Will Ackley

Nephrology fellow at YNHH, husband to a rockstar OB-GYN, father to a silly and amazing little girl

[ProPublica @propublica]

Doctors at a major US insurance company deny tens of thousands of claims a month without even looking at patients’ files.

“We literally click & submit,” a former Cigna doctor told @ProPublica & @Capitol_Forum. “It takes all of 10 seconds to do 50 at a time.”

The inside story 🧵

[NephroPOCUS @NephroP]

Basic cardiac #POCUS views image acquisition flash cards.
Courtesy of Philips Healthcare
#MedEd #Nephpearls #echofirst
🧵
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[Julie Vose @DrJulieVose]

Yesterday I spent an hour and 3 phone calls to get a pre-authorization for a routine PET scan after chemotherapy. Urge Congress to #FixPriorAuth &pass the Improving Timely Access to Care Act #HR3173 #S3018, #ASCOAdvocacy

[Will Ackley @ackley_will]

@DGlaucomflecken 2) Do POCUS findings meaningfully change mgnt, for a large pericardial effusion leading to tamponade- probably yes. For detecting serious optho pathology- doesn’t sound like it.

[Will Ackley @ackley_will]

@DGlaucomflecken It sounds like @DGlaucomflecken is highlighting some important points about POCUS 1) Is Ultrasound better than the other “point of care” diagnostics available. For detecting a pericardial effusion- yes. For many optho problems- no, they have other tests/skills.

[kylie baker @kyliebaker888]

I love this, I just sat watching it for ages. It made me want to start dopplering pulmonary veins (and that is a huge achievement, I have been pondering ever since @ottawaheartrob mentioned it...)

[NephroPOCUS @NephroP]

Interesting infographic depicting various types of fluid losses and their composition.
Courtesy: 🔗https://t.co/pEEfYmbW1U
#MedEd #Nephrology #MedTwitter

[Will Ackley @ackley_will]

@DeepthiGunasek1 While it doesn't outperform IVC assessment [the IVC studies for predicting RAP >10 have AUC ranging from 0.76-0.93 (Wang paper AUC=0.84)], it could potentially be a quicker/easier way to est. RAP without sacrificing Sens/Spec.

[Will Ackley @ackley_will]

@DeepthiGunasek1 Using the carotid for identifying the IJ collapse point in the Wang et al. paper seemed arbitrary, but if similar data can be reproduced, it would be an easy IVC alternative.

[Hocus Pocus: Vassar EM Ultrasound @NuvancePOCUS]

Systematic POCUS approach to the kidney

[Urs Weber MD @UrsWeberMD]

Update from the frontline. I had 13 #COVID19 patients today. 8 were #unvaccinated, of those 3 were under 65, and they were the sickest. The other 5 were #vaccinated but haven’t had a #booster. Still haven’t seen anyone who’s gotten 3 doses in the hospital. #GetVaccinated

[Mark D. Siegel @MarkDSiegel1]

Terrifying numbers as COVID explodes in Connecticut, but still no mask mandate from @GovNedLamont. @KaminskiMed @YaleIM_Chiefs @LDavisMD

[Eduardo R Argaiz @ArgaizR]

A tale of two hearts: Physiological observations on AV shunts and congestion 🧵

These are 2 patients on IHD I saw in the outpatient clinic

🔷 Both with severe venous congestion (#VExUS = 3)
🔷 Both with tortuous brachiocephalic AV fístula

1/11

[𝗗𝗮𝗻𝗶𝗲𝗹 @TaotePOCUS]

💮Ultrasonographic Evaluation of Venous Congestion

Portal Vein Doppler #𝗩𝗘𝘅𝗨𝗦

𝗡𝗼𝗿𝗺𝗮𝗹 𝗥𝗔𝗣 𝗛𝗶𝗴𝗵 𝗥𝗔𝗣
🟩🟩🟩🟩🟧🟧🟧🟧🟥🟥🟥🟥

[Anand Swaminathan MD MPH 🏳️‍🌈🇺🇦 @EMSwami]

When I was a resident, Dr. Goldfrank would ask us the same question on every patient we saw:

"What is the lesion in the healthcare system that brought this patient to us today?"

It was a challenge to look deeper into the root cause of emergencies

[Will Ackley @ackley_will]

A ray of hope with COVID patients is that discharges after >one mo. in the ICU are deffinitely possible! The “cure” likely lies within determination and attention to the small details of daily patient care as opposed to one of the many unproven medical therapies we’re using.

[Yale New Haven Hosp @YNHH]

After 50 days battling COVID-19, Mr. Carlos Y. was finally released from the hospital! He was greeted by the loving and cheering faces of his family as he made his way out of the hospital. Thank you to our #healthcareheroes! We are #inthistogether.

[Kartik Kalra MD,FNKF,FASN @kkalra_22]

@rabihmgeha @thecurbsiders @kidney_boy Great approach !! For more on #hypernatremia read our interesting @TheSkeletonKG case on @RenalFellowNtwk
https://t.co/tnrdBDBLbC

[Will Ackley @ackley_will]

The different fluid management strategies of an inferior MI vs a massive PE has perplexed me for a while. Just listened to a great talk by @SaraCrager about RV failure. I loved her pump/pipes/tank framework! It makes so much more sense! https://t.co/Ei8yRKEkO2