Hi
#CardioTwitter
#MedTwitter
this is my friend
@AlexBastiany
who is now Canada’s first Black Interventional Cardiologist.
Congratulate her amazing and pioneering achievement 👏🏻👏🏻👏🏻👏🏻
I failed my first anatomy exam in
#MedSchool
. Today, I find out I passed my last board exam ever! I'm a triple board-certified specialist and a Cardiologist & Intensivist. It takes hard work... and a village 🙏.
Latissimus dorsi who?
@DFisman
Montreal intensivist here. I will respectfully disagree. Worrisome yes, Bergamo no. We are on a plateau that is not down trending. We have 200-220 pts in ICU - same for ~2wks. The issue is that ERs are being flooded by non-COVID emergencies.
Here’s hoping this tweet ages well.
@Val_Plante
@jcc_montreal
@SPVM
Où est Mme Manaï?
Combien d’attaques terroristes doit-on subir ici à Montréal avant que la représentante officielle au racisme s’annonce ou se déplace pour rencontrer des citoyens affectés?
@UofT
@global_uoft
@UTSC
@UTM
@UofTStudentLife
I am ashamed to be an alumni. Is it that difficult to unilaterally condemn terrorism, murder, rape, antisemitism, kidnapping and indiscriminate rocket launching?
Or does one need a PhD to do so?
👏🏻Ventilators👏🏻are👏🏻not👏🏻an👏🏻antidote👏🏻
Here are more valuable tools to survive an
#ICU
stay w/
#COVID
:
- Receiving care from a multidisciplinary team of specialized physicians, nurses, RTs, pharmacists, PTs, social workers etc...
- Not catching it in the first place
@Val_Plante
Merci pour ce beau message. Allez-vous condamner maintenant la démonstration haineuse d’hier? Voici une image d’hier - des bonbons distribués pour fêter le meurtre d’innocents.
9 patients with Influenza on the unit. 5 on VV-ECMO and 4 proned. EVERYONE PLEASE GET YOUR FLU VACCINE. It’s still not too late for this year!
#influenza
#flu
#vaccine
First day with family visits in my
#ICU
.
68M with agitated
#delirium
for the past week. On a bunch of PRNs. Wife has been in the room for the past few hours. He’s awake, coherent and oriented.
Did those Rx finally “kick in”?!?
Nope. With delirium,family presence >>> any Rx
1/Can interventions performed in the
#ICU
and aimed at the substitute decision-maker (SDM) improve patient or family-centred outcomes?
This is the question we sought to answer in our
#SystematicReview
&
#MetaAnalysis
published yesterday
@JAMANetworkOpen
Tonight marks my 14th & last day in self-isolation. Thankfully, I had a very mild case of
#COVID19
.
My biggest challenges? The loneliness & lack of contact w/my wife & kids. Ive always considered myself a loner but total isolation can weigh heavily on one’s mental health.
1/2
@AHousefather
@nationalpost
So what will be done?
Policymaking is an MP’s job. As a Jewish-Canadian in your riding, I am counting on you to implement concrete policies to protect Jews, combat antisemitism and appropriately prosecute hate speech.
Do all OOH cardiac arrest pts need urgent cath?
Next
@CANCARESociety
LIVE Journal Club is on Thursday, April 4 at 3:30pm EST! We'll be talking about the
#COACT
trial. The PI & two main authors will be joining us from the Netherlands.
#ICU
#CVICU
#Cardiotwitter
#Cardiology
When the radiology tech tells you she won’t do the urgent CT scan w/contrast in your 86yo patient with severe AS unless you start IV NS at 200 cc/hr.
FYI the creat was normal.
Also FYI who cares that it was normal, CIN is a myth + scan was urgent 🤬😡🤬
Did you ever ask yourself: Should I start vasopressin or norepinephrine in my hypotensive patient after cardiac surgery? If so, join us this Thursday at 3:30 PM EST LIVE on
@zoom_us
. And if you haven't lost sleep over it, you're more than welcome to join!
