xenwan
@xenwan.bsky.social
Internal medicine/Emergency Medicine 🏥
Echocardiography 🫀
POCUS 🎛️
Echocardiography 🫀
POCUS 🎛️
Reposted by xenwan
NLR needs to be interpreted in clinical context
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
a close up of a man 's face with the words dr.doctor.tumblr visible in the corner
ALT: a close up of a man 's face with the words dr.doctor.tumblr visible in the corner
media.tenor.com
September 22, 2025 at 1:35 PM
NLR needs to be interpreted in clinical context
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
look at NLR for the next thousand evals you do & it will start making sense
short version:
NLR 1-3: normal
NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF)
NLR >~20: yikes territory (sepsis?)
NLR >40: super yikes (Gram neg rods?)
Reposted by xenwan
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
November 17, 2025 at 1:30 AM
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
Reposted by xenwan
New paper out! 🚀 This study presents a model combining B-mode ultrasound (BMUS) and CEUS for accurate prediction of the macrotrabecular-massive (MTM) subtype of HCC, and explores its potential to predict recurrence-free survival (RFS).
November 15, 2025 at 4:12 PM
New paper out! 🚀 This study presents a model combining B-mode ultrasound (BMUS) and CEUS for accurate prediction of the macrotrabecular-massive (MTM) subtype of HCC, and explores its potential to predict recurrence-free survival (RFS).
Reposted by xenwan
There’s now a “Google for doctors.” OpenEvidence is fast, eerily good, and sometimes confidently wrong — so still needs supervision. Here’s how it works, and how it compares to the existing 10,000 Pound Gorilla of Medical Information, UpToDate. #IDSky open.substack.com/pub/paulsaxm...
Yes, There's Now a Google for Doctors
How AI finally delivered on my colleague’s joke — and how it’s changing the way clinicians look up medical information.
open.substack.com
October 31, 2025 at 2:28 PM
There’s now a “Google for doctors.” OpenEvidence is fast, eerily good, and sometimes confidently wrong — so still needs supervision. Here’s how it works, and how it compares to the existing 10,000 Pound Gorilla of Medical Information, UpToDate. #IDSky open.substack.com/pub/paulsaxm...
Reposted by xenwan
TRUE ‼️
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
October 28, 2025 at 11:10 AM
TRUE ‼️
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!
www.coreimpodcast.com/2023/06/28/s...
Reposted by xenwan
It feels like there has been a sea change in studies on PRBC transfusion, with newer studies often tending to favor more liberal transfusion.
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
Three recent RCTs in acute brain injury show a consistent trend favouring liberal red cell transfusion, with fewer unfavourable neurological outcomes and less cerebral ischaemia or vasospasm than restrictive thresholds. zurl.co/rtzpF
October 26, 2025 at 1:08 PM
It feels like there has been a sea change in studies on PRBC transfusion, with newer studies often tending to favor more liberal transfusion.
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC
Reposted by xenwan
“Antibiotic stewardship-induced syncope. It's a new diagnosis.”
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
October 21, 2025 at 7:02 PM
“Antibiotic stewardship-induced syncope. It's a new diagnosis.”
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28
Reposted by xenwan
This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.
October 16, 2025 at 7:26 PM
This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.
Sent to the ED by PCP for fever and “left lower lobe consolidation”. Was still waiting for chest X-Ray.
~ 1 lt of purulent fluid drained.
#POCUS #POCUSFirsr #USFirst
#ButterflyIQ
~ 1 lt of purulent fluid drained.
#POCUS #POCUSFirsr #USFirst
#ButterflyIQ
October 15, 2025 at 4:26 PM
Sent to the ED by PCP for fever and “left lower lobe consolidation”. Was still waiting for chest X-Ray.
~ 1 lt of purulent fluid drained.
#POCUS #POCUSFirsr #USFirst
#ButterflyIQ
~ 1 lt of purulent fluid drained.
