Things look dire in SoCal hospitals. Check out these quotes!

“We’ve never had so many patients,” said Adrian Cotton, chief of medical operations at Loma Linda University Health in San Bernardino County.”
1/

(read to the last quote please)

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

I’m deeply saddened to learn that Dr Joseph Sonnabend, one of the most important figures in the history of AIDS, died yesterday. I spent time with him in 2018 for one of the last interviews he ever gave. Let me tell you about this man and what he did:

Sonnabend was one of the first doctors to raise the alarm. In 1979, while running a sexual health clinic in Greenwich Village, he wrote to the NY Health Dept to warn them of the symptoms he was seeing: low white blood cell counts, enlarged lymph nodes. He didn’t get a reply. 2/

So he kept speaking out. When a patient of his developed a very rare cancer – Kaposi’s Sarcoma – he linked up with a dermatologist at NYU who said that over a dozen gay men had it. Sonnabend knew there was something very wrong. He started working at the lab at NYU — for free. 3/

It was soon after this in 1981 that the New York Times famously reported “Rare Cancer Found In 41 Homosexuals”. The next decade would kill most of Sonnabend’s patients and friends — and all of his lovers. What Sonnabend did was to fight for every single of them. 4/

Want to know who was the first to publish advice to wear a condom? That was Sonnabend. In 1983 he co-authored the first safe sex leaflet to fight AIDS: “How To Have Sex In An Epidemic”. 5/

NEW—CDC was truly suffocated by Trump WH at every turn. Kyle McGowan, a former chief of staff at CDC, and his deputy, Amanda Campbell, witnessed WH dismissal of science, WH’s slow suffocation of CDC’s voice, meddling in messages & siphoning of CDC budget.
https://t.co/HeuNbUggiw

2) ““Everyone wants to describe the day that the light switch flipped—It didn’t happen that way—more of like a hand grasping something, and it slowly closes, closes, closes, closes until you realize that, middle of the summer, it has a complete grasp on everything at the CDC”

3) “Mr. McGowan and Ms. Campbell, both 34, say they tried to protect their colleagues against political meddling from WH and HHS but was largely stifled by the Trump administration.

4) “The White House insisted on reviewing — and often softening — the C.D.C.’s closely guarded coronavirus guidance documents, the most prominent public expression of its latest research and scientific consensus on the spread of the virus.”

5) “The documents were vetted not only by the White House’s coronavirus task force but by what felt to the agency’s employees like an endless loop of political appointees across Washington.
Mr. McGowan recalled a White House fixated on the economic implications of public health.

I think that, in the face of an ongoing global health emergency and a pressing need to reopen safely, some form of health pass is a reasonable option to consider. But debate is a good thing, so here are some brief thoughts on various concerns I've heard about them... [thread]

"A health pass discriminates against people who have refused the vaccine." No. A health pass should also support proof of test result for people who haven't been vaccinated, and exemptions for people who cannot be vaccinated (get vaccinated if you can though, for heaven's sake).

"A health pass is an invasion of privacy." No. A health pass should be privacy preserving, allowing you to prove your status to third parties without giving away personal data or letting them track you without your permission.

"A health pass is unfair to people without smartphones." No. A health pass should accommodate people without a smartphone, e.g. with a printable option as a fall-back (though for most of us, carrying a digital pass on our phone will be much more convenient).

"A health pass will become obsolete as the virus mutates." No. A health pass should actually give us more insight and flexibility to adjust our response as our knowledge of the virus, and the ways we test / treat / vaccinate for it, increases.

🧵 on Importance of correct indication of colonoscopic surveillance studies (English 🇺🇸🇬🇧)
@KM_Pawlak @KMonkemuller @drkeithsiau @JacquelineChuMD @PerelmansPearls @stevenbollipo @SWexner @DrBloodandGuts @ebtapper @DCharabaty @RashidLui @AdvaniRashmiMD @AtoosaRabiee @DrMohdZein

@GI_Guy @RodriguezParra_ @DrHarryThomas @TennysonMD @AustinChiangMD @KralJan @thomaskroner @alinkmd #GITwitter

1/ The implementation of screening and surveillance programs can reduce the incidence and mortality of

2 / But for these to be effective and to guarantee protection against CCR, they must meet a series of conditions. One of them is the correct indication for endoscopic studies for both screening and surveillance.

3 / According to a recent meta-analysis, the minority of patients who undergo colonoscopies have a correct indication, with less than 50% adherence to the surveillance intervals proposed by scientific