Michael Fishman

PEM Fellow @BCH | @GlassHealth Deputy Section Editor, Pediatrics | @theBCRP + @UChiPritzker Alum | #MedEd | proud husband and dog dad | he/him | views = mine

[Dereck Paul, MD @dereckwpaul]

AI CDS is here #MedTwitter #MedX

@ycombinator @Initialized @GlassHealthHQ

[Glass Health @GlassHealthHQ]

Our Glass AI CDS platform has been upgraded with a new core feature...🥁🎁

Glass Consult is our NEW clinical reference chatbot✨

Consult uses physician-validated context to answer clinical reference questions with in-text references at https://t.co/xbCxXToA9A🎊🦾

#MedX

[Michael Fishman @_FishmanMD]

#tilt Acute respiratory alkalosis can cause hypophostatemia through ⬆️ intracellular pH, which ⬆️ phosphofructokinase thus ⬆️ glycolysis, thus ⬆️ ATP production, ⬇️ intracellular phosphate and drawing in from the serum.

Should begin to resolve with normalization of pH.

[Michael Fishman @_FishmanMD]

Also friendly reminder that LR does not cause hyperkalemia and can be safely used in hyperkalemia (NS is actually worse due to its hyperchloremic metabolic acidosis...) #MedTwitter

PMID 15845718, 18569935, 22237237

[Michael Fishman @_FishmanMD]

#tilt Reminder that IV fluids are medications as well, and should be treated as such. Know what the components are (lytes, buffers, etc), what the pH is (NS is acidic!), and know effective osms (tonicity).

Be intentional about your fluid choices!

[Michael Fishman @_FishmanMD]

#tilt Why can metformin poisoning cause elevated lactate levels? 🧐

➡️ Drug accumulates in mitochondria, inhibits complex I of the electron transport chain (ETC), thus 🚫 oxidative phosphorylation. Leads to ⬆️ pyruvate ➡️ ⬆️ lactate.

[Michael Fishman @_FishmanMD]

Feedback doesn't make better doctors.

➡️Unbiased and effective feedback does.

Proud to share our small contribution to this important body of work. @OPENPediatrics @BAiyanyor @carolynhmarcus @KWarlaumont + Marcella Luercio.

https://t.co/J0lk1BQrU2

[Michael Fishman @_FishmanMD]

@KateMichelson2 @DrDanSchumacher Ariel Winn, and many others!

https://t.co/pBctWlezrA

[Michael Fishman @_FishmanMD]

#meded #tilt Fascinating paper on prospective entrustment decision making from competency committees. Want to know the main factor that CCC’s look for to entrust?

Trainees’ ability to know limits and seek help.

Asking and knowing limits is always a sign of strength. 🔑

[Michael Fishman @_FishmanMD]

BCx time to positivity (TTP) not only useful for determining contaminants, also independent predictor of ⬆️mortality. Adult studies➡️TTP=independent predictor for both Staph aureus+S. pyogenes! Use info to risk stratify! #tilt

https://t.co/sVFrT8j6IP
https://t.co/LizKusLvd2

[Michael Fishman @_FishmanMD]

#tilt Neonatal mastitis➡️full SBI work up? Retro study of >600 infants:
🔑 Low prevalence of SBI (contam BCx >> true pathogens)
- concurrent UTI/Blood/CSF rates [1.1%/0.3%/0.2%]

If well-appearing: likely no SBI testing, but admit for close 👀.

https://t.co/Wk68EF9rc8

[Michael Fishman @_FishmanMD]

#tilt Amazing in vivo study of HFNC demonstrating that it's mechanism of action ⚙️ to reduce work of breathing 🫁 is through dead space wash out, rather than PEEP. No consistent end-expiratory lung volume (EELV), tidal volume (TV) with use. #PedsICU

https://t.co/OdvfCtfyFl

[Chris “The Chiu Man" Chiu, MD @cjchiu]

For an upcoming @TheCribsiders episode, we just had a fantastic discussion with @DrPrathima and Dr. Alex Hirsch about APPENDICITIS! Unfortunately, https://t.co/UTfQk9dO9O did not do a screen grab with them on, but you can see how pumped the production team was!

[Michael Fishman @_FishmanMD]

Retrospective study, but >1000 doses of hypertonic saline through PIV in peds demonstrate overall safety of use, esp bolus. In acute situations (often when reaching for HTS), feel reassured using a PIV, but always monitor for extravasation! #tilt

https://t.co/RcY8ByeKCO

[Michael Fishman @_FishmanMD]

@therealMikeToce Such a great point, and getting more than 1mL in a nostril may not be the most pleasant either. Knowing alternative route strategies (IN, IM, etc) is so helpful to have in your back pocket.

[Michael Fishman @_FishmanMD]

#tilt Pediatric pain control, esp w/out an IV, in the ED is 🔑.

New retrospective study ➡️ safety/minimal AEs of higher dose IN fentanyl (2-5μg/kg; max 200μg) in peds, even in combination w/ IN midaz. F/u to show ⬆️pain control needed, but good start!

https://t.co/0DKV78bsSN

[Michael Fishman @_FishmanMD]

🦴Lisfranc injuries in peds:
- 💥direct blow to foot after jump/fall or forced dorsiflexion w/ rotational force
- pain/swelling at base of 1st/2nd metatarsal
- test by holding hindfoot, abduct/pronate the forefoot --> pain=concern
- 🩻 WEIGHT-BEARING films, AP/lat/oblique
#tilt

[Michael Fishman @_FishmanMD]

So honored and excited for all of the amazing humans that will be joining the @TheBCRP family! 🥳🍾🎉

What a TRULY phenomenal class of pediatricians. So excited to work with and learn from all of you!!!! 🩺

#pedsmatch2022

[Michael Fishman @_FishmanMD]

Delayed hemolytic transfusion reactions (DHTR) are rare but life threatening. Mgmt 🔑:

1) Stopping hemolysis (IVIg, steroids, eculizumab)
2) ⬆️ RBC production (EPO, iron, vitamins)
3) Optimize DO2/VO2 given critical anemia and shock-like state

#tilt

https://t.co/wHwIi0asAu

[Michael Fishman @_FishmanMD]

QTc is a vital sign for poisoned patients. Bazett formula most common (⬇️🎯 w/ extremes of HR), though ⬆️use of QT nomogram developed to link HR-QT pairs + risk for TdP/dysrhythmia. Being prospectively studied in kids, ?⬆️🎯 and true neg rate. #tilt
https://t.co/4in9E5Z3uu