Tony Breu @tony_breu
Hospitalist, VA Boston. Assistant Professor, @harvardmed and @HMSbioethics. Co-host, @CuriousClinPod. Usually at #AMreport. Views are my own. connects.catalyst.harvard.edu/Profiles/displ… Boston, MA Joined April 2012-
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1/18 🤔Why does heart failure with preserved ejection fraction (HFpEF) lead to sodium retention? With reduced ejection fraction (HFrEF), decreased cardiac output (CO) leads to neurohormonal activation and sodium avidity. If CO is preserved in HFpEF, what's the inciting event?
1/ Why do patients with hyperbilirubinemia become jaundiced? Patients with hemochromatosis don’t get “scleral bronze”. Why does bilirubin “do" what it does? The answers will require review of an article written 90 years ago, in German…
Don’t miss our first video podcast on YouTube! Why do your fingers wrinkle in the bath? youtu.be/V5cL_hd26JU?si…
Hannah, Avi, and I are very excited to announce our new Curious Clinicians YouTube page. Check out our first video and subscribe to see what we have in store! youtube.com/channel/UCnhM2…
Things We Do for No Reason™: Routine respiratory pathogen panels for emergency department and hospitalized patients …mpublications.onlinelibrary.wiley.com/doi/full/10.10…
1/10 Does epinephrine improve outcomes in patients with cardiac arrest? This is a question with a complex answer. This thread is only meant to scratch the surface and is a follow-up to a recent tweetorial on the use of epinephrine for cardiac arrest.
@tony_breu If you have an intervention that increases ROSC/survival but does not simultaneously protect the brain, then you will get more survivors with both good & bad neurological outcome with ratios likely dependent on median ROSC time. You would likely find the same for CPR/defib (1/n)
1/17 🤔Why do we use epinephrine to treat cardiac arrest? Epinephrine can CAUSE cardiac arrest. And yet we give it as part of ACLS to treat the condition it caused. This paradox requires explanation.
📣 Cool announcement! 📣 We have officially launched the @CuriousClinPod YouTube channel! First episode answers the question, why do your fingers wrinkle in the bath? youtu.be/V5cL_hd26JU?si…
1/ Why hasn’t group A strep (GAS) developed resistance to penicillin? This is particularly odd given that other closely related gram-positive species (e.g., Strep pneumoniae) have resistant strains. Given the global burden of disease, understanding GAS is essential...
Why do your fingers wrinkle when you take a bath? Find out the answer on our latest episode, ‘Aquagenic Wrinkling’! curiousclinicians.com/2024/04/17/epi… podcasts.apple.com/us/podcast/the… open.spotify.com/episode/5CwLIg…
1/16 🤔Why does subarachnoid hemorrhage lead to deep/inverted "cerebral T-waves"? This ECG finding is so dramatic. But as we will see, these patients often have normal hearts. Why does an issue in the brain manifest on a test of the heart?
1/ How does acetaminophen decrease fever and pain, without affecting inflammation? NSAIDs affect all three. What explains the difference? This thread, a cross-over with the @COREIMpodcast, will try to answer these questions. x.com/coreimpodcast/…
1/ How does acetaminophen decrease fever and pain, without affecting inflammation? NSAIDs affect all three. What explains the difference? This thread, a cross-over with the @COREIMpodcast, will try to answer these questions. x.com/coreimpodcast/…
For anyone who attended my TWDFNR session, please send along questions and comments. I’ll reply here!
