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
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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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PMN> 250
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Never by wbc or pmn alone
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When there is sepsis
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The wbc is really high
32 votes • Final results
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PRIME Procedural Research and Innovation retweeted
25 May 2023
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
nejm.org/doi/full/10.1056/NE…
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Ensure proper training and technique
litfl.com/intraosseous-acces…
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PRIME Procedural Research and Innovation retweeted
13 Apr 2023
#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
Image courtesy: pubmed.ncbi.nlm.nih.gov/2555…
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I use POCUS to confirm NG tube placement
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Never
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Exclusively
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Yes, still get xray
51 votes • Final results
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Cochrane wants further study of this technique
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Nice description the technique here: brownemblog.com/blog-1/2021/…
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PRIME Procedural Research and Innovation retweeted
14 Nov 2022
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!
13 Nov 2022
#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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PRIME Procedural Research and Innovation retweeted
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!
sciencedirect.com/science/ar…
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PRIME Procedural Research and Innovation retweeted
12 Nov 2022
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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PRIME Procedural Research and Innovation retweeted
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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PRIME Procedural Research and Innovation retweeted
12 Nov 2022
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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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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More info on thoracentesis complications and how to avoid them here:
ncbi.nlm.nih.gov/pmc/article…
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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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