#POCUS #POCUSFirsr #USFirst
#ButterflyIQ
Reposted by xenwan
DKA Tip #2: Urine dip can mislead
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
Ketones in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
October 15, 2025 at 3:33 PM
DKA Tip #2: Urine dip can mislead
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
Reposted by xenwan
antibiotic stewardship pearl:
Pneumonia patient on ampicillin-sulbactam
Blood grows Strep pneumo, sensitivity pending
Patient is improving
Sulbactam adds *nothing* to ampicillin for S. pneumo (resistance not mediated by beta-lactamase)
So you can immediately narrow to ampicillin #IDsky #EMIMCC
Pneumonia patient on ampicillin-sulbactam
Blood grows Strep pneumo, sensitivity pending
Patient is improving
Sulbactam adds *nothing* to ampicillin for S. pneumo (resistance not mediated by beta-lactamase)
So you can immediately narrow to ampicillin #IDsky #EMIMCC
a close up of a woman 's face with the word skymed written on the bottom
ALT: a close up of a woman 's face with the word skymed written on the bottom
media.tenor.com
October 11, 2025 at 3:54 PM
Reposted by xenwan
A man in his 50s seeks the ED for the umpteenth time since his abdo pain started a few years ago. He says that it’s his gallbladder, surgery has been denied because of diffuse pain and normal blood tests. Today CRP 9, Leukocytes 11. #POCUS He got his operation the next day. #EMIMCC
October 9, 2025 at 9:45 AM
Reposted by xenwan
if you’re getting a CT chest for a critically ill patient in respiratory failure of unclear etiology, it should be a CT angio to evaluate for PE (& other stuff)
sometimes being thorough is more effective than being smart
also, contrast allows evauation of cardiac chamber size & IVC reflux
sometimes being thorough is more effective than being smart
also, contrast allows evauation of cardiac chamber size & IVC reflux
a man in a black shirt is standing in front of a fire and the words do it
ALT: a man in a black shirt is standing in front of a fire and the words do it
media.tenor.com
September 29, 2025 at 3:13 PM
if you’re getting a CT chest for a critically ill patient in respiratory failure of unclear etiology, it should be a CT angio to evaluate for PE (& other stuff)
sometimes being thorough is more effective than being smart
also, contrast allows evauation of cardiac chamber size & IVC reflux
sometimes being thorough is more effective than being smart
also, contrast allows evauation of cardiac chamber size & IVC reflux
Reposted by xenwan
Pondering Penicillin? Check out this week’s KASIC pearl to learn that when it comes to Penicillin for S. aureus, Is it Aye or Nay? kymdro.org/kasic/?p=8559
#IDSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
#IDSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
September 20, 2025 at 4:07 PM
Pondering Penicillin? Check out this week’s KASIC pearl to learn that when it comes to Penicillin for S. aureus, Is it Aye or Nay? kymdro.org/kasic/?p=8559
#IDSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
#IDSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
Reposted by xenwan
Orforglipron is an oral, small-molecule, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist being evaluated for the treatment of type 2 diabetes. Research findings from the ACHIEVE-1 phase 3 trial are summarized in a new Quick Take video. nej.md/42tGbHh
September 20, 2025 at 7:01 PM
Orforglipron is an oral, small-molecule, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist being evaluated for the treatment of type 2 diabetes. Research findings from the ACHIEVE-1 phase 3 trial are summarized in a new Quick Take video. nej.md/42tGbHh
Reposted by xenwan
Is Cefpodoxime Active? Check out this week’s KASIC pearl to learn about Ceftriaxone Guided IV to PO kymdro.org/kasic/?p=8544
#IDTSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
#IDTSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
September 13, 2025 at 3:38 PM
Is Cefpodoxime Active? Check out this week’s KASIC pearl to learn about Ceftriaxone Guided IV to PO kymdro.org/kasic/?p=8544
#IDTSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
#IDTSky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs
Reposted by xenwan
Algorithm for the Management of Type B Aortic Dissection.
Read the full review by Firas F. Mussa, MD, and Panos Kougias, MD (@KougiasP): nej.md/4mKYgcb
Read the full review by Firas F. Mussa, MD, and Panos Kougias, MD (@KougiasP): nej.md/4mKYgcb
September 9, 2025 at 5:03 PM
Algorithm for the Management of Type B Aortic Dissection.
Read the full review by Firas F. Mussa, MD, and Panos Kougias, MD (@KougiasP): nej.md/4mKYgcb
Read the full review by Firas F. Mussa, MD, and Panos Kougias, MD (@KougiasP): nej.md/4mKYgcb