Wow! We learned so much! How about you? 🤯 Diuresis speed: bit.ly/3VZl3GD Pip/tazo vs Cefepime: bit.ly/4aBorvO Periop ACE/ARB: bit.ly/3xuiWjO Asymptomatic HTN: bit.ly/3Q1YL3o #SHMConverge24 #MoreThanAJournal VA by @CatieGlatz
5/ The differences in anatomy result from distinct embryologic origins. The smooth muscle cells of the TA derive from neural crest cells whereas the AA derives from mesodermal cells. Amazingly, the thoracic and abdominal aorta are distinct organs! linkinghub.elsevier.com/retrieve/pii/S…
We wrote a thing! Arbitrary discharge time doesn't really help hospital flow. As with all things in medicine, it's just more complicated than that. Things We Do for No Reason™: Discharge before noon - Dunn - Journal of Hospital Medicine - …mpublications.onlinelibrary.wiley.com/doi/10.1002/jh…
1/ Ever wonder: Why are abdominal aortic aneurysms (AAAs) more common than thoracic aortic aneurysms (TAAs)? I have! Follow this thread to see how the answer to this question makes use of long-forgotten medical classes. And there’ll be an appearance by The Great Mimicker.
And take a look at how many of the sodiums were above 120 13 out of 15 cases Also note that only 2 patients had rapid correction of sodium😳 Malnutrition, hypokalemia, and alcohol continue to represent as they do in every study. 4/4
Aaron Goodman - “Pa.. @AaronGoodman33
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116K Followers 3K Following Pulm/Crit physician and PD @OSUPCCM_Fellows • @JournalofGME editor • Podcast @curiousclinpod • Dad/husband • Views my ownRobert Oubre, MD | Th.. @Dr_Oubre
35K Followers 526 Following I simplify clinical documentation & billing | Have helped 500+ become efficient & effective clinicians by optimizing notes with my Resident Guide video course.Cynthia Cooper, MD @DrCindyCooper
42K Followers 433 Following Adult Hospitalist.☀️Haikus/tankas celebrating the language of Medicine☀️Author: Medicine in Brief @HarvardMed Views own/not advice𝗡𝗶𝗵𝗮𝗿 .. @nihardesai7
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62K Followers 4K Following Saying the product of the kidneys is urine is like saying the product of a factory is pollution. Urine is a by-product. The product is homeostasis COI: link👇🏼The Wolf of College S.. @AdiG1993
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0 Followers 346 FollowingVikas Ravi @VikasRaviMD
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0 Followers 65 FollowingAneta @Aneta_m11
1 Followers 389 Following Ana Morchadze, MD from Georgia 🇬🇪 . Passionate about medicine, art, literature, philosophy and many more.Omar Helmy @3mar_7elmy
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35K Followers 526 Following I simplify clinical documentation & billing | Have helped 500+ become efficient & effective clinicians by optimizing notes with my Resident Guide video course.Adi @IDdocAdi
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62K Followers 4K Following Saying the product of the kidneys is urine is like saying the product of a factory is pollution. Urine is a by-product. The product is homeostasis COI: link👇🏼𝙟𝙤𝙨𝙝 𝙛.. @PulmCrit
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37K Followers 342 Following Teaching Physicians how to explore flexible, lucrative careers beyond full-time, clinical medicine through online digital courses. 👩🏽💻NEW PODCAST ➡️🎙️Elliot Tapper @ebtapper
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17K Followers 1K Following Internist, Curbsider. Opinions my own, and tweets and retweets are not medical advice. He/him/his @[email protected]Michelle Kittleson MD.. @MKIttlesonMD
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27K Followers 7K Following Retired academic living the dream | 🎙The Career Rx Podcast | 👩💼Board of Directors @APSForg | 👩⚕️Adj Professor @UNC_anesthesia | #medtwitter | she/herPennsylvania Court Rules for Hospital in Conflict over Ineffective Treatment: The Lehigh County, Pennsylvania Court of Common Pleas has sided with Luke's University Hospital in a dispute over inappropriate treatment sought by patient Guy Ferraiolo. The… dlvr.it/T5ygDr
@tony_breu Love that point, thanks Tony! Just asked OpenEvidence this.. it tracks with what I think you were implying..
