Matt Tsai @thematttsai Twitter profile

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Matt Tsai

@thematttsai

2 years

How many times have you heard: “Patient's MAP is 50! What pressor should we start?” A 🧵on shock and pressors... /1

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Matt Tsai

@thematttsai

2 years

Took some time last week to focus on my own learning gaps regarding DIGOXIN 💊 What are its 2 main indications? How does it work for those indications? How do we monitor toxicity and how do we treat? This is what I've learned, in a tweetorial🧵(graphic at the end!) /1

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Matt Tsai

@thematttsai

2 years

Spent yesterday reviewing some common coagulation 🩸labs and their interpretations. Here is a graphic I made as a refresher🙂 Keep reading for a few additional points on PT and PTT. /1

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Matt Tsai

@thematttsai

1 year

First time on the wards as a senior resident this week, with @ShreyaTrivediMD as my attending (talk about pressure to impress)! I'm prepping a talk to my interns on Acute Kidney Injury. Here is a tweetorial 🧵 on how I think about AKI. Take-home graphics at the end!😀 /1

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Matt Tsai

@thematttsai

2 years

I am fascinated by Right❤️Catheterizations and wish I had learned how to interpret its results earlier than I did in my intern year. Sharing some of the lessons I've been taught in this graphic (thanks to @ShreyaTrivediMD for extensive feedback and support)!

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Matt Tsai

@thematttsai

2 years

First let’s review🚨SHOCK: a state of decreased perfusion enough to cause end organ damage (AKI, mental status change, elevated LFTs etc). Not all shock requires a low blood pressure, but thinking about shock in terms of low MAP can be helpful to organize its etiologies 👇 /2

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Matt Tsai

@thematttsai

2 years

Thanks for following along! 🙂 Hope you enjoyed this thread as much as I enjoyed making it. Shoutout to @BIDMC_IM PCCM Dr Ginny Brady for her feedback! /END

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Matt Tsai

@thematttsai

2 years

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Matt Tsai

@thematttsai

2 years

Dobutamine and milrinone are ino-dilators: they ⬆️ inotropy while⬇️SVR. This can be useful in structural cardiogenic ♥️ shock when poor cardiac output is the issue and afterload reduction is key to offloading the heart. See how these compare to other pressors 👇 /8

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Matt Tsai

@thematttsai

2 years

Norepinephrine is usually🥇first-line in vasodilatory shock, e.g. septic shock. It acts primarily on alpha 1 (+ some beta 1) receptors resulting in vasoconstriction with mild inotropy. Great for Low SVR states like sepsis! 👇snapshot of @SCCM Surviving Sepsis Guidelines /5

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Matt Tsai

@thematttsai

2 years

Phenylephrine is a pure alpha 1 agonist, offering vasoconstriction without any inotropy. In fact it can often cause reflex bradycardia. Ideal for Afib RVR with hypotension, in situations where cardioversion 🌩️fails or is not feasible. /11

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Matt Tsai

@thematttsai

2 years

Lastly, remember that NOT all shock should be managed with pressors. 🥤Resuscitate Hypovolemia. 🛠️Fix Obstruction. 💊Treat hypothyroidism or adrenal insufficiency. 🧐Consider mixed etiologies. /14

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Matt Tsai

@thematttsai

2 years

Contrast w/ Vasopressin, a pure vasoconstrictor by V1 receptor agonism and common adjunct to Norepi. VASST trial found no overall mortality difference in septic shock between Norepi + Vaso compared to Norepi alone…but did find benefit among 1 subgroup: less severe sepsis. /6

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Matt Tsai

@thematttsai

4 years

I've been spending this month on the infectious disease service🦠and thinking more deeply about a favorite antibiotic on the wards...vancomycin! Why do we use it and when does it *actually* work? Sharing what I've learned in a🧵 1/n #medtwitter #medstudenttwitter

