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David Snider

@DavidGSnider

GIM University of Manitoba

 Winnipeg, Manitoba
Joined December 2019
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Replying to @katiewiskar
@katiewiskar Hey Dr. Wiskar, I'm an incoming GIM fellow in Manitoba and I'm strongly considering a POCUS fellowship and was wondering if you'd have some time to chat about your career path?
Nephro attending: You'll always be surprised at what an NSAID will do to the kidneys in a volume depleted state
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Screening in ED o/n: How to screen in 1-2min - referral reason - HPI: substrate (function, relevant comorbidities), CC + tempo of illness -> severity at 1st medical contact (VS + pertinent labs/rads) -> tx(s) and responses - your exam 1/
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2/ - provisional dx with key supporting features and focused ddx focused on life-threatening, treatable, and common conditions - dispo (admit vs. not, ward, tele, ICU) w/ comment on anticipated course
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In neuro clinic: - role of EEG in seizure is to delineate pattern of epilepsy, prognosticate first time seizure and rule out NCSE - if unprovoked seizure, normal neuroimaging and equivocal EEG, repeat once with sleep-deprived EEG and if nothing don’t tx with AED 1/
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2/ - if two unprovoked sz >24h apart, EEG isn’t going to change management so don’t order - it’s possible to get secondary migraines (I.e. AVM associated) so there’s a role for neuroimaging as you may be able to cure it - abn neuroimaging and/or EEG in setting of sz warrant AED
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In cardio clinic: - pre-eclampsia in women with chest pain signals increased risk of developing IHD - normal MPI signals ~1% risk of cardiac event in 5y - perindopril is OD (in IHD and HFrEF), greater antihypertensive effect vs. ramipril and comparable in price #MedEd #FOAMed
In endo clinic: - think of TGs separately from other lipids: they are fuel for muscle and adipose tissue and travel in blood via chylomicrons - insulin facilitates LPL which allows uptake of TGs into these tissues - insulinopenic states generally have high TGs 1/
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2/ - DKA pts generally have high TGs - insulin, fibrates, and lifestyle all can lower TGs - I’ve had two recent cases with acute pancreatitis 2/2 hypertriglyceridemia that both responded beautifully to IV insulin #MedEd #FOAMed
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In ID clinic re: UTI - relapse (not recurrent) is return of sxs within 2 weeks s/p abx - ½ of simple cystitis get better on their own - pain with defecation can signal prostatitis - ask about concurrent constipation, sexually activity and dehydration #MedEd #FOAMed
In heme clinic: HAS-BLED used for bleeding risk in pts being tx'd for VTE, but remember the HAS-BLED was studied in older pts and may overestimate risk of bleeding. #MedEd
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Old cardio attending in clinic: "When prioritizing a ddx, two of the major considerations: Common to less common, and treatable to less treatable" #MedEd #FOAMed
Replying to @kidney_boy
@kidney_boy Can you point me to any literature on rhabdo and how if there’s not an aki early, it probably won’t develop.
Re: curbsiders episode 230, @MKIttlesonMD, we don’t deserve you. Buzzing after that one. @thecurbsiders
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1/ Type 1 HRS, nonrandomized study with 13 consecutive pts: - first 8, dopamine/HSA - last 5, mid/oct/HSA GOAL: >15mmHg in MAP -> 3/5 (mid/oct/HSA) survived hospital discharge (1 txp, 1 alive at 472d, 3rd died upon d/c of medical tx) -> 7/8 (dop/HSA) died during first 12 days
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2/ Retrospective study of 60 pts with HRS tx'd with mid/oct/HSA and 21 concurrent pts only received HSA - mid/oct/HSA had significantly lower mortality (43 v 71%) and higher proportion of pts who had resolution of HRS (40 v 10%)
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Replying to @SC48008940
@SC48008940 yo

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