From “Disposition” to Dignity: Finding the Person in the Patient I had an unexpected epiphany during my geriatrics rotation — not amid the chaos of a bustling hospital, but within the reflective calm of a…

Medicine is more than just protocols, it’s about the human moments in between. Sharing my thoughts.

From ‘Disposition’ to Dignity: Finding the Person in the Patient by Aditya Singh
medium.com/p/beyond-dis...

@agawande.bsky.social @kevinmd.bsky.social
#Medicine #Wellness #IMG

Ketamine vs Etomidate for RSI-NEJM trial
-28-day mortality: No difference (Ketamine 28.1% vs Etomidate 29.1%)
-Ketamine ↑ risk of peri-intubation cardiovascular collapse (22.1% vs 17.0%)
@nejm.org
Graphic generated using AI
#CriticalCare #RSI #ICU #MedTwitter #PulmCrit

tinyurl.com/bdzekh49

Ever wondered where QTc actually comes from? 🫀

QT shortens as HR rises, but not linearly

ECG data showed: QT ∝ √RR

So we “flattened” the curve:
QTc = QT / √RR (Bazett, 1920)

⚠️ Overcorrects in tachycardia
✅ Fridericia/Framingham better in ICU

#ECG #Cardiology #PCCM

Oct 2025 NEJM issue is a goldmine for cards🫀

🚨STEMI + multivessel disease: Immediate or Deferred Nonculprit Lesion PCI🫀
@nejm.org #UPDATE

🫀Immediate iFR-guided PCI ≈ Deferred MRI-guided PCI at 3 yrs
⚡No difference in death, MI, or HF hospitalization (HR 0.95, p=0.81)
🧠 Stroke/TIA lower with iFR

tinyurl.com/ystr7kvm

Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients at 7 Years | NEJM Five-year data from the PARTNER 3 trial showed that among low-risk patients with severe, symptomatic aortic stenosis, outcomes were similar among patients who had undergone transcatheter aortic-val...

🚨TAVR vs SAVR in Low-Risk Patients at 7 Years 🫀
@nejm.org PARTNER 3 Trial #updates

👉No sig. diff in 🪦 death, 🧠 stroke, or 🏥 re-hospitalization

Valve durability 💪 similar too.

#TAVR #CardioTwitter #MedTwitter #AorticStenosis

tinyurl.com/yd748jxt

🚨AI-ECG analysis for STEMI triage (JACC 2025)🫀⚡️ #JournalWatch

✅ ↑ Sensitivity 92% vs 71%
✅ ↓ False activations 7.9% vs 41.8%
✅ Better detection of LCx (40.6%) misses

#Cardiology #STEMI #AI @jaccjournals.bsky.social

tinyurl.com/54m23uj4

Thoughts?-POCUS for Setting PEEP🫁

🫧Lung US→Detect recruitment, monitor aeration
💪Diaphragm US→Track diaphragm geometry, contractility, predict NIV/weaning outcomes.

📈 Integrating both helps balance recruitment vs overdistension.

tinyurl.com/35ttec4f

🫀SCCM 2024 - Guidelines on Adult Critical Care Ultrasonography 🏥:

Conditional recommendations-
🫢 Acute dyspnea / resp failure
💧 Targeted volume management
❤️ Cardiogenic shock
🦠 Septic shock

+/-⚖️ Cardiac arrest

#POCUS #ICU #PCCM @sccmcriticalcare.bsky.social

tinyurl.com/5a7w3k8k

🫀💊Aspirin & Oral Anticaogulation in Chronic Coronary Syndrome /
🧑‍🎓AQUATIC Trial (NEJM Oct 2025):

✅Adding aspirin ↑ CV events, ↑ mortality, & ↑ major bleeding vs placebo

👉 No ischemic benefit
❤️‍🔥More harm

@nejm.org #Cardio #updates

tinyurl.com/2zc5zh38

💊🫁Therapies in CTD-ILD (ATS 2020):

🔹Steroids- acute inflammation
🔹Mycophenolate/Cyclophosphamide- immunosuppression backbone
🔹Rituximab/Tacrolimus- for refractory disease
🔹Nintedanib/Tocilizumab- antifibrotic & targeted

#ILD #PulmCC @atscommunity.bsky.social
tinyurl.com/kyyvnftu

🫁Connective Tissue Disease Associated ILD (ATS 2020)

🔹RA-UIP pattern
🔹SSc-NSIP
🔹IIM (Idio Inflam Myopathy)– NSIP + OP overlap

#Updates
#PulmCC #Rheum #ILD @atscommunity.bsky.social

tinyurl.com/kyyvnftu

Brensocatib in Bronchiectasis — A New Sheriff in Town? | NEJM Bronchiectasis unrelated to cystic fibrosis is the third most common chronic pulmonary disorder after asthma and chronic obstructive pulmonary disease.1 Bronchiectasis has multiple causes and is ch...

