A lot of brands will be making statements today about what happened at our nation's capital yesterday. Most will run the range from "insincere" to "oblivious."

We debated if we should. But as a mental health platform, we feel we have a responsibility to say a few things.

“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.…

1/23 We haven't had a lot to celebrate during this pandemic. But achieving the milestone of offering vaccine to the over 70s, health and care workers and the most clinically vulnerable just before target date is a huge cause for celebration, given the scale of the achievement.

2/23 When Margaret Keenan got her first jab in Coventry on December 8th last year, who’d have thought that, by Valentine’s Day, we’d have vaccinated over fourteen million people across the UK in just ten short weeks? Amazing, extraordinary and truly, really, world class!

3/23 I’ve been struck by how much joy and relief has been brought to those doing the vaccinations and those receiving them. A GP told me yesterday that nothing had given him greater pleasure in his long career. And that the patient's relief was sometimes overwhelming.

4/23 It's vital to recognise the extraordinary contribution of the staff and volunteers who have made this happen. One of my close family had their jab yesterday and was in awe of the volunteer standing outside in the freezing cold for a four hour shift meeting and greeting.

5/23 What I wanted to share in this thread was the slightly untold story of some of the extraordinary challenges the NHS has had to overcome to deliver this target. Requiring superhuman effort from NHS leaders and staff, way beyond the call of duty. Five challenges set out below.

THIS IS A CATCHY & ATTENTION-GRABBING TITLE

Today, the Province will likely announce what zone of the reopening framework we'll shift into as of Tuesday. Whatever is announced, though, doesn't change what we need to do. Why?

Kindly read these 14 tweets & we'll tell you. (1/14)

Fun fact: COVID-19 does not follow us on Twitter. COVID doesn't know, or particularly care, if we're in the Red or Orange zone.

The behaviours of the virus do not depend on the current ‘zone’ of public health restrictions. And, to be perfectly candid, neither should ours. (2/14)

Once upon a time we used to say #WeAreInThisTogether in our messaging. Here's the thing: we are, but we aren't. Not everyone is experiencing this pandemic the same.

Nurses, doctors, paramedics & healthcare workers have experienced things much differently than most of us. (3/14)

Some people have been home & isolated for months, while others haven't been able to stop working.

Business owners & hospitality workers have been on a rollercoaster of openings & closures.

Students, parents, teachers & school staff have had to adapt to going from online (4/14)

to in-person learning (and back again) numerous times.
And this virus has disproportionately affected some groups more than others.

But there's the thing: while our experiences of this pandemic haven't been shared, we do have a shared goal.

And we can reach it together. (5/14)

Ashtangha Yoga or the eight limbs of Yoga-

Many people think Yoga is just an Indian physical exercise but that's wrong. Yoga is a way to connect with the Supreme in Hinduism and attain Moksha(liberation).
The proper yoga as described in Hindu scriptures consists of 8 limbs:

1) Yamas- They are the 5 ethical rules of Hinduism. The 5 Yamas are:
i) Ahimsa: Nonviolence (this also includes not eating meat)
ii) Satya: truthfulness
iii) Asteya: non-stealing
iv) Brahmacharya: chastity, sexual restraint
v) Aparigraha: non-avarice, non-possessiveness

2) Niyamas- They are the 5 "do's". The five Niyamas are:
i) Shaucha: purity of mind, speech and body
ii) Santosha: contentment
iii) Tapas: austerity, self-discipline
iv) Svadhyaya: study of Vedas(Holy books of Hindus)
v) Ishvarapranidhana: contemplation of the Ishvara (God)

3) Aasana or the physical yoga-
Asana is a posture that one can hold for a period of time, staying relaxed, steady, comfortable and motionless. The aasana postures are believed to have been given by Mahadeva (Hindu God) himself. Hatha Yoga Pradipika mentions 84 aasanas.

Okay, let's start this hypersomnia thread!

[note - I am not looking for unsolicited advice.]

Idiopathic hypersomnia or narcolepsy (not the same, but similar) is very hard to describe to people.

When I say "I slept 10 hours last night and I'm still tired" I'm not bragging. 1/16

For me, the accommodations I need are about time. My body doesn't care what I want to do - when I want to wake up or be asleep. My body wants to wake up at 10-11am, and go to sleep at 3am, always.

Just a one hour shift in my sleep schedule can screw me up for days. 2/16

When I tell people that I'd really "prefer it" if we could meet at 10am or later, it's because getting up before that has consequences for me. Big consequences. Most people won't see them. Sometimes I still give in and say it's fine. It ruins 2-3 of my days, sometimes more. 3/16

Let me explain. When I am required to wake up at 9am, esp. in covid times working from home, my body pays me back for it later.

I'm going to show you ways this happens. I can usually withstand 1 day of waking up early, with some consequences, but 2 days in a row kills me. 4/16

Let's say this graph represents Day 1, the first time I am required to get up early. The y-axis is my level of Sleepiness. Any symptom listed higher up includes that symptom + every other symptom below it. Getting up that early means I can't listen or concentrate all day. 5/16