#ICU
#Cardiology
#CVICU
Join us at this Thursday at for a
@CANCARESociety
virtual
#JournalClub
discussing the
@JAMA_current
#FIBRES
trial. Fibrinogen versus Cryoprecipate after cardiac surgery: who won and can claim prestigious non-inferiority!
PSA: Discourage hydroxychloroquine and azithromycine. They should not be taken without medical surveillance as the risk of Long QT and fatal arrhythmia is real, especially on a global scale. That trial was preliminary, at best. We need more data.
#COVID19
As a
#raptors
fan since ‘95 I like to believe that:
I came to Toronto for Fellowship ➡️ Raptors trade for Kawhi ➡️ I bump into him in an elevator and wish him good luck in the playoffs (he said thanks) ➡️ RAPTORS WIN THE NBA CHAMPIONSHIP!!!
#WeTheNorth
Ce fut une des semaines les plus difficiles pour moi et ma communauté.
J’espère d’avoir bien représenter la communauté juive de Montréal qui est maintenant plus unie que jamais, et en tout cœur avec Israël.
Merci
@tvanouvelles
et
@elatraverse
!
Couldn’t agree with this more.
Other pseudo-indications to abolish:
- Low GCS due to toxidrome/metabolic in pts protecting airway
- For transport (if you’re so concerned, accompany the patient and bring the kit)
- Pressors increasing but otherwise all ok
What else?!
The real
#HealthcareHeroes
?
The family members of our patients.
Stuck at home, apart from loved ones, feeling nervous, lonely and completely helpless. I can’t even imagine what they are living.
@DFisman
The concern is real. It’s worrisome that despite physical distancing for almost two months, we’re not seeing a trend downwards. I would have liked to see that before considering relaxing measures.
Merci pour le RT et
@tvanouvelles
pour l’invitation. Les applaudissements, on en prendra tous (peu importe notre rôle vis à vis la pandémie) à la fin de cette histoire.
On my way to
#Houston
for the Houston Shock Symposium. I’m going to present a remarkable
#ECMO
case (with even more remarkable patient recovery). Excited to represent
@ccmtoronto
and
@CANCARESociety
and... to attend my first rodeo!
T-1 until
#CCCMTL
. I’ve met so many people and learned tremendously from the CCC over the past years. This year I’m part of the planning committee for the Cardiogenic Shock day. Hoping for a great turnout.
I thought a lot about our most vulnerable. Isolated & alone for months. It’s inhumane. We must find better ways to protect them.
And if you know someone in isolation, give them a call. It can go a long way in boosting morale, even if they’re self-proclaimed loners. 2/2
In non
#COVID
related news, I (successfully) treated alcohol withdrawal with phenobarbital IM for the first time last night.
Thanks
@PulmCrit
@adamdavidthomas
for the post/podcast.
To cool or not too cool?
Join us for a
@CANCARESociety
free Virtual Journal Club this Thursday at 3:30 PM EST to discuss the recently published landmark
@NEJM
#TTM2
trial w/first author Dr. Niklas Nielsen, joining us LIVE from 🇸🇪.
See details below for information!
Key points from our 3rd
@CANCARESociety
VJC:
1. LV unloading in VA-
#ECMO
seems to work (exact timing and modality TBD)
2. Most studies used IABP but local policies seem to dictate practice.
3. No signal for⬆️ in harm.
4. RCTs are needed!
Thanks
@barryburstein
. Next VJC April 4!
@selfdriven12
@AlexBastiany
Ya, so I'm going to disagree with you.
1. The road to interventional cardiology is hard.
2. Women in medicine are faced w/more challenges by MDs/patients.
3. BIPOC are seriously under-represented in medicine.
4. She is now a phenomenal role model for all girls, women and BIPOC.
Merci à
@tvanouvelles
et à
@PaulLarocqueTVA
de m’avoir invité afin d’expliquer la situation aux Soins Intensifs de l’Hôpital Pierre-Boucher. Effectivement, on est rendu à la limite de nos ressources les plus importantes, nos infirmières/ers.
#COVIDqc
I sent this tweet to my colleague caring for a
#COVID19
patient breathing at 18/min on 4L NP with 89% saturation. 5 minutes later...
