATS2025

@jb_katz Just saw one as MICU consult. Lactate 4.5ish. N/V + abd pain. CT AP with anasarca. POCUS with LVEF ~10%. Went to CCU but did well with just afterload reduction and diuresis.

Nausea and emesis should be a vital sign…better than a CVP sometimes #cardiogenicshock #normotension ditch the zofran and consider anti-emetic dobutamine

@mdonnino @KateMBerg @PulmCrit @PulmPEEPs @BIDMCEM @MHayes_MD @tony_breu @jeremyfaust @AliRaja_MD @HarvardPulm @jandersUF Would do a quick POCUS on r hemithorax to discern pleural effusion vs collapsed lung w/ elevated diaphragm

80 yr male recovering from sepsis (off pressors/weaning from vent) s/p pigtail for pneumothorax 2 days ago now with sudden hypotension (130/80 > 70/30) and severe hypoxia (SpO2 97% on Fio2 .4/PEEP 5 to SpO2 80% despite Fio2 of 1.0/PEEP 15). CXR as seen. Thoughts?

@utswheart Ddx strongyloides, other parasites, eosinophilic PNA, hypereosinophilic syndrome, CMV?, rejection, PTLD

We're back with another Medical Mystery with Dr. Hardin! What's your diagnosis? Let us know in the comments and check back at the end of the day for the reveal. #WhatsYourDiagnosis

You asked and we delivered! Our popular Medical Mysteries series is back! Hear from E. Ashley Hardin, M.D. as she shares the mystery this year. What's your diagnosis? Check back in later this afternoon for the big reveal. #WhatsYourDiagnosis

Answer for #MedBits 2 Nebulized budesonide 4-8 mg/day

#MedBits 2 For patients with acute exacerbations of chronic obstructive pulmonary disease who have contraindications to systemic steroids, what alternative medication, route, and dose would provide similar anti-inflammatory effects?

@lucypgeridoc @WilliamAird4 I’ve seen point 2 not infrequently and the only thing I could find is a possibility of decreased platelet function (despite many having thrombocytosis)

@WilliamAird4 Agree! Prof Aird, I wonder if point 2 may be partly concomitant Vit C deficiency? In the UK we don’t test for this but I suspect it’s commoner than we realise- eg widowed older man, bruising, weakness, terrible teeth, no vegetables or fruit for years..

RANDOM OBSERVATIONS ON IRON DEFICIENCY (ID) 1. I saw a patient today who chews her tongue when iron deficient, but not when Fe stores are normal 2. I keep seeing ID patients with easy bruising 3. I see many patients with cramping of legs at night, not restless legs per se

3. (theoretical) Terlipressin alters Pulm vascular resistance. In some cases -> increased PVR -> worsens pulm hypertension/exacerbates hypoxic pulm vasoconstriction. In other cases -> decreases PVR -> impedes protective benefits of hypoxic pulm vasoconstriction (shunt)

Answer for #MedBits 1 1. Terlipressin -> metabolized to vasopressin -> increases systemic vascular resistance (V1) -> increased LV afterload -> Pulm edema 2. Terlipressin -> vasopressin -> activates V2 receptors -> H2O retention in collecting duct -> Pulm edema

#MedBits 1 What are three mechanisms responsible for terlipressin associated respiratory failure when used for hepatorenal syndrome AKI?

I’m starting a series called #MedBits, where I’ll share internal medicine-related questions that come up throughout residency. I hope to have people answer them, and I’ll post a summary of the responses, along with any answers I can find online, the following day.

@WilliamAird4 Copper deficiency would be a rare cause

CHALLENGE: An approach to normocytic anemia can sometimes feel paralyzing, requiring rote memorization of a laundry list of conditions. Below is an organizing framework that I find really useful. Can you name any condition(s) not covered by this scheme (I can, though rare😀)

#criticalcare and #nephrology X, how fast are you correcting severe symptomatic hyponatremia (<120) & what factors influence your rate of correction?

@jasonryanmd IM resident clinic at a large VA: asthma/copd, lots of chronic msk pain, mood disorders, substance use disorders, dementia, hypothyroidism, CKD, primary headache disorders, gout, peripheral neuropathy, & more

Serious question that was put to me by a student: outside of diabetes, HTN, high cholesterol, what are some chronic conditions that primary care docs manage without involving a specialist? Heart failure? Lupus? Parkinson’s? I don’t have a sense of what the average PCP is managing these days versus what gets referred out.

Proud to represent UTSW at Texas ACP and thrilled to take home 2nd place in Doctor’s Dilemma! Incredible teamwork and a great experience. #TexasACP #DoctorsDilemma #UTSW @UTSWIMchief @UTSWInternalMed @AndreeFrans @ACPIMPhysicians

ACP Texas Chapter Meeting ✔️UTSW IM 2nd place in Doctor’s Dilemma ✔️Clinical Vignette from legendary Parkland ✔️ Great talks with @ClinicianCorner @Texas_ACP @UTSWIMchief @UTSWInternalMed

@DShaywitz @EvidenceOpen @UpToDate @zakkohane @Bob_Wachter @atulbutte In my experience it’s best for specific (more research oriented) questions. For clinical recommendations, it can often draw info from articles that are 10-20 years old. You have to be specific with wording to get good results. Still very helpful and I use it daily as a resident.

Real question especially for interns/residents but also for MDs more generally: someone suggested to me that @EvidenceOpen (openevidence.com) has now largely replaced @UpToDate at least among young docs in hospitals? Any truth to this? @zakkohane @Bob_Wachter @atulbutte

An important pearl that recently came up in treating an immunocompromised patient with diarrhea