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Matt Tsai

@thematttsai

2 years

Limitations to pressor effectiveness include acidosis and hypocalcemia, both of which can impair cardiac contractility and vascular tone. Acidosis can also decrease binding of vasopressors to their receptors. /13

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Matt Tsai

@thematttsai

2 years

Aside: monitoring progress on ino-dilators while also adjusting other cardiac meds can be tricky. A right heart cath can be helpful here (remember those? throwback!) 👀 /9

Matt Tsai

@thematttsai

2 years

I am fascinated by Right❤️Catheterizations and wish I had learned how to interpret its results earlier than I did in my intern year. Sharing some of the lessons I've been taught in this graphic (thanks to @ShreyaTrivediMD for extensive feedback and support)!

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Matt Tsai

@thematttsai

3 years

There's some exciting language in Congress' 5500+ page appropriations bill re: funding for new residency spots! From what I gather, this bill funds 1000 new positions (200/year) starting FY2023. One step towards addressing health equity & an impending physician shortage 1/5

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Matt Tsai

@thematttsai

2 years

In summary, recall what we discussed: 🫀Types of shock by mechanism (HR x SV x SVR = MAP) 💊Pressor choices based on that mechanism 🧐Limitations of pressor efficacy See summary graphic, next. /15

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Matt Tsai

@thematttsai

1 year

Take-home graphic (1 of 2) /19

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Matt Tsai

@thematttsai

3 years

Still in disbelief I matched IM at @BID_CMRs !! 🥳 Praise the Lord. It’s going to be an amazing next few years. #Match2021

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Matt Tsai

@thematttsai

1 year

Take-home graphic (2 of 2) /end

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Matt Tsai

@thematttsai

2 years

⭐️Knowing the underlying mechanism of shock informs our selection of pressors/inotropes, which can help correct low cardiac output or low SVR. Let’s try some cases! /3

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Matt Tsai

@thematttsai

2 years

Digoxin indirectly⬆️baroreceptor sensitivity which ⬆️vagal tone, + prolongs AV node refractory period! This works best when pts are sedentary. Making Dig a rate control option in atrial or supraventricular tachycardias, esp in decompensated HF when BB or CCB contraindicated /4

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Matt Tsai

@thematttsai

2 years

Case 1: Older man with hx diabetes admitted with several days of dysuria and lethargy. Vitals: T 101, BP 90/40, HR 110. Lactate 4. Urine cultures grow E coli 🦠. Abx started. BP unchanged after fluids. Which pressor would you start ⁉️ /4

Norepi to raise SVR

6760

Epinephrine for inotropy

355

Dobutamine for afterload

442

Phenylephrin for inotropy

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Matt Tsai

@thematttsai

1 year

🚨Some caveats: GFR can only be measured in steady state, so by definition you CANNOT determine GFR in the middle of an AKI 📈 💊 Some common drugs can impair creatinine secretion, mimicking an AKI without actual renal injury. Pip-Tazo, TMP-SMX are some examples. /4

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Matt Tsai

@thematttsai

4 years

@TxicMegacolon @UWO_Gen_Sx_PD I'm not a surgeon (just a @TxicMegacolon fan!), but here is a helpful graphic by Dr @VectorSting that paints this bigger, more worrisome picture. As COVID19 cases begin to stabilize, we must be prepared for the aftershocks

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Matt Tsai

@thematttsai

2 years

Final Case 3: a young woman develops afib RVR, rate to 150s with BP 80s/50s. Altered😵‍💫. Rate unresponsive to fluids or beta blockade. Cardioversion did not work and Cards fellow is 10 minutes away🕔. Which pressor could you use to help stabilize MAP? /10

Phenylephrine, raise SVR

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Dobutamine for inotropy

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Vasopressin, raise SVR

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Norepi, inotropy + up SVR

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Matt Tsai

@thematttsai

2 years

Moving on to Case 2: Middle aged man admitted with STEMI🫀. EF 20%. MAP in 50s. Extremities cool. Crackles in the lungs 🫁. What’s your move? /7

