How I made that short video about interpreting ABGs

Here are the tweets (I’m using WordPress’ ability to post a tweetstream, pretty cool)

We need to know if it is alkalosis or acidosis, so we ordered an ABG.

Thought I’d try my hand at a @HannahRAbrams style explanatory animation for the above ABG. Need to get it down under 2:20 to fit in a tweet.

And the last bit

Originally tweeted by Joel M. Topf, MD FACP (@kidney_boy) on October 7, 2020.

I made the video with Keynote, it is a single slide with a lot of animation. Here is the slide (all 750 kilobytes):

Creating the animation just takes patience. This slide has 44 steps to the animation. It is a mixture of build ins, actions, and build outs.

Once I had the animation perfect I used “Record Slideshow…” to record the animations and my narration, then exported the movie using “Export To Movie…”

Ascension St John Nephrology Fellowship closing argument

If you are a resident looking for a nephrology fellowship take a moment to consider St John. We are a small nephrology fellowship that values hand-crafted nephrology education. Ascension St John hospital is a 714 bed hospital that is literally on the border of Detroit and Grosse Pointe. Yes, that Grosse Pointe.

This provides us a steady stream of patients with diverse backgrounds. St John operates a busy ER with a healthy mix of trauma. We get people from the upper socioeconomic classes and their unique presentations and diseases. Importantly, especially for a community program, St John is big enough to offer all the services:

  • ECMO
  • CRRT
  • Plasma exchange
  • Red and white cell pheresis
  • Acute PD
  • Kidney transplant

We still do our own biopsies. We have our own interventional nephrology suite, where we place tunneled venous catheter, provide fistulagrams, and do access angioplasty for our hemodialysis patients.

But the most important part of our fellowship is that we are not a rough and tough, traditional, malignant program. We take a gentler, kinder approach to medical education. Over the last few years we have decoupled our reliance on fellows to do the work of nephrology. It wasn’t trivial and it required buy in from the entire staff but we realize that treating fellows as worker mules was not good for their education. This uncoupling means fellows will be busy, experience requires being busy, but we don’t let our fellows get overwhelmed by the work. Our program takes fellows by the hand and guide them through a bespoke education track to provide them with a top notch nephrology education. Regardless of how unsteady or unsure you are about your kidney knowledge, we will turn you into a first rate nephrologist. That’s our promise.

So if you have finished your interviews but still haven’t found the program that feels like home, check us out.

DDAVP Clamp

Bibliography:

Perianayagam, A. et al. (2008) ‘DDAVP is effective in preventing and reversing inadvertent overcorrection of hyponatremia’, Clinical journal of the American Society of Nephrology: CJASN, 3(2), pp. 331–336. https://cjasn.asnjournals.org/content/3/2/331

Gharaibeh, K. A. et al. (2015) ‘Risk factors, complication and measures to prevent or reverse catastrophic sodium overcorrection in chronic hyponatremia’, The American journal of the medical sciences, 349(2), pp. 170–175.

The initial infusion rate (mL/hr) of 3% saline can also be simply calculated as a product of patients’ weight (kg) and desired correction rate (mEq/L/hr)

Sood, L. et al. (2013) ‘Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia’, American journal of kidney diseases: the official journal of the National Kidney Foundation, 61(4), pp. 571–578. https://www.ajkd.org/article/S0272-6386(12)01471-0/fulltext

Rafat, C. et al. (2014) ‘Use of desmopressin acetate in severe hyponatremia in the intensive care unit’, Clinical journal of the American Society of Nephrology: CJASN, 9(2), pp. 229–237. https://cjasn.asnjournals.org/content/9/2/229

Adrogué, H. J. and Madias, N. E. (2000) ‘Hyponatremia’, The New England journal of medicine, 342(21), pp. 1581–1589. https://www.nejm.org/doi/pdf/10.1056/NEJM200005253422107

Mohmand, H. K. et al. (2007) ‘Hypertonic saline for hyponatremia: risk of inadvertent overcorrection’, Clinical journal of the American Society of Nephrology: CJASN, 2(6), pp. 1110–1117. https://cjasn.asnjournals.org/content/2/6/1110

Morris, J. H. et al. (2018) ‘Rapidity of Correction of Hyponatremia Due to Syndrome of Inappropriate Secretion of Antidiuretic Hormone Following Tolvaptan’, American journal of kidney diseases: the official journal of the National Kidney Foundation, 71(6), pp. 772–782. https://www.ajkd.org/article/S0272-6386(18)30004-0/fulltext