Matthew Lyons

Fresh faced Pulm/CC fellow @StanfordMed, Internal Medicine/Pediatrics grad from @OSUWexMed and @Nationwidekids

[Joel M. Topf, MD FACP @kidney_boy]

We need to know if it is alkalosis or acidosis, so we ordered an ABG.

[Intensive Care Medicine @yourICM]

Neurally adjusted ventilatory assist vs lung-protective MV in acute respiratory failure from several etiologies, multicenter RCT:
NAVA associated with increased ventilator-free days & decreased duration of MV, although it did not improve survival. #FOAMcc https://t.co/ZU1I32u7sl

[Matthew Lyons @lyonscrit]

Me two weeks into fellowship

[Matthew Lyons @lyonscrit]

@AkshayVijayara1 Ya or CPT for bronchiolitis. Population may not extrapolate to individual patient. Routine is the not the same as patient tailored

[Matthew Lyons @lyonscrit]

Well so much for my fond feelings towards aggressive initiation of RRT

[Paul Young @DogICUma]

The @STARRTAKI trial led by @drseanbagshaw & @DrRonWald has been published today in the @NEJM
https://t.co/rknUvbr7xD

Accelerated initiation of RRT did not reduce day 90 mortality but it increased the chances of dialysis-dependence at day 90 (NNH approx 23).

[Matthew Lyons @lyonscrit]

@AkshayVijayara1 Hmm pH is down to 7.0 and tele is sin wave, I guess we can...🤷🏻‍♂️

[Matthew Lyons @lyonscrit]

And they stuck the landing!

[Preeti Cho @preeti_cho]

The mitral applause

[Matthew Lyons @lyonscrit]

@AkshayVijayara1 What you have stock in Chiesi

[Matthew Lyons @lyonscrit]

Friendship ended with Brilinta, now Effient is my new best friend

[Salim R. Rezaie, MD @srrezaie]

ISAR-REACT 5: Ticagrelor vs Prasugrel in ACS

-4018pts randomized
-Composite of Death, MI, or Stroke at 1 Year lower with Prasugrel > Ticagrelor
-Findings of study driven by reduction in MI, not death or stroke

https://t.co/ld1bvYNT8c

#FOAMed

[Matthew Lyons @lyonscrit]

@AkshayVijayara1 @DrM_ISeeYou 😊

[Matthew Lyons @lyonscrit]

*gulp*

[Gabriel Bosslet @gbosslet]

Final preparations for welcoming the new #PCCM fellows tomorrow and I'm reminded of the emotions of the first year of fellowship- I think this graph captures it well.
@IUPCCM @IUMedSchool @IUIntMed

[Matthew Lyons @lyonscrit]

@msiuba Cool case! Thanks for sharing

[Matt Siuba @msiuba]

Intrope trial wins!

Dobutamine was started at 5 mcg/kg/min, within 5-10 min frequent PVCs/non-sust VT were seen, so dose cut to 2.5.

Over about an hour, HR began to improve to 120s-130s. MvO2 modestly improved to 54.

[Matt Siuba @msiuba]

Fortunately, he was able to be supported without incident on MCS.

After several days, LV/RV function recovered to normal levels. He was decannulated and able to leave the hospital, neurologically intact, within 10 days.

[Matthew Lyons @lyonscrit]

@msiuba What’s the exam like at this point? UOP and lactate?

[Matthew Lyons @lyonscrit]

Quickly headed that way if not already there

[Matt Siuba @msiuba]

More info before we break:
Mentation: anxious, A/O
Urine output: adequate but downtrending
Skin: cool/clammy

Is he in shock? Recall earlier data too.

[Matthew Lyons @lyonscrit]

Either HFNC or NIPPV depending on resources available and institutional practice

[Matt Siuba @msiuba]

Unlike most MC questions, you also get to choose a therapeutic maneuver while dx is happening. What's your first choice?

More case details to follow tomorrow!

[Matthew Lyons @lyonscrit]

Put on Mr POCUS, won’t allow a underlying dx but at least rapidly allows me to get a sense of where we are at CV and resp systems while we stabilize

[Matt Siuba @msiuba]

WOB is moderately elevated.

What diagnostic manuever do you think is most important at this point?

[Matt Siuba @msiuba]

🚨 Multi-part case #Tweetorial
24y man no PMH. 3-4 days myalgias, freq diarrhea. 2L saline given on med floor -> hypox/tachypnea. COVID pend.
A 👍
B RR30-34, SpO2 92% 5L NC
❤️ MAP 90, HR 110s ->150s over 12 hrs
D Avpu
E Anxious
L CRP 58 (ULN 0.9), Cr 1.4 (no baseline), Lact 4.8

[Matthew Lyons @lyonscrit]

Yes of course, the logical solution

[Deranged Physiology @derangedphys]

The cause of the sustained respiratory alkalosis during pregnancy was investigated by feeding methylprogesterone to eleven men. [https://t.co/iJcmpizLtf]
[https://t.co/DcTfOK6juV]