Vasopressin, raise SVR

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Dobutamine for inotropy

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Phenylephine, raise SVR

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Norepi for inotropy

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Matt Tsai

@thematttsai

1 year

Any of the above! @goKDIGO defines AKI as any one of those three criteria. Which means... You can have an AKI with a "normal" creatinine. It all depends on your baseline! /3

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Matt Tsai

@thematttsai

1 year

Think of the mnemonic A.E.I.O.U. Any one of these should prompt a phone call to your neighborhood nephrologist👩‍⚕️(and perhaps preparation to place a central HD line) /6

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Matt Tsai

@thematttsai

4 years

✅ just like that, my 1 month Medicine Acting Internship is over. This has hands down 👏 been my favorite course so far in med school. Grateful for the learning, laughs and confirmation. 🥳 #InternalMedAllTheWay #IMProud #StudentDoctor

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Matt Tsai

@thematttsai

1 year

Had an absolute blast teaching #infographic design to Med Educators at #NEGEA23 alongside @BIDMC_IM coresident @caseyjkim and mentor @ShreyaTrivediMD Thanks for having us!! @UVMLarnerMed @TheNEGEA

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Matt Tsai

@thematttsai

2 years

Like any medication 💊, we must remember that pressors also have their limits. Which of the following would decrease pressor efficacy? /12

Acidosis

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Alkalosis

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Hypernatremia

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Anemia

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Matt Tsai

@thematttsai

4 years

@DrPess 1. I'm Matt and I'm a rising M4 at @UVMLarnerMed and aspiring internist. 2. Current hobbies include podcasting, making spoken word videos, and exploring Ben & Jerry's ice cream flavors (in vermonter style). Thanks to soccer star @karabachev for the tag! I'm tagging @sambepstein

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Matt Tsai

@thematttsai

2 years

Digoxin Toxicity presents as: Hyperkalemia - because it ❌ the Na/K pump Bradycardia or heart block - because ⬆️vagal tone Tachyarrhythmias because of its inotropic effect ⚡️ GI Upset (most common), Vision changes If we are concerned for toxicity, how would we treat? /8

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Matt Tsai

@thematttsai

2 years

This relates to digoxin's more well-known mechanism, inhibition of the Na/K ATPase Pump! This process drives up intracellular calcium stores, which⬆️ inotropy. In other words, digoxin is a potential inotropic agent in HFrEF with NYHA III/IV symptoms despite standard GDMT /6

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Matt Tsai

@thematttsai

2 years

The good news is we have a targeted antidote: Digoxin specific antibody fragments! Indications for this include unstable arrhythmias and hyperkalemia >5. /9

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Matt Tsai

@thematttsai

4 years

✅ 4th year AIs complete ✅ Step 2 CK ✅ ERAS certified & submitted I’m anxious but excited for one of the most unusual residency application seasons in modern history. Time to zoom forward. Let’s do this! 🎙👨‍💻 #match2021 #IMProud

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Matt Tsai

@thematttsai

4 years

@TravisABenson Hey #MedStudentTwitter ! I’m a rising M4 and native Californian studying in Vermont 😎 Passionate about Internal Med, Med education Co-host of Green Mountain Medicine podcast ()! Country music fan 🎶 and happy foodie

Green Mountain Medicine | ACPVermont

Green Mountain Medicine is an original podcast series for all things internal medicine, sponsored by ACP Vermont. Hosted by University of Vermont medical students Caity Decara and Haley Bayne, this...

acpvermont.podbean.com

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Matt Tsai

@thematttsai

1 year

Day 1 of my first #ATS2023 ! Love the learning and 🫁🫀 community. @PCCSM_BIDMC @BIDMC_IM @atscommunity

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Matt Tsai

@thematttsai

3 years

What’s better than matching at @BIDMC_IM ? Matching with some awesome co-interns, then making a pun about it on Twitter 😆 @AaronTroyMD