#TwitterSavesLives
Thank you
@behnam_tehrani
for joining our
@CANCARESociety
JC. I think the most important takeaway is the value & impact of teamwork. Creating a "Cardiogenic Shock Team" led to earlier recognition of the need for MCS and significant ⬇️ in mortality (with a little help from a PAC).
Free Mechanical Ventilation course by some of the best in the world. For ICU/non-ICU docs and any HCP’s.
#cardiotwitter
make sure to register. Ping
@CANCARESociety
Free online Mechanical Ventilation course offered by
@ccmtoronto
@SMHCoEMV
"Basics of Mechanical Ventilation" from April 14-17, 2020 from 6:00-7:30pm every day.
Registration are open to all. To register kindly RSVP .
@alexgauthier92
@erickdahan
Sur les réseaux sociaux, une liste de commerces dont les propriétaires sont juifs circule pour que nos nobles citoyens les boycott. J’ai les captures d’écran.
@IsmaelSeck
Si je comprends bien: la solution définitive aux actes terroristes commis par des québécois antisémites ici est que notre PM demande un
#CessezLeFeu
à Gaza🤔
Voici une autre solution qui suit un raisonnement illogique: s’il n’y a plus de juifs, il n’y aura plus d’antisémitisme!
@TheeBlackDoctor
Can I add: AF at 100-140 doesn’t need stat cardizem IV. Regardless of the BP, the first step should be answering why is the patient tachycardic. Rapid AF in isolation is rarely the only cause of hypotension.
Come join us in 30 minutes at the Community Forum. We’ll be discussing the
#PADIS
guidelines. Not as sexy as
#ECMO
but guaranteed to improve your
#CICU
and patient outcomes.
@bariweiss
Bari, this book changed my life. You called it all in 2019, before even May 2021. It should be mandatory reading in all Jewish High Schools.
Thank you and
@TheFP
for your stellar work.
A few hours until the
@CANCARESociety
Cardiogenic shock sessions
@CriticalCareCA
. I’ll be presenting on the initial evaluation and medical management of Cardiogenic Shock. Basically everything but
#ECMO
... just as important and much less controversial!
I think ARDS at this point is semantics. Once intubated, we should be adhering to protective ventilation, PEEP optimization and proning. What is itching everyone is: what is this disease? How can one sat at 45% and be well? Will I cause harm if I intubate just for a low sat?
Ok, I have to say something, especially as I keep getting pulled into in these posts. COVID-19 causes ARDS. I keep hearing the refrain that it is not ARDS because “the compliance is normal.”
Summary of our
@CancareSociety
#COACT
@NEJM
Trial JC w/
@RaynerHartleyMD
:
In pts w/OOH cardiac arrest w/initial shockable rhythm, no STEMI and no shock, there was NO benefit of immediate vs delayed (ie after neuro recovery) angiography.
Interventional cardiologists rejoice.
One of the rare occasions you’ll see cardiologist
@LiorBibasMD
talking about the non-cardiac ACS... Excellent
@ccmtoronto
morning teaching on abdominal compartment syndrome!
@UofTSurgery
@UHN
@JayBPatelMD
@cardionerds
@CCF_PCCM
@CCFcards
@TallRoundsTM
@ACCinTouch
AI that is chronic (or maybe subacute). Acute AI (ex lealet flail/rupture) has a narrow pulse pressure and a not-so-low diastolic pressure due to reduced stroke volume and high SVR. Unlike chronic severe AI, acute AI did not have the time to adjust physiologically.
Poetic wknd on call in
#Cardiology
.
35M👷🏻♂️no PMHx w/accidental electrical shock ⚡️. Presented w/rapid AF, otherwise fine. Normal TTE. Troponin ➖.
Didn’t convert 24h later so decided to electrically⚡️cardiovert⚡️back to SR. DC on DOAC x 4 weeks.
#cardiotwitter
#medtwitter
What does today's
#CICU
look like?
Join our next
@CANCARESociety
LIVE Journal Club this Thursday Sept 5 @ 3:30 PM EST on (ID: 8442160526) to discuss the recently published
@JAMACardio
paper with authors Dr.
