PRIME Procedural Research and Innovation
@ProcedurePRIME
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PRIME: Procedural Research and Innovation for Medical Educators. We aim to advance procedural research + education within Internal Medicine. R/T not endorsement
Joined March 2022
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!
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In patients *without cirrhosis* who have culture-negative neutrocytic ascites, I treat for peritonitis when
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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/
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Ensure proper training and technique https://t.co/OEqTEdjNoo
litfl.com
Intraosseous (IO) access can be obtained using manual or drill-inserted devices for insertion of specialised needles; IO access uses the medullary space as a non collapsible entry point into the...
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#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
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Nice description the technique here:
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Cochrane wants further study of this technique
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This study found a sensitivity of 96.5% (95% CI, 88–99.6%) and a positive predictive value (PPV) of 98.2% (95% CI, 98.1–98.3%).
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Interesting, would love to hear from folks who use POCUS exclusively
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Discussion tomorrow after poll concludes :)
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I use POCUS to confirm NG tube placement
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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!
#POCUS puzzle time again: What's the large circular anechoic structure seen here? Probe is placed on the patient's abdomen in the epigastric region. Patient was in the ICU in profound shock NYD.
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@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
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One of the feared complications in thoracentesis is hemothorax due to laceration of an intercostal artery. Let's talk about how to avoid it 🧵
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One of the feared complications in thoracentesis is hemothorax due to laceration of an intercostal artery. Let's talk about how to avoid it 🧵
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This is pretty neat. Directly applies to pigtail placement. The rib is your first target. Not the space.
One of the feared complications in thoracentesis is hemothorax due to laceration of an intercostal artery. Let's talk about how to avoid it 🧵
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Thanks for reading! Would love to hear your thoughts and practice tips. Ping @DrGalenMD @MFleshner301 @ria_dancel @curlypocusmd @buckeye_sanjay @katiewiskar @JosephineCool1 @ProcdocAU @IM_POCUS @G2Disrupt @cameron_baston @DrKukaracha @medmanny @EAFischer
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More info on thoracentesis complications and how to avoid them here: https://t.co/TzfxUFgzIY
pmc.ncbi.nlm.nih.gov
Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and...
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The second one looks in our proposed needle entry location over the rib to confirm that there is no vessel in that location:
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Our practice when doing this is to take two clips: the first one confirms a vessel on the underside of the rib (where we don't want to hit)
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When doing this, it is essential to use a Doppler mode targeted to low-velocity flow. This means either using regular colour Doppler with your Nyquist set to LOW; or using Colour Power Doppler.
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