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Matt Tsai

@thematttsai

2 years

The second (less common) indication for digoxin: HFrEF with NYHA III or IV symptomatology (ie severe symptoms with exertion or symptoms at rest). 🚨Caveat: this is a second-line agent, to be considered AFTER all standard GDMT /5

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Matt Tsai

@thematttsai

1 year

Decompensated heart failure❤️‍🔥can cause AKI from vascular congestion 🚦 limiting circulating blood volume - it's still pre-renal! And our kidneys respond the same way to HF as they would to hypovolemia: by concentrating urine (which is a helpful clue!) /10

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Matt Tsai

@thematttsai

1 year

Here is where more specialized testing like urine microscopy can be super helpful. Learn how to spin the urine or ask Nephro Bros like @themarcusfoo and @immaculatedensa to help you. /15

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Matt Tsai

@thematttsai

1 year

If you made it this far, I hope you enjoyed this virtual chalk talk. Credits to @jwilliamMD and @LaurenBurdine for feedback on my take-home graphics (scroll down to see)! Got feedback for me? Send me a DM or drop it in the comments! /17

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Matt Tsai

@thematttsai

2 years

Obviously, prevention is🔑 How? ✅Check digoxin level (does not correlate to toxicity well, but can determine compliance) 🧪Check electrolytes (hypoK ⬆️toxicity risk) 🚨Beware drug interaction 🫘 Monitor kidney fx (hence digoxin less commonly used outpt) ❤️EKG, telemetry /10

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Matt Tsai

@thematttsai

4 years

Dropped a new podcast episode today w/ @healthvermont commissioner & @ACPinternists fellow Dr. Mark Levine, on his experience combatting #COVID19 in VT as a physician in gov't. Humbled & inspired by his words. Listen w/ ApplePodcast🔹Spotify🔹GooglePlay🔹 .

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Matt Tsai

@thematttsai

1 year

He's diagnosed with acute interstitial nephritis (a topic for another day). You stop the ibuprofen and his creatinine returns to baseline. You are inspired to become a nephrologist at @BID_NephFellows 🥳Great job! /16

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Matt Tsai

@thematttsai

4 years

@karenerrichetti 1. I’m Matt! 4th year Med student in VT, podcaster and aspiring internist / Med educator 2. Most recent pandemic goal has been to sample more Ben&Jerry ice cream flavors (call it the Vermont experience) 🍨 3. @JennaDafgek @therealtwoodin

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Matt Tsai

@thematttsai

2 years

@PulmPEEPs @BID_CMRs @BidmcCvi @david_furfaro @nickmmark @MHayes_MD @RonukModi @msiuba @jbricha1

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Matt Tsai

@thematttsai

4 years

@karenerrichetti Hey! I'm Matt! 4th year med student, podcaster & aspiring internist. My inbox is full of emails lamenting these "unprecedented times." Tagging rockstars @therealtwoodin @shermieVT and @karabachev

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Matt Tsai

@thematttsai

4 years

Back in May, I tweeted about MS4 Report: a #MedEd Project I helped launch to engage @UVMLarnerMed students as we were pulled off service in the setting of COVID19. #MedTwitter Our work has since been published in Medical Science Educator 😃 🧵below 1/8

"MS4 Report": a Student-Led and Remote Model for Case-Based Learning in Preparation for Residency -...

