Blessan Sebastian

Academic Hospitalist @UTSWMedCenter
@VCUHealth | @WUSTL Alum

[Blessan Sebastian @BSebastianMD]

@rvawellmd @NestlerQODay @palettala @TedRader4MD @RaslanRasha Common genetic causes: Factor V Leiden, Prothrombin mutation, Protein C or S deficiency, Antithrombin deficiency. Acquired causes: previous VTE, malignancy, recent surgery (especially if age >40), immobilization, pregnancy, drugs (OCPs, hormone replacement, tamoxifen).

[Blessan Sebastian @BSebastianMD]

@palettala @rvawellmd @RaslanRasha @TedRader4MD Each day on my IM rotation, I am reminded that I have signed up to be a life-long learner. Getting the practice reps in now and taking in every learning opportunity from our patients with a positive attitude will pay off dividends down the road! #reflectiononrounds

[Blessan Sebastian @BSebastianMD]

@palettala @NestlerQODay @rvawellmd @RaslanRasha @TedRader4MD GET SMASHED = Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypercalcemia or Hypertriglyceridemia, ERCP, Drugs. Initial txt: NPO, bowel rest, fluid replacement, pain control, nutritional support, ABx for extrapancreatic infection or in pancreatic necrosis.

[Blessan Sebastian @BSebastianMD]

@palettala @NestlerQODay @RaslanRasha @TedRader4MD @rvawellmd Complications include: Cardiac - valve insufficiency, perivalvular abscess, conduction abnormalities; Neuro - embolic stroke, cerebral hemorrhage, brain abscess, encephalitis, meningitis; Renal - kidney infarct, glomerulonephritis; MSK - osteomyelitis, septic arthritis

[Blessan Sebastian @BSebastianMD]

@NestlerQODay @palettala @rvawellmd @RaslanRasha @TedRader4MD

[Blessan Sebastian @BSebastianMD]

@palettala @NestlerQODay @rvawellmd @RaslanRasha @TedRader4MD Here's the article! It goes over multiple aspects of history, physical exam, EKG findings, and clinical decision tools for ACS and gives sensitivity, specificity, and LRs for all. Awesome data!

https://t.co/Bgczl1vRYl

[Blessan Sebastian @BSebastianMD]

@palettala @NestlerQODay @rvawellmd @RaslanRasha @TedRader4MD Found a JAMA published review of 58 studies that found: In hx, pain w radiation to both arms had highest +LR (2.6). On physical, hypotension sbp<100 had highest +LR (3.9). On EKG, ST depression was the best at +LR of 5.3. For risk factors, abnormal stress test wins at +LR of 3.1.

[Blessan Sebastian @BSebastianMD]

@rvawellmd @NestlerQODay @palettala @RaslanRasha @TedRader4MD @VCU_IMRes Cx include: Vaso-occlusive crises (acute chest, avascular necrosis femoral head, stroke); splenic infarcts leading to autosplenectomy (look for Howell-Jolly bodies); aplastic crisis with Parvovirus; renal papillary necrosis causing hematuria.

[Blessan Sebastian @BSebastianMD]

@palettala @NestlerQODay @RaslanRasha @TedRader4MD @rvawellmd In all 3 disorders, plt counts are low. TTP and ITP should have normal PT/PTT. However, TTP typically presents with anemia and schistocytes on blood smear (MAHA). DIC also results in schistocytes, but in this case PT/PTT will be elevated (consumption of all clotting factors).

[Blessan Sebastian @BSebastianMD]

@rvawellmd @NestlerQODay @palettala @VCU_IMRes @RaslanRasha @TedRader4MD As discussed in Team 2 room today with @palettala , mnemonic AEIOU: A=Acidosis, E=Electrolytes (severe or refractory hyperkalemia), I=Ingestion (ex. lithium, methanol, salicylates, ethylene glycol), O=Overload of fluid, U=Uremia (pericarditis, encephalopathy).

[Blessan Sebastian @BSebastianMD]

@palettala @NestlerQODay @rvawellmd A study from JAMA of VA pts looked at reliability of "pallor" in face, conjunctiva, or palms for anemia. Sensitivity was low (0.65), but specificity was high (0.95), suggesting that pallor may confirm anemia, but absence of pallor does not r/o anemia.

https://t.co/80bJKS00Nx

[Blessan Sebastian @BSebastianMD]

@NestlerQODay @liverprof Important Qs for history - prior GI bleed; GI symptoms including pain, change in bowel (melena), nausea/vomiting, weight loss, reflux; long term NSAID, ASA, or EtOH use; potential causes of cirrhosis such as hepatitis, alcohol, drug use; recent GI procedures/surgeries.

[Blessan Sebastian @BSebastianMD]

@NestlerQODay @jaideeppatelmd @JCook2035 @cderekleiner @NateWarnerMD This cross-sectional analysis of a pop. sample (n=4885) aged 50+ with self-reported syncope and falls found that AFib was sig. associated w syncope (OR=2.0). When stratified by age, it was strongest in 50-64 yo. AFib could be a risk indicator for falls!

https://t.co/3VXeY2qsiE

[Blessan Sebastian @BSebastianMD]

@NestlerQODay Interestingly, this recent meta-analysis of 13 studies with 11,144 participants found that Procalcitonin has the highest likelihood ratio and specificity. However, it is also the least sensitive! *CXR was not assessed as a diagnostic tool in this study.

https://t.co/dNwc14K8ne