PRIME Procedural Research and Innovation

PRIME: Procedural Research and Innovation for Medical Educators. We aim to advance procedural research + education within Internal Medicine. R/T not endorsement

[PRIME Procedural Research and Innovation @ProcedurePRIME]

Hi #medtwitter! We’re #PRIME - a group of (mostly) Internal Medicine physicians dedicated to advancing procedural innovation, safety, and research.

Follow us for discussions around procedural technique; evidence updates, live Q&A, and more!

[PRIME Procedural Research and Innovation @ProcedurePRIME]

@DrGalenMD @ebtapper ⬇️

[Tony Breu @tony_breu]

1/16
Why does cirrhosis predispose to "bacterial translocation"?

I have long heard that this is the mechanism of spontaneous bacterial peritonitis (SBP), but I hadn't understood why cirrhosis leads to more of it.

[Or where the bacteria translocate to...]

Let's have a look.

[PRIME Procedural Research and Innovation @ProcedurePRIME]

In patients *without cirrhosis* who have culture-negative neutrocytic ascites, I treat for peritonitis when

[Nick Mark MD @nickmmark]

Interesting RCT in @NEJM about platelet transfusions prior to CVC placement in people w/ thrombocytopenia (Plt 10-50k):
- higher rate of grade 2-4 bleeding w/o Plt transfusion: 11.9% vs 4.9%
- difference driven by much more bleeding w/ subclavian lines
https://t.co/MwlDtLPxub
1/

[PRIME Procedural Research and Innovation @ProcedurePRIME]

Ensure proper training and technique

https://t.co/OEqTEdjNoo

[Journal of Brown Hospital Medicine @BrownJHM]

Obtaining intraosseus access @scientissimum #Medtwitter

[NephroPOCUS @NephroP]

#POCUS image of the day 📸
Classic example of rapid atrial swirl sign (RASS) - rapid opacification of right atrium after saline (preferably agitated but not necessary) injection. Positive test suggests correct placement of central venous catheter
#MedTwitter #Nephpearls #FOAMcc
Image courtesy: https://t.co/gRPhxWUVKK

[PRIME Procedural Research and Innovation @ProcedurePRIME]

@phlegmfighter @RabbleRouseED @ria_dancel Sure you can look solely based on time. You can also factor in the patients’ fear, anxiety, pain, inconvenience when having to reposition…

[PRIME Procedural Research and Innovation @ProcedurePRIME]

Nice description the technique here: https://t.co/zOyVqN1SHS

[PRIME Procedural Research and Innovation @ProcedurePRIME]

I use POCUS to confirm NG tube placement

[PRIME Procedural Research and Innovation @ProcedurePRIME]

Cochrane wants further study of this technique

[Katie Wiskar @katiewiskar]

Ok team. Let's talk about this mysterious, pulsatile-appearing thing in the abdomen.

Many of you were concerned that this was a massive AAA 😱😱😱

And, to be fair, that was my first split-second reaction when I scanned the patient as well.

BUT!

[PRIME Procedural Research and Innovation @ProcedurePRIME]

@TanpingWong @DrGalenMD @MFleshner301 @ria_dancel @curlypocusmd @buckeye_sanjay @katiewiskar @JosephineCool1 @ProcdocAU @IM_POCUS @G2Disrupt @cameron_baston @DrKukaracha @medmanny @EAFischer Love it! What a neat little study. Underscores the importance of using colour Doppler every time 👌🏻

[PRIME Procedural Research and Innovation @ProcedurePRIME]

One of the feared complications in thoracentesis is hemothorax due to laceration of an intercostal artery.

Let's talk about how to avoid it 🧵

[PRIME Procedural Research and Innovation @ProcedurePRIME]

@ranch_doc @DrGalenMD @MFleshner301 @ria_dancel @curlypocusmd @buckeye_sanjay @katiewiskar @JosephineCool1 @ProcdocAU @IM_POCUS @G2Disrupt @cameron_baston @DrKukaracha @medmanny @EAFischer Fantastic article; thanks for sharing!

[Carlos A. Metidieri Menegozzo MD, PhD, FACS, TCBC @carlosmenegozzo]

@ProcedurePRIME @DrGalenMD @MFleshner301 @ria_dancel @curlypocusmd @buckeye_sanjay @katiewiskar @JosephineCool1 @ProcdocAU @IM_POCUS @G2Disrupt @cameron_baston @DrKukaracha @medmanny @EAFischer Agree 100%. I've been teaching a simple approach for tube thoracostomy using ultrasound. Published it in 2018. This seems like a great opportunity to share!

https://t.co/1usxLCJhQj

[PRIME Procedural Research and Innovation @ProcedurePRIME]

@carlosmenegozzo @DrGalenMD @MFleshner301 @ria_dancel @curlypocusmd @buckeye_sanjay @katiewiskar @JosephineCool1 @ProcdocAU @IM_POCUS @G2Disrupt @cameron_baston @DrKukaracha @medmanny @EAFischer This is great! Will add to our reading list for trainees. Fantastic resource 🙌

[PRIME Procedural Research and Innovation @ProcedurePRIME]

@critconcepts They’re small arteries! I don’t have a good citation for the average velocity of flow; but lowering your Nyquist will only increase your sensitivity, and I’ve never run into trouble with excess signal. Will play around with different Nyquists and report back

[SrivatsaNagachandan @Srivatsa34]

#Usg #thoracentesis #avoidinghemothorax #upperborderoflowerrib #safeentry

[Segun Olusanya (He/Him) [email protected] @iceman_ex]

This is a nice thread on a common #pocus procedure. #foamed