Case-based conference preparation is a valuable skill rarely covered in medical school training. We implemented an innovative program to teach fourth-year medical students to prepare and facilitate a...

pubmed.ncbi.nlm.nih.gov

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Matt Tsai

@thematttsai

1 year

But what do those mean? Let's agree on some definitions and then walk through a case together! 🩸Pre-renal: poor circulating blood volume 🌊Renal: intrinsic nephron injury 🪨Post-renal: urinary obstruction (distal to kidneys) /8

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Matt Tsai

@thematttsai

1 year

How do you think about diarrhea in the immunocompromised patient? 🤨 Check out this nifty chart from @AaronTroyMD during @BIDMC_IM #intakerounds #clinicianeducator @BIDMC_IDFellows

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Matt Tsai

@thematttsai

1 year

Finally, for med students looking for their dream program, plz consider @BIDMC_IM . Come train with amazing co-residents like @nsrosenberg @DanielaarangoMD @caseyjkim @benjamin_osh @MargaretL16 @kandersonMD21 @SK_Sundararaman @AaronTroyMD This is how we do it. /18

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Matt Tsai

@thematttsai

5 years

Did my first shave biopsy today. Of course, not on a human but an 🍊. Nevertheless, I’m happy I can look back and say my first derm patient was a cutie. #medtwitter #hisnameisOJ

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Matt Tsai

@thematttsai

1 year

In someone more stable who doesn't meet those criteria, we have some more time to investigate potential causes of that AKI. I was taught to group AKI into 3 buckets🪣 ⬇️Pre-renal ⬇️Renal ⬇️Post-renal /7

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Matt Tsai

@thematttsai

4 years

@DrPess 1. Hi! I’m an MS4 in Vermont and co-host of the @ACP_Vermont podcast “Green Mountain Medicine” 2. Remembering first time doing a paracentesis 🥳 🌊 3. @SoujanyaK95

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Matt Tsai

@thematttsai

2 years

In summary: We started with 3 questions. ❓Digoxin indications ❓Mechanism(s) ❓Sx and Rx of Toxicity Take a moment to recall what we covered. Answers (in a graphic!) next. Thank you to @AdamRodmanMD and @ShreyaTrivediMD and @jasonmatosmd for their feedback on this🧵! /end

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Matt Tsai

@thematttsai

4 years

@TravisABenson Hey! My name is Matt. I’m an MS3 at LCOM at UVM, interested in #internalmedicine and MedEd! I split my free time between working on my podcast “Green Mountain Medicine” and looking for Asian food in Vermont

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Matt Tsai

@thematttsai

4 years

@karenerrichetti Love this time of the week! Hey everyone! 1. I’m Matt, M4 student, podcaster and aspiring internist. 2. Celebrating stronger family connections post-quarantine (despite living on opposite coasts) 3. Tagging @SeanPMeagher @therealtwoodin @JennaDafgek :)

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Matt Tsai

@thematttsai

4 years

Attending: “it was great working with you! Any questions?” Me: “Thanks! Feedback for me?” Attending: “Work on your shoulder strength” In other words, after a 7 hour long operation today, my most valuable take home lesson was the surgeon’s translation of “do you even lift?”

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Matt Tsai

@thematttsai

2 years

There we have it. A graphic reviewing PT/PTT and 3 examples of related abnormalities. Let me know what you think! Thank you @AaronDunnMD @jlberrymd for valuable feedback on that infographic! /END

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Matt Tsai

@thematttsai

1 year

A classic post-renal example! Urinary tract obstruction and pressure buildup causing upstream injury 🌊 Think about functional vs. structural causes 🚨 Do not be fooled by overflow incontinence. If you suspect obstruction, get the bladder/renal ultrasound. /12

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Matt Tsai

@thematttsai

4 years

“How can we use this to make something better of our situation?” Finally got my @Vot_ER_org kit in the mail! Excited to help my patients register to vote + find a seat at the table. #MedTwitter friends, get your kit for FREE at ✅

The New York Times

@nytimes

4 years

As the pandemic curbs in-person voter registration, a growing number of doctors and nurses are registering their patients to vote

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Matt Tsai

@thematttsai

2 years

Not only is factor VIII the only factor not made by the liver, but this factor ⬆️ to compensate for liver disease related coagulopathy. Hence a compensated, normal PTT (absent severe liver disease). Isn't that cool?! /5

