Me: Made a thread about how people don't understand hyperacusis and give advice that obviously I've already tried.

This person only a few tweets into the thread:

[Thread]: Old school "medicine" ads obviously created by aliens.

Let's begin with cocaine toothache drops, for only 15 cents.

Dr. Batty’s asthma cigarettes were not recommended for "children under 6.”

Best prescription for malaria, chills and fever: Grove's tasteless Chill Tonic, obviously.

"It is simply iron and Quinine in a tasteless form".

The cheapest specific for the relief of cough: heroin.

There's also Dr Williams' Pink Pills for Pale People.

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

I transformed my body in 6 months.

People charge INR 25,000+ for this information. It should be free.

Just follow these simple fat loss rules:

Exercise:
• 3-4x per week
• Weights > Cardio
• Compound movements first
• Cardio after weights

Don't focus on burning calories focus on getting stronger

Video

Nutrition:
• 20-25% calorie deficit
• 1.6-1.8 g/Kg Protein
• 2x fruits & veggies daily
• Limit eating out

Food quantity determines weight loss. Food quality determines health.

Video

Sleep:
• Fix wake up time
• Sleep 8 hrs
• No caffeine after 2 pm
• Dinner 2-3 hours before bed

Have a routine, and be consistent. Routines save your time and maximise your energy.

Video

Simple is beautiful.

Don't bookmark and forget.

• Commit to the end goal
• Disappear for 6 months
• Build yourself in private

Before you go, I would love to give you 10 bonus tips to make you unstoppable-

(with step-by-step video tutorials)

Anxiety resides in 4 spaces:

1. The space inside you
2. The space between you and another
3. The space between others
4. The space inside another.

A powerful de escalation tools is to first locate the anxiety. Where is it?

Often the answer is 'all 4.' Yikes!

1/

Anxiety is contagious, we spread it and escalate it unless we know how to manage it.

This was perhaps my biggest lesson as a trauma chaplain - the very hard work of not catching someone's anxiety.

2/

When I caught it, I was no good to them. I no longer saw what was going on, I was now 'infected' by my own triggers, assumptions, the story I tell myself. I was all wrapped up in myself.

But when I managed my anxiety, I was able to be calm, aware and fully present to them.

3/

Even in the very worst moment of their lives, even if they had me by the shoulders screaming, 'how could God allow this to happen?'

4/

Incidentally, early in chaplaincy, I thought this was an actual question. Because I was anxious, I was more infected by my need to answer than I was to simply be calm and present with them in their pain.

5/