Joseph Nicholas @joebeigemd
URMC Med Ed, clinical reasoning and orthogeriatrics. Finger Lakes junkie. New York, USA Joined January 2013-
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Joseph Nicholas retweeted
(1/3) In the ICU we focus a lot on Mean Arterial Pressure, Systolic Blood Pressure, and even Pulse Pressure Variation... Pulse Pressure itself is often overlooked but one of the most valuable quick upgrades to your blood pressure assessments! Why? Its a great surrogate of…
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Joseph Nicholas retweeted
Makes reviewing with residents/fellows so much easier, speaking the same hemodynamic language!
Joseph Nicholas retweeted
5/5 SPLENOMEGALY/HYPERSPLENISM RBC count is compensated via ↑EPO when counts fall. Platelets and WBCs: no equivalent hormone feedback. → In hypersplenism, anemia is less marked, but thrombocytopenia & neutropenia are common.
wonderful emphasis on perfusion and microcirculation over MAPs and protocols- every person is unique
wonderful emphasis on perfusion and microcirculation over MAPs and protocols- every person is unique
Joseph Nicholas retweeted
1/ 💉 Resuscitation fluids – life-saving in true hypovolaemia. Give them for the wrong reason and you harm patients. We’ve covered maintenance & replacement fluids — now the trilogy ends with resuscitation. Here’s how to get it right. #MedX
Joseph Nicholas retweeted
1/ Last time we tackled maintenance fluids – what the body needs day to day. x.com/Turningthe_Tid… Now let’s talk about replacement fluids – what to give when something’s been lost. Same volume. Same composition. That’s the key. Let’s keep it physiological. 💧
1/ Last time we tackled maintenance fluids – what the body needs day to day. x.com/Turningthe_Tid… Now let’s talk about replacement fluids – what to give when something’s been lost. Same volume. Same composition. That’s the key. Let’s keep it physiological. 💧
Joseph Nicholas retweeted
1/ IV fluids have two main purposes: 💧 To maintain daily needs 🔄 To replace losses (We’ll come back to whether we should even use the term 'resuscitation' fluid in a future thread). Let’s talk about maintenance fluids – when they’re needed, and when they’re not. 🧵 #MedX…
Joseph Nicholas retweeted
Choosing the right anticoagulant @thecurbsiders #MedX
Critical famine risk in Gaza. Support @RESCUEorg. The International Rescue Committee helps people whose lives and livelihoods are shattered by conflict and disaster to survive, recover and regain control of their future. help.rescue.org/donate/evergre…
Joseph Nicholas retweeted
🧵 Lymphangions: The Hidden Pump Protecting You From Oedema 1️⃣ What if I told you that you have hundreds of tiny hearts quietly pumping litres of fluid every day? They’re called lymphangions—segments of your lymphatic system that actively contract to return interstitial fluid to…
Joseph Nicholas retweeted
Right here. And that clinician is truly misled by the fact that there was a brief positive response to the fluids. “They really needed it, they just need a bit more and everything will be ok.” Its well-meaning but cam be fatal.
Right here. And that clinician is truly misled by the fact that there was a brief positive response to the fluids. “They really needed it, they just need a bit more and everything will be ok.” Its well-meaning but cam be fatal.
Joseph Nicholas retweeted
@Rajiv_Sinanan @icmteaching @ThinkingCC @ArgaizR @NephroP 3/3 followed by a clinician brainstem reflex to continue a prescription of more fluids that temporarily improve MAP at the expense of further uncoupling of the circulation and worsening tissue perfusion. Rinse, repeat. Patient dies despite “we did everything we could”.
Joseph Nicholas retweeted
💥 July 1 is coming. That means brand new interns and brand new Neuro residents! Ready to turn that reflex hammer into a GPS for finding lesions? Let's review how to localize using your neuro exam 👇
Joseph Nicholas retweeted
1/ Most people think the heart drives circulation. But what if that’s backwards? Anderson’s model flips the whole idea of cardiac output on its head — and it changes how you think about fluid, flow, and failure. 🧵👇 #physiology #FOAMed #MedTwitter #criticalCare #cardiacOutput
Joseph Nicholas retweeted
🚨 Heart failure (HF) decongestion ≠ simple fluid removal. Let’s explore the fascinating electrolyte changes happening behind the scenes and how they interact with diuretic therapy. 🫀💧⚡ Here follows a thread.🧵 Full review by @FH_Verbrugge and me: onlinelibrary.wiley.com/doi/10.1002/ej…
Joseph Nicholas retweeted
1/ You might think: "Why give NaCl to someone overloaded with salt and water? Shouldn’t we be pulling sodium out, not putting it in?" 🧂💧 It feels wrong — but correcting chloride can unlock natriuresis. Let’s break the paradox. 🧵
Joseph Nicholas retweeted
@FH_Verbrugge @ArgaizR Some pearls of wisdom on this subject in this thread 👇🏻
@FH_Verbrugge @ArgaizR Some pearls of wisdom on this subject in this thread 👇🏻
Joseph Nicholas retweeted
🧵1/ Hypovolaemia is the most overdiagnosed concept in medicine. We say it reflexively — especially in sepsis. But here’s the uncomfortable truth: We can’t measure blood volume. We infer it. Often wrongly. Let’s unpack why that matters. 👇 #MedTwitter #FOAMed
Joseph Nicholas retweeted
Quick ECG Clues Every Clinician Should Know😍
Joseph Nicholas retweeted
Congratulations to @PCSDSutherland senior Aaliyah Nicholas for earning a spot in the top 10 of the NYC Bound regional Jimmy Awards Competition for performing arts! #PittsfordPride #IamPittsfordSchools
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