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Matt Tsai

@thematttsai

2 months

Working hard and eating harder with amazing interns and med students. This is residency life like it should be. 🥩 @allisonoconn @BMCimRES @BIDMC_IM @BrighamMedRes Now if only we could get some of that matcha ice cream in the workroom @tony_breu 😏

Allison Fitzgerald, MD, PhD

@allisonoconn

2 months

There are a lot of good things about working at the Boston VA, but a highlight is working with residents and med students from across different programs!! And a special feature from soon-to-be chief resident at BIDMC @thematttsai ! @BrighamMedRes @BMCimRES @BIDMC_IM @tony_breu

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Matt Tsai

@thematttsai

4 years

@emily_fri Dr Jeffrey William at BIDMC has a great module on hyponatremia, with a framework on how to approach and differentiate among its many causes. I’ve been using it this month to teach MS2s during their renal course. Worth looking into!

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Matt Tsai

@thematttsai

7 months

Excited to represent @BIDMC_IM at @SocietyGIM ! What an awesome community!

Katie Jobbins, DO, MS, FACP

@DrKJobbins

7 months

#SGIMNewEngland workshop on how to build an infographic and take your #MedEd to the next level! @thematttsai @caseyjkim @SocietyGIM @canva

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Matt Tsai

@thematttsai

1 year

Such a pleasure working with @ShreyaTrivediMD and @TimRowesays on this! Who knew #tracheostomy care could be so fascinating? 🤩

CORE IM

@COREIMpodcast

1 year

1/ 🚨Trach Care: 5 Pearls Episode 🚨 What is the process for #decannulation ? How do speaking valves and capping trials work? 🎧: 🗒️: Sponsor: @ambossmed

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Matt Tsai

@thematttsai

1 year

Our patient recovers and follows up in clinic 2 weeks later. He shares he had a gout flare🔥after discharge, but this slowly improved with some ibuprofen💊. But his creatinine has doubled and urine microscopy🔬is below (taken from @UpToDate ) /13

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Matt Tsai

@thematttsai

1 year

Let's start with definition. What is an acute kidney injury (AKI)? /2

Cr > 0.3 mg/dL in 48 hr

256

Cr incr 150% in 7 days

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Oliguria

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Any of the above

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Matt Tsai

@thematttsai

3 years

In the last 7 days I: 💪Got my 2nd COVID vaccine shot ♥️ Performed 1st synchronized cardioversion 📜Certified my #match2021 rank list and ⌛️ Turned 26 while repairing a scalp laceration My remaining goals include match day, graduation & achieving EM doc skill level with POCUS🤞

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Matt Tsai

@thematttsai

4 years

Don't forget to register for this year's @SocietyGIM New England & Mountain West Regional Conference! Virtual, on November 6-7, featuring great sessions like keynote address from Dr. @UREssien on "Bending the Arc Towards Justice in Health." Register at:

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Matt Tsai

@thematttsai

4 years

That's it! Thanks for reading all of this. Hope you found it helpful. I've got a personal interest in medical education so please let me know if you have feedback for me (DM or comment!) :) 16/n

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Matt Tsai

@thematttsai

4 years

I made a graphic to express a Happy #NationalDoctorsDay to all the physicians on the front lines against #COVID19 , including the awesome @UVMLarnerMed faculty at @UVMMedCenter . Thank you for all that you do! Sincerely, Your local med student #DoctorsDay #doctorsday2020

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Matt Tsai

@thematttsai

1 year

Stoked to meet the next class of @BIDMC_IM residents! 2024 is going to be amazing 😎

BIDMC Department of Medicine

@BIDMC_Medicine

1 year

Welcome to our newest @BIDMC_IM class! We are so excited for you to join us in Boston from medical schools all across the country and a big congratulations to all on #Match2023 !