@EBohula
and Dr. David Morrow. See flyer below!
Do all OOH cardiac arrest pts need urgent cath?
Next
@CANCARESociety
LIVE Journal Club is on Thursday, April 4 at 3:30pm EST! We'll be talking about the
#COACT
trial. The PI & two main authors will be joining us from the Netherlands.
#ICU
#CVICU
#Cardiotwitter
#Cardiology
@emily_fri
Although Dexa-ARDS showed a benefit, I couldn’t find if any of the patients had viral pneumonia. Data with regards to steroids in influenza and SARS are consistent with a signal for harm. Keeping it for usual uses (COPDe, septic shock) until we have more data.
Join us this Thursday at our LIVE Virtual Journal Club from 3:30 PM to 4:15 PM EST with the authors of the recently published JACC paper "Standardized Team-Based Care for Cardiogenic Shock". See details in flyer and DM any questions!
Looking forward to a great day attending
#CCCongress
@SCC_CCS
.
My highlights for the day:
1. Cardiogenic Shock Program @ 10 AM
2. Neuroprognostication @ 1 PM
3. THE ANNUAL
@CANCARESociety
#CANCARECup
!!! Hosted by yours truly!
🙏🏻🙏🏻🙏🏻
Simple ARDS review for cardiologists.
#cardiotwitter
#MedTwitter
Right in time for second wave but kind of hoping it just ends up being an easy and informative read!
Great team effort led by
@RaynerHartleyMD
@alexgauthier92
Aucune surprise. Les juifs se trouvent dans l’angle mort des programmes DEI.
On n’a qu’à regarder ce qui se passe dans les campus universitaires ici et chez nos voisins du sud.
A bit late on this one but we’re failing our pts with delirium. We know it happens, we know it’s bad and we know that it leads to mortality. But our meds don’t work! I still think non-pharm measures are the way to go but here’s hoping that one day, we’ll beat it.
#delirium
#ICU
Original Article: Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness (MIND-USA)
Editorial: Dopamine Antagonists in ICU Delirium
#LIVES2018
@DavidLBrownMD
@iamritu
What about “Mixed” Cardiogenic Shock or Cardiogenic Shock with low or abnormally normal SVR (with SIRS-like physiology)? 20% of CS in SHOCK trial had low SVR.
Thank you! Technical difficulties were no match for us 👊
@RaynerHartleyMD
. Looking forward to hosting monthly Journal Clubs and hearing from national and international experts in Cardiac Critical Care. Thank you to those present incl.
@JerroldLevy
@TheRakeshArora
@seanvandiepen
Here is BEST resource for non-intensivists about to get their hands dirty with
#COVID19
in the
#ICU
. Thank you
@JennaSpring
@ccmtoronto
for getting me involved. All your hard work will make a lot of MDs less nervous (and save lives too)!
Share away!
A new ICU educational resource for clinicians who may find themselves caring for critically ill patients during the
#COVID19
pandemic. A huge thank you to all of our contributors. Please share widely and send us your feedback.
@uoftmedicine
@ccmtoronto
@emily_fri
Totally agree. We had a couple “academic days” each block in ICU fellowship
@ccmtoronto
. Great for research, meetings, presentations, wellness, appointments etc...
They make trainees feel important - like their own life/work/goals matter. Not all about the scutwork.
@laxswamy
@SCCM
@ATSCritCare
@accpchest
We use it in pure hypoxemics (similar to FLORALI population) in neg pressure rooms with full PPE.
Most that required high levels of O2 ended up tubed or in comfort care if DNR/DNI. We did have a few younger pts that were on HFNC for up to three weeks and survived to discharge.
Yes - it’s a press release
Yes - we *should* wait for the published study
But I’m optimistic for the 1st time in a while bc steroids:
- Beneficial in ARDS and severe CAP
- Retrospecitve Chinese data in favour of Solumedrol daily
- Cheap/available
Will this tweet age well?
if you're wondering whether to use dexamethasone for COVID patients requiring oxygen, the answer is *yes* (based on available evidence). let's take a step back and walk through this... (1/7)