@DrNasrien
That’s not the issue with APRNs. The issue is they often practice outside their scope and training and have very little oversight in terms of their training. There are absolutely excellent nurse practitioners but they should stay within the level of training and expertise.
52 yo m w/ hx of substance abuse complicated severe LV dysfunction with LV thrombus, recent PE from SVC/subclavian venous thrombosis presented 5 days post
#radialfirst
SCA with acute cool, pale, and numb hand. CTA and US c/f ulnar and radial artery occlusion. IR balked to cards.
@bpromd
@RachelRiechelm2
All these people I’m sure have never given a medication off label without a large multi-center adequately powered RCT to support its use. Hypocrites.
Great start to my interventional year at
@BCMHeart
Female in her 70s with unstable angina. Left coronary system normal. Predilated with 2.5 followed by 3.5 balloon. Difficulty with stent delivery and wanted to avoid guide extension due to proximal location of lesion. Angios below
This is a very privileged opinion. Not everyone can choose to go to a “private hospital”. This is especially true for poor minorities and undocumented immigrants who rely on safety net hospitals which are usually heavily staffed by residents. I guess we should force them.
A 91 yo patient
@Umair2017
and I performed LM PCI a few months ago celebrated his 92nd birthday today. He sent us a picture of him blowing out his birthday candles. It’s nice to get little reminders of why we do what we do.
@BCMHeart
@bcmhouston
@docHJ
@LakkisN_MD
@critconcepts
You need right sided support. Period. Your systemic MAPs are fine even though they are not pulsatile. At this point the RV failure is the main problem. Fluids will make the hemodynamics worse.
@DrJayMohan
@Allison_Dupont
Doing caths without prior ischemic testing or CCTA is a quality metric at many facilities unless it’s ACS. I rarely cath outpatients without a nuclear study and if I do I always do FFR or IVUS to document objective significance before PCI.
Our experience with STEMI in a possible COVID patient. Gown over scrubs, with lead, then sterile gown. On face N95 with surgical mask with face shield. We ended up placing a second faceshield over the head. Patient also with mask with faceshield.
#COVID2019
#cardiotwitter
@mosdefwilliam
@_criscristopher
@DanyelleSargent
Because only Trump fans can be idiots? I’m agreeing with you he’s an idiot, just to be clear. But there are equal number of idiots in both sides of political spectrum.
@Toaster_Pastry
@wedenskyeffect
Ruled out ischemia how? Negative troponin doesn’t rule out ischemia. Still deserves coronary angiography based on ECG and abnormal wall motion.
Trainees-file under “How to be judgmental without knowing or understanding the details of a case posted on social media”. Imagine how you would feel if you were so perfect.
@ReddyTheRobot
Just because we are able to do this things doesn’t mean we should. What’s the end game? A lot of resources and money for what would very likely be minimal neurological recovery.
I had an almost identical case several weeks ago. LVEDP was 14 pre intervention. Still used
@Abiomed
impella and several times during
@ShockwaveIVL
and predilation we lost pulsatility. Was able to wean and perclose post procedure without complications.
Impella or not? Bad PVD=Can’t rando in Protect 4. 68 yo, EF 30-35%. Surgical TD due to poor LAD target. What is the critical data you wanna know to decide if you support (PercAx here) vs. not? Horrible calcified LM with slow flow in LCX and RCA CTO. Will need Rota…
@ProtectedPCI
Peri-procedural MI is not the same as spontaneous MI especially in the era of high sensitivity biomarkers. Spontaneous MI is much more clinically relevant.
#ISCHEMIA
found statistically significant reduction in both CV Death/MI and spontaneous MI.
@docHJ
@LakkisN_MD
@NadeenFaza
@DrJayMohan
@JReinerMD
@drjohnm
You assume your respect is something he actually strives for. As opposed to the most of
#medtwitter
, he at least thinks analytically for himself and raises interesting questions. Is he wrong sometimes? Sure. We all are. You’re just mad he doesn’t “fall in line” like a good boy.
@drdanchoi
@Phil72637
Not true. Very inexpensive to have life insurance if you are young. Have a $5 million policy for $100 a month. People don’t get life insurance because they are lazy and shortsighted.
@SJcardio
6F L Radial access, 0.035 guide wire across with peripheral balloon ready to inflate. Angioseal with 15 minutes of manual pressure. Then DSA to make sure no bleeding. Watch for additional 15 minutes and reimage. At least 6 hours bed rest.
As someone who is conservative and has been supportive of Trump on many issues, I disagree with his executive order banning H-1B visas. Just thought I’d go on record.
I have several patients with chronic chest pain with multiple PCIs and CABG in some cases with normal subsequent ischemic evaluations (non-invasive or invasive)z They seem so surprised when I raise the question that their chest pain was never cardiac to begin with.
Outpatient. 50y F. Father died of MI at 50y. Atypical chest pain 2 months ago, radiating to left hand and fingers. Referred to CAG. 60% mid LAD stented. Pain persisted. 4 weeks later PCI dist Cx max. 50% stented. Comes to me because pain continues as it was.
Quick poll for
#cardiotwitter
. If a patient presents with AMI with culprit lesion on coronary angiogram and subsequent cardiac arrest without prior COVID symptoms but with positive test what would you list as cause of death and why?
@LakkisN_MD
@docHJ
@BaylorCardio
@BCMHeart
This! I have learned so much in my time out of training because I have to learn as I go. I use my training and intuition to solve problems daily. I think academics stunt the growth of young cardiologists, especially in procedural fields.
Doctors should be required to practice outside of academia for 2-5 years before being able to become faculty.
It would provide a perspective outside of the ivory tower, sharpen clinical skills, and disrupt the echo chamber that is academic medicine.
@yourheartdoc1
If you didn’t watch the trial how do you know there wasn’t? They tried to portray him as the aggressor to void his self defense argument. There was overwhelming evidence that the first person killed was the aggressor. It’s not illegal in Wisconsin to carry that weapon.
@DrQuinnCapers4
Any thoughts on
@choo_ek
alleged actions as outlined in the the lawsuit. Her use of race to deflect responsibility for reporting sexual assault is abhorrent.
🔺Abnormal coagulation is common in severe
#COVID19
🔺D-Dimer >1ug/dL is an independent risk factor for in 🏥 death
🔺Extensive intravascular microthrombosis seen at autopsy
🔺Rx w anticoagulation if possible
@ACCinTouch
For the past six months, he's been working with an illustrator to animate him and his girlfriend into her favorite movie
Then he filled a theater with her friends and family and popped the question
Cutest and the coolest proposal I've ever seen 😭❤
This is insane.
A bride taking wedding photos as the explosion happens in Beirut.
And she’s one of the lucky ones, fortunate to survive.
(video by Mahmoud Nakib)