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Matt Tsai

@thematttsai

2 years

Recall that PT and PTT measure clotting times relating to the extrinsic and intrinsic pathways of the coagulation cascade, respectively. From this, elevated PT or PTTs in patients with specific factor deficiencies or inhibitors can be easily predicted 😎 /2

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Matt Tsai

@thematttsai

4 years

Humbled & honored for this new role in the amazing field that is #internalmedicine . I’m looking forward to working with @SocietyGIM NE and @ACP_Vermont to represent med students, residents and fellows throughout our training. #IMProud

ACP Vermont

@ACP_Vermont

4 years

Major congratulations to Vermont ACP Council Member @thematttsai for his selection as Associate Representative for SGIM New England! Strong work to represent the field of Internal Medicine on so many fronts. We know you'll do a fantastic job! #IMProud #SGIM #medstudenttwitter

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Matt Tsai

@thematttsai

2 years

⭐️Did not have Spinal Cord Infarct on my DDX for chest pain, until now! Welcome to twitter, @kandersonMD21 ! Awesome tweetorial and graphic!! @AdamRodmanMD @BIDMC_IM @ShreyaTrivediMD @EricLawson90 @MargaretL16 @AaronDunnMD @srkumarasena @caseyjkim @nsrosenberg @benjamin_osh

Kelsey Anderson

@kandersonMD21

2 years

Phew that was a lot! An infographic to summarize

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Matt Tsai

@thematttsai

2 years

2⃣ Citrate is also present in pRBCs and can cause hypocalcemia during massive transfusion. That hypocalcemia will inhibit clotting -> prolonged bleeding, more transfusions -> worse hypocalcemia 🚨 Break the cycle. Monitor calcium levels and replete. /8

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Matt Tsai

@thematttsai

4 years

@JeanMoorjani Hi everyone! I’m Matt, MS4 at UVM applying #internalmedicine for Match 2021! My Q to former applicants is: what components of a program do you think are most telling of a supportive culture (workload/backup schedule, interactions btw residents, wellness events)? 🤔 Thanks!

3

1

12

Matt Tsai

@thematttsai

2 years

First, which is NOT an indication for Digoxin? /2

Rate control afib/flutter

226

HFrEF NYHA III or IV

693

Arrhythmia rhythm control

982

Rate control of SVT

1352

1

11

Matt Tsai

@thematttsai

4 years

@Marina__Haque I was just asking the same thing on Twitter! My institution restricts student involvement with COVID19 patients, but there must be other ways we can help to offload the burden for the rest of our clinical team.

2

0

11

Matt Tsai

@thematttsai

1 year

Continuing with the case➡️You start IV diuretics and his heart failure exacerbation, including his AKI, resolves. 😃 But on hospital day 3, he becomes oliguric. Bladder is enlarged on ultrasound. He realizes he forgot to mention tamsulosin as a home med💊. What's going on? /11

pre-renal

16

renal

70

post-renal

964

2

0

11

Matt Tsai

@thematttsai

4 years

Summary🧐 Vancomycin... ➡️🚫cell wall synthesis ➡️🎯gram positives including MRSA ➡️empiric Rx for MRSA, meningitis (pneumococcal coverage) ➡️Renal dosing ➡️Goal AUC/MIC>400 in moderate/severe infection. Beware troughs ➡️Side effects! ➡️think resistance if MIC>1 15/n

1

2

11

Matt Tsai

@thematttsai

4 years

@JeanMoorjani I’m Matt, MS4 in Vermont! Love to follow people who are passionate about their work, tweet about patient care/advocacy or MedEd. And I’m always down to follow fellow med students. #MedStudentTwitter @therealtwoodin @C_Westbom

0

11

Matt Tsai

@thematttsai

4 years

@karenerrichetti @MedlawDan @AcademicChatter 3rd year Med student interested in #meded and #hospitalist & #internalmedicine ! I like to tweet snapshots in the life of a Med student, post updates on my medicine podcast, and retweet interesting things I learn on MedTwitter. Also broke so spending #BlackFriday sleeping in!

