Green QOD

Daily medical questions, answers, and discussion for residents and med students hailing from #TJUHospital. #foamED #meded #GreenQOD. maintained by @rjmdphilly

[Green QOD @greenQoDay]

Two pneumonia questions for today - first - risk scores - PORT vs CURB65, which is better?

Second - for Lizzy not on twitter - explain the historic trajectory of the HCAP/HAP designation and how do we think about pneumonias acquired in healthcare settings now?
#greenqod

[Green QOD @greenQoDay]

Great thread team (also showing the power of #medtwitter and #greenQOD to engage outside experts and support learning!) https://t.co/iMDY6tOtRX

[Green QOD @greenQoDay]

Terribly late! I’m sorry! Let’s talk about Tranq since we are all wondering - what does withdrawal look like? How do you manage it? What does intoxication look like? #greenQOD

[Green QOD @greenQoDay]

“Think tranq in pts who are needing unusually 🔼 doses of methadone/bup or not responding as expected to Rx, w inc BP out of proportion to underlying med issues and/or the other signs of withdrawal, presence of necrotic skin lesion(s), & in pts predominantly (+) for fentanyl.”

[Green QOD @greenQoDay]

Here’s a visual from a review arrival describing the “toxidrome” - meaning what it looks like when someone of on it. Remember this isn’t withdrawal this is intoxication.

[Green QOD @greenQoDay]

F bioavailability when taken orally is highly variable but around 50%. B is better. BUT effect let’s linger when given orally, so you might stay above the “diuretic” level longer leading to more net UOP. Hard to predict.

[Green QOD @greenQoDay]

#greenQOD see a lot of back and forth about lasix vs bumex (one to the other, PO vs IV) - what factors influence efficacy of each? In what situations does it make sense to switch from one to the other for better diuresis?
@theABofPharmaC feel free to chime in

[Green QOD @greenQoDay]

Important to remember three cut points:
1 The diuretic dose (dose at which you pee)
2 The max effective dose (above which you won’t pee more)
3 Max daily dose (where you get toxicity)

If near 2, dose more often not higher.

[Green QOD @greenQoDay]

@nephronDO @RJmdphilly @theABofPharmaC Always hear about decreased absorption of lasix with bowel wall edema. Is this specific to lasix, or true for loops more generally? Or a general statement about PO meds?

[Green QOD @greenQoDay]

@nephronDO @RJmdphilly @theABofPharmaC What do you make of this thread?
https://t.co/8sjRpUOvjQ

[Grant Turner, MD, MHA, FACP, FCCP @GrantTurnerMD]

Something that often comes up on ICU rounds it’s time to demistify - there’s no benefit in giving metolazone 30 minutes before Lasix other than delaying the administration of both (in my experience). #diuresis #PCCM

[Green QOD @greenQoDay]

https://t.co/eeAs7nGhkx

[David Juurlink @DavidJuurlink]

We owe a debt of gratitude to @PulmCrit / @EMcrit for this superb online resource about Covid-19: basic biology, infection control, diagnosis, treatment, prognosis and more. https://t.co/VViBwS11LR

[Green QOD @greenQoDay]

Similar to last thread - looking at growth vs resources. This one compared two cities, one with late social@distancing and the other with early, demonstrating positive impact on case burden. https://t.co/Cl7Rx8H8NY

[Marc Lipsitch @mlipsitch]

In places with many known & suspected COVID cases it is getting really intense. Efforts to do contact tracing are overwhelming even the top health departments https://t.co/SeI2cRoEV9. At this stage it is wrongheaded to pour exponentially growing resources into this strategy.

[Green QOD @greenQoDay]

A good thread talking through the numbers regarding covid19 and resource management. This is why we need to slow the curve.

https://t.co/f70Mtwh8fO

[Liz Specht @LizSpecht]

I think most people aren’t aware of the risk of systemic healthcare failure due to #COVID19 because they simply haven’t run the numbers yet. Let’s talk math. 1/n

[Green QOD @greenQoDay]

Here is the second thread from Seattle, GME focus:

https://t.co/EIdERiKxwq

[Jennifer Best @drjenniferbest]

John Choe, a fellow APD, had the great idea that we should share leasona from our residency program’s recent experience with the arrival of COVID-19 in Seattle with the APDIM @AAIMOnline listserv.

Adapted here for #MedTwitter Please RT!

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[Green QOD @greenQoDay]

Two great links from Seattle we can learn from. First here:

https://t.co/4gsWUItn5T