@yuvalpatelMD @YihanYangMD This is a great story to illustrate the importance of focusing on the alcohol. The ferritin is a biomarker of alcohol toxicity. The patient can watch it fall with abstinence to reinforce behavior change and if after 6-12 months of negative PETH it is still high, can think more
Yet another brilliant tweetorial from @tony_breu
1/17 🤔Why do we use epinephrine to treat cardiac arrest? Epinephrine can CAUSE cardiac arrest. And yet we give it as part of ACLS to treat the condition it caused. This paradox requires explanation.
@tony_breu If you have an intervention that increases ROSC/survival but does not simultaneously protect the brain, then you will get more survivors with both good & bad neurological outcome with ratios likely dependent on median ROSC time. You would likely find the same for CPR/defib (1/n)
Loving the original name for CPR: “closed-chest cardiac massage.”
5/ Despite the 1906 study results, epinephrine alone wasn't enough and it sat on the shelf, waiting for other interventions that could be used alongside it. Then, in 1960, Kouwenhoven published his report on the success of CPR in cardiac arrest. pubmed.ncbi.nlm.nih.gov/14411374/
My kind of explanation - in depth 👏 @tony
1/17 🤔Why do we use epinephrine to treat cardiac arrest? Epinephrine can CAUSE cardiac arrest. And yet we give it as part of ACLS to treat the condition it caused. This paradox requires explanation.
@AvrahamCooperMD @CuriousClinPod yess! 🔥
No way!!!! One of my favorite podcasts EVER. 10/10 recommend. It is based on UNDERSTANDING
📣 Cool announcement! 📣 We have officially launched the @CuriousClinPod YouTube channel! First episode answers the question, why do your fingers wrinkle in the bath? youtu.be/V5cL_hd26JU?si…
About to speak at #shm2024! Come join if you’re still around!
T-50mins until #UpdatesinHM with @zahirkanjee at #SHMConverge24! So excited to share some science and silliness with @SocietyHospMed
@tony_breu @lynn_laidlaw @RobShmerling Also the vessel distribution in Takayasu is very different...right from carotids till infrarenal aorta...any thing from top to bottom may be involved!
The best #mottirl story - @SocietyHospMed brought us together to prepare a 1-hr plenary...and we are finally getting to meet in person after over a year of working together virtually! Paired up with this brilliant and charismatic doc for #SHMConverge24 #UpdatesinHM! @zahirkanjee
If you want to know more about the biology of why it's necessary to give a patient magnesium before giving them potassium, here's a medical educator's explanation: x.com/tony_breu/stat…
1/ Why do we need to correct hypomagnesemia in order to correct hypokalemia? This thread is for all the interns out there, repleting, and repleting, and repleting...
As always great thread @tony_breu on a fascinating condition
1/ Why does giant cell arteritis (GCA) have a predilection for the temporal artery? There are many medium/large-sized vessels in the body, and yet GCA hones in on early branches of the aorta. As you might guess, I think the answer is pretty cool...
#VascularMedicine @SVM_tweets 🔍Vascular medicine fellows, tweetorial on GCA arteritis predilection for the temporal artery?? by @tony_breu
1/ Why does giant cell arteritis (GCA) have a predilection for the temporal artery? There are many medium/large-sized vessels in the body, and yet GCA hones in on early branches of the aorta. As you might guess, I think the answer is pretty cool...
#SHMConverge24 @gradydoctor: One of the ways in which your organizations are judged by potential applicants is your online presence. How does the website and social media reflect the organizational culture?
Giant Cell Arteritis… - Dendritic Cells - Vasa Vasorum The best thread I have seen for ages…
1/ Why does giant cell arteritis (GCA) have a predilection for the temporal artery? There are many medium/large-sized vessels in the body, and yet GCA hones in on early branches of the aorta. As you might guess, I think the answer is pretty cool...
@tony_breu Thank you for the clear & helpful illustration!
@tony_breu @ScottKeeney7 Which should raise the question, does this need daily dosing? MWF rosuvastatin likely gives you very close to all of any absolute benefits while decreasing dose dependent adverse effects like insulin resistance.