0

11

Matt Tsai

@thematttsai

4 years

Today, I presented the 1st case of our new "M4 Report" series to @UVMLarnerMed Dr. Emily Greenberger! We modeled this new teaching initiative for M4s after IM @UVMIMRES resident noon reports. Shoutout to Dr. @eldakas for her support!🩺 #pulm #lifelonglarner #canyouhearme #IMProud

0

2

10

Matt Tsai

@thematttsai

4 years

@karenerrichetti Third year (soon to be 4th!) Med student interested in internal medicine, foodie and budding podcast co-host. Tagging classmate and twitter newbie @thesethwolf to join the party :)

1

0

10

Matt Tsai

@thematttsai

1 year

Okay but let's say your patient has a true AKI. First step: triage🏥 When is it an emergency❓ What are the big 5 indications for urgent dialysis ⁉️ /5

1

0

10

Matt Tsai

@thematttsai

4 years

@karenerrichetti I'm Matt, incoming M4 at Larner Med at UVM. I like writing and recording spoken word videos. Nervously started a youtube channel last month (you can check out my latest piece at )! Tagging talented twitter classmate @sambepstein .

0

10

Matt Tsai

@thematttsai

4 years

@JeanMoorjani 1. Interested in Internal Medicine! 2. I have not seen it yet! Definitely on the list now that it’s on Disney+ 3. Everything & the reaction of friends who have already seen it a half dozen times 4. Like @JennaDafgek 😆

0

10

Matt Tsai

@thematttsai

4 years

I could not have asked for a better dream team to co-TA the ⁦ @UVMLarnerMed ⁩ Cardio, Respiratory & Renal preclinical course this month. 🙌 Shout out to Michael Weber & Bridget Moore for being true teammates, from review sessions to daily color schemes & everything between.

0

1

10

Matt Tsai

@thematttsai

4 years

We will get through this pandemic. Together. But until then I mustache you to stay calm and wear your mask 😷

1

10

Matt Tsai

@thematttsai

1 year

What GDMT to start first in HFpEF? Does the EF matter if it’s preserved? Some awesome pearls from my awesome coresident @caseyjkim 👇

Casey Kim

@caseyjkim

1 year

I’m no Cardiologist, but even I picked up some learning points after being on the inpt heart failure service for the past 5 wks 🤷‍♀️🫀 - A series of “🦪 📿” on a variety of heart failure topics for the internist. First one is on GDMT in HFpEF! #MedTwitter #CardioTwitter

7

57

363

0

2

10

Matt Tsai

@thematttsai

4 years

@Marina__Haque I'm Matt! Rising M4 in Vermont :) I co-host an internal medicine podcast called Green Mtn Medicine (). We're working on a COVID19 episode to inform ppl on COVID19 (pathophys, epidemiology, Dx workup, new Rx and trials etc). #Students_Against_COVID

Green Mountain Medicine | ACPVermont

Green Mountain Medicine is an original podcast series for all things internal medicine, sponsored by ACP Vermont. Hosted by University of Vermont medical students Caity Decara and Haley Bayne, this...

acpvermont.podbean.com

2

1

9

Matt Tsai

@thematttsai

4 years

It generally only covers gram-positive organisms. Why? 🤔 Glycopeptides like Vanc are BIG, which isn't a problem for gram➕bugs w/cell walls on the outside. But the cell walls of gram➖bugs are🥪'ed between 2 membranes with a porin entryway. In other words, Vanc can't fit. 5/n

1

2

10

Matt Tsai

@thematttsai

5 years

Happy #NationalInternalMedicineDay everyone! 🎉 Excited to share a moment of this #IMProud feeling with fellow internists & internists-to-be. Shout out to organizations like @ACP_Vermont @ACPinternists and @SocietyGIM for building up our incredible community 🙌🙌

0

2

10

Matt Tsai

@thematttsai

5 years

@UVMLarnerMed represent! Presenting on social determinants of health at #sgimne19 with @therealtwoodin @HalleSobel @hadleystrout @beth_wahlberg

0

3

10