Derek Smith

Anesthesia | Sports | Novels | The great outdoors. Wander where the Wifi is weak.

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

The quest to prevent rebound pain: clarity or uncertainty?

• There is not a universally accepted definition of rebound pain.
• The pathogenesis of rebound pain is unknown.

@DrTimJen @Ropivacaine

#anaesthesia #MedTwitter #pain

https://t.co/dHNvaQpskc

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Rebound pain after peripheral nerve block

Pre-emptive opioids were not shown to offer meaningful benefit and, based on current evidence, appear to be the least effective among the drugs evaluated.

@SinghNP_23

#anaesthesia #regionalanaesthesia #regionalanesthesia #MedTwitter

https://t.co/409AiHrTtd

[Critical Care Reviews @CritCareReviews]

Central Venous Pressure Revisited: Physiology, Pitfalls, Misconceptions, and Modern Clinical Interpretation in Critical Care 

CCR Journal Watch
https://t.co/Sp06oA6IDG

[Critical Care Reviews @CritCareReviews]

Alveolar dysregulation of host response in pneumonia and ARDS: implications for immune modulation and infection  

CCR Journal Watch
https://t.co/Sp06oA6IDG

[Ritika Tuli @RitikaTuliMD]

Myth: “Statins cause dementia.”

It is one of the most common myths online — but the evidence doesn’t support it.

The 2012 FDA warning was based largely on anecdotal reports, not randomized trial data.

Since then, large studies involving tens of thousands of patients have consistently shown:
• no increase in cognitive impairment
• no worsening in memory testing
• no difference vs placebo

Interestingly, some studies even suggest statins may be associated with lower rates of dementia and Alzheimer disease.

Vascular disease itself contributes to cognitive decline — so preventing strokes and atherosclerosis may help protect the brain over time.

A reminder that in medicine, headlines often outlive the evidence.

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

New from our "Core Topics" series - here is a mechanistic framework for interpreting shock and hypotension!

#anaesethesia #MedTwitter

@icmteaching @PARADicmSHIFT @ICUltrasonica @Wilkinsonjonny

https://t.co/bGvetfnZIo

[Derek Smith @derekedsmith]

@cnick777 @stanfordanes @marthpodi Why are nurse anesthetists doing spine procedures? This isn’t low risk.

[Ritika Tuli @RitikaTuliMD]

#CardioNugget™

Cardiac amyloidosis = “stiff heart, slow tissue Doppler.”

Think 3 fives on TDI:
s′ < 5 cm/s → ↓ longitudinal systolic function
e′ < 5 cm/s → impaired relaxation
a′ < 5 cm/s → impaired atrial contribution

When s′, e′, and a′ are all <5, think infiltrative/restrictive physiology — especially amyloidosis.

#CardioNugget #MedEd #CardioMed #EchoFirst

[Melody Anderson, MD @anesthesiadocmd]

Sciatic nerve blockade in the supine position is highly effective for trauma patients and others unable to tolerate leg repositioning.
This video reviews lateral and anteromedial approaches to expand your regional anesthesia toolbox 💉🛠️
https://t.co/ptv1FZ9CHd

[Ritika Tuli @RitikaTuliMD]

CardioNugget 🫀

Aortic valve infective endocarditis
→ infected AR jet hits AML
→ endothelial injury + seeding
→ mitral leaflet “mycotic” aneurysm
(bulges in systole, may rupture → acute MR).

“Mycotic” is a misnomer (William Osler): refers to mushroom-like shape, not fungal cause.

#CardioNugget #MedEd #InfectiveEndocarditis #EchoFirst

[小谷祐樹 Yuki Kotani｜集中治療医 @YukiKotani5]

重症患者の気管挿管における循環動態の総説が、編集後のPDFとして見られるようになりました！
全文フリーでダウンロードできます👇
https://t.co/1ZMg6PdKBH

[Ritika Tuli @RitikaTuliMD]

#CardioNuggets 🫀

Why does SAM (systolic anterior motion) occur?

Fast LVOT flow “pulls” the anterior MV leaflet into the septum → dynamic obstruction + posterior MR

Classic settings:
HCM, hypovolemia, vasodilation, inotropes, post-MV repair, stress cardiomyopathy.

Worse: Valsalva, dehydration, nitrates
Better: fluids, β-blockers, ↑afterload

#CardioNuggets #SystolicAnteriorMotion #SAM #MedEd #CardioMed

[Derek Smith @derekedsmith]

@nickmmark @Askins_Razor @TheAirwaySite Like you said Cook catheters can oxygenate - but are also at risk of barotrauma if left in too deep (subcarinal) and at mistakenly higher flows.

[Ritika Tuli @RitikaTuliMD]

❤️ #CardioNuggets

Some exercise &gt; none.

Even small activity → big ↓ CV risk.

Guidelines:
👉 150–300 min/wk moderate OR
👉 75–150 min/wk vigorous (+ strength 2 days) (NCBI)

👉 Consistency &gt; intensity

#CardioNuggets #Prevention

[Derek Smith @derekedsmith]

@nickmmark @TheAirwaySite Honest question - advantage of this over traditional stylet?

[Aravind Palraj @Rheumat_Aravind]

Proximal vs distal RTA - easy to memorize, easy to confuse.

But in rheumatology, this distinction matters:

• Urine pH behavior
• Stones → distal RTA
• Sjögren’s = distal RTA
• UAG helps differentiate

One slide to remember 👇

#MedTwitter #Rheumatology #Nephrology #ClinicalPearls #MedEd #InternalMedicine #FOAMed @docakx @IhabFathiSulima #MedStudents #ResidencyLife #Sjögrens

[Derek Smith @derekedsmith]

@alandrummond2 Reckless and dangerous. Nobody seems to capture that before medical intervention maternal morality and neonatal mortality were not scarce occurrences. People sometimes don't like to hear the truth - sorry if it hurts, but its entirely selfish to do this.

[NEJM @NEJM]

Original Article: Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults (RSI trial) https://t.co/KjMmYm2WSD

#Pulmonology #CriticalCare

[小谷祐樹 Yuki Kotani｜集中治療医 @YukiKotani5]

ノルアドレナリンが循環動態を良くする機序は血管収縮だけではありません。実は前負荷を増やす効果もあるんです。

ということを説明するのに毎回紹介している文献がこちら。ノルアドレナリンの機序が一枚で図示されていて好きなんです。
https://t.co/aGv7JJnCce

[Derek Smith @derekedsmith]

@BradSpellberg @ABsteward @DrToddLee I tried it and got non-stop cat reels and American political hatred despite being from Canada. Could never figure out how to streamline in.