📚 Bronchiectasis Update - NEJM (April 2025):

🫁 Brensocatib reduces exacerbations in non-CF bronchiectasis
💊 Targets neutrophilic inflammation via DPP1 inhibition, a novel approach beyond antibiotics

#PulmCC #Bronchiectasis @nejm.org
tinyurl.com/ycxz9xhk

Big week ahead at #CHEST2025 🫁🧑‍🔬🥼✨
Presenting multiple 🪧 posters, a 🎤 rapid-fire oral presentation, and honored to be a 🏅 semifinalist for the Top Scientific Abstract Poster Award!
Grateful & excited to share our work 🙌
#PCCM #CHESTSoMe @accpchest.bsky.social

Made it to Chicago for #CHEST2025! 🫁🌇
Honored to be part of the Social Media team - can’t wait to dive into sessions, meet colleagues & share it all with you. #CHESTConference #PulmCC #MedTwitter #CHESTSoMe @accpchest.bsky.social

🫁ARDS Mx (ATS 2024):

✅Lung-protective vent(Vt 4–8 mL/kg PBW, Pplat <30)
✅Prone >12 h/day for severe ARDS
🟡Consider: Steroids, VV-ECMO, NMB, higher PEEP (no LRMs)
🚫No HFOV & prolonged LRMs

@atscommunity.bsky.social
#ARDS #CriticalCare #Pulm #ICU

tinyurl.com/sxuwd3f5

Tirzepatide-OSA (NEJM 2024)💉🛏️💤

⚕️FDA Approves First Medication for Obstructive Sleep Apnea

💊Drug: Weekly tirzepatide > placebo
🧑‍🤝‍🧑Pop: OSA + obesity (no non-obese)
👉Effect: ↓AHI, ↓wt, ↓SBP, ↓hsCRP @ 52wks

@nejm.org @fda.gov
tinyurl.com/mrytwruc

High Dose IV Vit B12 in Septic Shock, Phase 2 Trial (Pilot):

🧑‍🔧Mechanism: H₂S scavenger → ↑vascular tone
💊Intervention: 5 g IV hydroxocobalamin ×1 vs placebo
👉Result: ↓vasopressor need (−36% vs 4%); safe & feasible

tinyurl.com/3de9k7c8 @accpchest.bsky.social #Sepsis

Pulm-renal syndrome serology (ERS 2023)🫘📷💊

🩸ANCA Vasculitis:GPA→PR3+, MPA→MPO+, EGPA→MPO±
🩸Anti-GBM: Ab 95–100% sens/spec
🩸CTD: SLE→dsDNA/Sm/C1q; APS→aCL/Lupus AntiCoag; RA→RF/anti-CCP; MCTD→Anti-RNP

@europeanrespsoc.bsky.social

tinyurl.com/4zz3fh74

Pulmonary-renal syndrome Tx (ERS 2023)🫘🫁💊

🙀Induction: Steroids+CYC/RTX±PLEX ±IVIG/AC (APS)
😼Maintenance: Per etiology-Steroids/AZA/MTX/CYC/RTX

@europeanrespsoc.bsky.social doi.org/10.1183/2073...

Fleischner 2017- Solid Pulm Nodule🫁
👉<6 mm:Low risk-no FU;High risk-optional CT@ 12 mo
👉6–8 mm:CT@ 6-12 mo→ consider @ 18–24 mo
👉>8 mm:CT@ 3 mo±PET/CT or biopsy

⚡️Use most suspicious nodule if multiple
🤯risk = smoker/upper lobe/morphology @rsnasky.bsky.social
doi.org/10.1148/radi...

AI can predict AKI 24-48h before changes in s.Cr levels and identify sub-phenotypes with distinct characteristics and outcomes.
Promise is huge but validation, ethics & data quality remain key.
#Nephrology #AI @jasminenephro.bsky.social Nephro DOI: 10.1097/MCC.0000000000001202

Burnout, Depression, and Diminished Well-Being among Physicians | NEJM Diminished well-being among physicians is of growing concern. The authors review measures of burnout and depression, causal factors, and interventions to improve well-being.

NEJM review 10/2024:
Physician burnout overlaps heavily w/ depression
Key driver: workload(long hours spike symptoms 5-6x in residents)
Fixes: Reduce hours,add support(scribes/AI), mindfulness/CBT #burnout #wellness @nejm.org
nejm.org/doi/full/10....

🚨PEERLESS Trial🚨
Large-bore mechanical thrombectomy (LBMT) vs catheter-directed thrombolysis (CDT) for intermediate-risk PE.

LBMT✅=fewer clinical deteriorations, less ICU use, and shorter hospital stay with no ↑ in mortality or bleeding. @ahascience.bsky.social

www.ahajournals.org/doi/10.1161/...

Counting down to #CHEST2025! As Social Media Ambassador, I'm geeking out over sessions on AI and newer advances. What's the 'next big problem' in medicine we need to solve? Will be tweeting live from Chicago! Oct 19-22. #CHESTSoMe #MedEd #ARDS #CHEST2025
@accpchest.bsky.social