Marshall Nickel, MD

Family medicine physician with diverse medical experience spanning primary care, hospital, military, urgent care/ER, telemedicine, and medical tech.

[Marshall Nickel, MD @msnickelmd]

https://t.co/8BFhFpKQnw

[Marshall Nickel, MD @msnickelmd]

T2DM not at goal on metformin? ACP 2024 (strong rec): add an SGLT2i (↓ death, MACE, CKD progression, HF hospitalization) or a GLP-1 RA (↓ death, MACE, stroke). Skip the DPP-4i: no morbidity or mortality benefit. https://t.co/8WNXykik7a

[Marshall Nickel, MD @msnickelmd]

Bleeding scores (e.g., HAS-BLED) shouldn't be used alone to deny anticoagulation. Use them to find and fix modifiable bleeding risks (BP, NSAIDs, alcohol, etc.).

2023 ACC/AHA/ACCP/HRS AF Guideline: https://t.co/wedyxBHh0a

[Marshall Nickel, MD @msnickelmd]

AFib pearl: Anticoagulate when annual stroke risk is ≥2% (≈CHA₂DS₂-VASc ≥2 in men, ≥3 in women). Choose a DOAC over warfarin unless there's a mechanical valve or mod-severe mitral stenosis. Aspirin ± clopidogrel is NOT stroke prevention in AF. 🧵

[Marshall Nickel, MD @msnickelmd]

Skip the routine vitamin D level. Endocrine Society 2024: no routine 25(OH)D testing (even w/ obesity or darker skin) and no D above the DRI for healthy adults <75. Do suggest empiric D for ages 1–18, ≥75, pregnancy, and high-risk prediabetes. https://t.co/liAQrpCm7m

[Marshall Nickel, MD @msnickelmd]

In the 3,121-patient derivation cohort, the 5 high-risk factors were 100% sensitive for needing neurosurgical intervention. Rule excluded patients on anticoagulants, under 16, or with seizure/focal deficits. Stiell, Lancet 2001: https://t.co/QooRCSWLVC 2/2

[Marshall Nickel, MD @msnickelmd]

Minor head injury, adult, GCS 13-15 with LOC/amnesia/disorientation? Canadian CT Head Rule says CT if any: GCS <15 at 2 h, suspected open/depressed skull fx, basal skull fx signs, vomiting >2x, age >65, pre-impact amnesia >30 min, dangerous mechanism. 1/2

[Marshall Nickel, MD @msnickelmd]

Influenza: Start antivirals ASAP for suspected flu if hospitalized, severe, or high-risk (≥65, <5, pregnant, chronic disease). Don't wait for tests; treat even >48h if hospitalized/severe. Uncomplicated: oseltamivir 75 mg BID x5d or 1-dose baloxavir. CDC: https://t.co/DmxC892hJ8

[Marshall Nickel, MD @msnickelmd]

@rhancoug17 Agree!!

[Marshall Nickel, MD @msnickelmd]

@traviskimball @SouthwestAir Ha…assumed it was the trip coming back from the state and game not to be mentioned 😂

However, I did learn some interesting background of the not-mentioned game above…hope it’s true.

[Marshall Nickel, MD @msnickelmd]

@traviskimball @SouthwestAir Serves you right for flying cheap when you’re with your wife!

[Marshall Nickel, MD @msnickelmd]

TRUST RCT (n=737, age 65+): levothyroxine lowered TSH (3.63 vs 5.48) but changed hypothyroid symptom and tiredness scores by 0.0 and 0.4 points at 1 yr. https://t.co/n2EMaaQsvh

[Marshall Nickel, MD @msnickelmd]

Chronic insomnia pearl: CBT-I is first line for ALL adults, not a hypnotic (ACP strong rec, moderate-quality evidence). Add meds only if CBT-I alone fails, via shared decision-making on short-term benefits, harms, and costs. https://t.co/3xSh0V4Nki #FamilyMedicine

[Marshall Nickel, MD @msnickelmd]

@BenCriddleShow Who cares! Play football! Let’s go Poppinga!

[Marshall Nickel, MD @msnickelmd]

Acute migraine pearl (ACP 2025): If an NSAID alone isn't enough, ADD a triptan instead of switching (strong rec). Triptan + acetaminophen is a reasonable alternative. Treat early after onset, and avoid opioids and butalbital. #FamilyMedicine https://t.co/u1fu7KSpAB

[Marshall Nickel, MD @msnickelmd]

@traviskimball @Dronetakeoff0 Serious mic 🎤 drop!

[Marshall Nickel, MD @msnickelmd]

Acute low back pain? Most patients get better regardless of treatment. ACP: start with heat, massage, acupuncture, or spinal manipulation. If meds are wanted, use an NSAID or muscle relaxant. Acetaminophen didn't beat placebo.

https://t.co/JhI1c4UtC8

[Marshall Nickel, MD @msnickelmd]

https://t.co/jGsemL2yLc

[Marshall Nickel, MD @msnickelmd]

@BYU @jsnshep @byumedschool Love it!

[Marshall Nickel, MD @msnickelmd]

Ottawa Knee Rules - skip knee x-ray after acute trauma if NONE: age greater than or equal to 55, isolated patellar tenderness, fibular head tenderness, can't flex to 90°, or can't take 4 steps right after injury AND in clinic. Sens 98.5%, neg LR 0.05. Bachmann Ann Intern Med 2004
https://t.co/GWaQCAqJii
Bachmann's 2004 pooled review of 6 adult studies with 4,249 patients.

[Marshall Nickel, MD @msnickelmd]

Unlikely Wells DVT (score less than or equal to 1) + neg D-dimer safely skips duplex - failure rate 1.2%, rules out ~29% of patients (BMJ IPD meta, n=10,002). Avoid in cancer; add 1 pt if prior DVT. https://t.co/MAtpfFgqKf