10 incredible websites that will transform your next presentation (and cost you nothing):

1/ Attending: “Sam, what is the level of bilirubin at which scleral icterus is noticeable?” Sam thinking: [1. I can make a guess, but 2. Who cares?] Seem like a familiar scenario? Let’s help this attending ask a better question.

1/10 Why is the routine use of neuroimaging for hospitalized patients with delirium a #TWDFNR? This #tweetorial is a supplement to the review published in the July 2019 issue of the @JHospMedicine https://t.co/WMX7bkBisR

2010 - The FDA releases an advisory due to complications of retained IVCF. From here, there is a modest reduction in IVCF use in the US (and an uptick in lawsuits).

2001 - the first retrievable filter becomes available in the US (Gunther Tulip - not FDA approved until 2003). IVCF use reaches a peak in 2010 where nearly 425 filters are placed per 100,000 hospital admissions in the US (Saeed et. al. JAMA 2017).

1998 - First large RCT. PREPIC looks at IVCF + AC vs AC alone in patients with acute proximal DVT. Findings: reduced acute recurrent VTE but no mortality benefit + increased risk of recurrent DVT in IVCF group. An 8-year follow-up shows similar findings.

1984 – Radiologists from @NorthwesternMed /@umnmedschool publish the first report of percutaneous placement of IVC filters using the Kimray-Greenfield IVCF via the IJ or femoral approach. More permanent filters enter the market over the decades to follow.

1973 - Shortly afterward, the stainless steel Kimray-Greenfield filter enters the market in 1973 with a much better safety profile than the Uddin filters which had an IVC thrombosis rate of 73%.

Mobin-Uddin and his group report their findings in 90 patients who had recurrent VTE despite anticoagulation, and report an overall mortality rate of 19% (not great, but better).

1967 - Dr. Mobin-Uddin and a group of CT surgeons from @umiamimedicine introduce the first IVC filter. Their umbrella filter is placed transvenously via an IJ cutdown. The device is delivered in a capsule, similar to the design used today.

🔙1936-ish- heparin is first used as AC in humans (another story on its own), and about 20 years later Warfarin enters the market as a human drug. So, from 1930 until 1967 the options for VTE ppx in patients with DVT were essentially venous ligation or anticoagulation.

1943-1945 – Surgeons Ochsner, Debakey, and O’Neil popularize IVC ligation as a treatment for DVT and PE prophylaxis.

Homans was dedicated to the craft. His deathbed words were reported to be “I deeply regret I won’t be able to see my own autopsy and find out what my left iliac artery looks like.”.

Homans pioneers femoral plication/ligation as the first real treatment for DVT to prevent VTE. Problem? Mortality is nearly 40% and recurrent VTE can occur in the contralateral femoral vein.

1934 - John Homans (of the Homans’ sign fame), a @harvardmed surgeon and father of modern vascular surgery, further advances the idea that pulmonary emboli come from lower extremity thrombus by physically putting together clots from the leg and PA at autopsy.

1868 – Armand Trousseau cites Dr. White in his Phlegmasia Alba Dolens lecture at the Hotel-Dieu, Paris that “Perhaps, in such cases...following White’s recommendation...to try to interpose a barrier between the clot and the large veins”.

1846 - Hematology OG and anti-evolutionist/germ theory doc Rudolf Virchow proposes the concept of thromboembolism: "The detachment of larger or smaller fragments from the end of the softening thrombus...are carried along by the current of blood and driven into remote vessels.".

1784 – Our story begins with Charles White, a 🏴󠁧󠁢󠁳󠁣󠁴󠁿 surgeon, who described unusual extremity swelling in postpartum women and suggested this may be due to lymphatic injury during birth. He postulated that a lymph barrier could possibly prevent the “rise” up the leg.

When you make the findings but miss the diagnosis #radres

TSC-LAM #radres