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David Warner (he/him)

@davidwarner2.bsky.social
430 followers 849 following 221 posts

First-generation, non-traditional MS4 at UCincy. UNC ‘14. MSMP CWRU ‘21. Former high school teacher and lab tech. Budding nephrologist. Interested in physiology, medical education, LGBTQ+ health, and the kidneys. Skeets are my own/not medical advice. 🏳️‍🌈

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Reposted by David Warner (he/him)
Dr. Amy Acton @amyactonoh.bsky.social · 04/06/2025
Starting today, I’m launching a four-day, 15-stop listening tour across Ohio. Across the state, I’m meeting with families, teachers, and local leaders to hear what’s working—and what’s not. Because the best ideas come from the people living them.
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Reposted by David Warner (he/him)
Edgar V. Lerma 🇵🇭 @edgarvlermamd.medsky.network · 21/05/2025
On this day in 1747, James Lind began his study on sailors with scurvy, the world's "first clinical trial." #ClinicalTrialsDay #NephSky 👉 www.bbc.com/news/uk-engl...
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Reposted by David Warner (he/him)
Erin Reed @erininthemorning.com · 18/03/2025
1. Incredible ruling! An Ohio appeals court has ruled that trans care is healthcare, strikes down youth trans care ban! It made the ruling using the Republican-passed "health care freedom amendment" meant to overturn Obamacare! Subscribe to support my journalism. You'll want to read this one.
erininthemorning.com
Ohio Appeals Court Rules Trans Care Is Healthcare, Strikes Down Ban For Trans Youth
The ruling was in part based on a 2011 Amendment in the state guaranteeing healthcare freedom, originally meant to challenge Obamacare.
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
One of the biggest lessons I've learned in medical school is that almost everyone has some form of impostor syndrome. What defines success is whether you choose to let it inhibit you or allow it to motivate you. #MedSky #FoodForThought
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
AOA induction dinner! Congratulations to my amazing classmates; can’t wait to see where you end up in 2 weeks and hear about your future accomplishments! #Match2025 #UCCOMClassof2025
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Summary: 🧠 MSCC is an onc emergency causing severe back pain + FND 🧠 Dx: whole-spine MRI 🧠 Tx: steroids, pain control, radiotherapy, +/- surgery Sources: 1. 2023 NICE Guidelines: buff.ly/3DC4SrM 2. Review by Akanda/McKay: buff.ly/4iZOoK8. 3. Youtube: buff.ly/40koN7i
nice.org.uk
Recommendations | Spinal metastases and metastatic spinal cord compression | Guidance | NICE
NICE guideline [NG234] Published: 06 September 2023
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Surgical options include decompression and stabilization. Indications: 🧠 Single level cord compression 🧠 Adequate baseline performance status 🧠 Spinal instability present 🧠 Uncontrolled pain 🧠 Radioresistant tumor 🧠 Histological diagnosis Surgery is often followed by adjuvant radiotherapy.
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Rades et. al published a validated scoring system to predict prognosis within 6 months to guide radiotherapy. 🧠 Score 20-30 = poor prognosis (short-course recommended) 🧠 Score 30-35 = intermediate prognosis 🧠 Score 36-45 = favorable prognosis (longer course recommended, as more likely to recur)
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Radiotherapy: 🧠 Offer within 24 hrs if the pt is not a surgical candidate (unless pt has been tetra- or paraplegic for 2 wks and pain is managed) 🧠 Assess desire for future fertility 🧠 Repeat radiotherapy if good response and symptoms return >3 months after treatment
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Management: 🧠 Spine immobilization 🧠 Corticosteroids (16 mg as soon as suspected, taper after radiotherapy/surgery) 🧠 Radiotherapy 🧠 Surgical decompression and/or stabilization 🧠 External spine support (e.g. halo vest or Milwaukee brace) if spine instability and not a surgical candidate
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Workup: 🧠 MRI w/in 24 hrs: sagittal T1 and T2-weighted sequence of whole spine + axial imaging of detected lesions 🧠 CT + myelogram if MRI contraindicated 🧠 Bladder scan if relevant + Foley if needed 🧠 Assess for spinal instability (e.g. Spinal Instability Neoplastic Score)
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Clinical features: Back pain is the most common symptom. 🧠 Severe and localized 🧠 Worse when coughing, sneezing, defecating or lying down 🧠 Progressive worsening 🧠 Disturbs sleep Other features 🧠 Weakness 🧠 Sensory disturbance 🧠 Autonomic dysfunction 🧠 Paralysis 🧠 Cauda equina syndrome
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
MSCC usually results from hematogenous spread to the vertebrae with the thoracic spine most commonly affected due to its blood supply. The mechanisms of MSCC include 🧠 tumor invasion into the epidural space 🧠 encroachment of vertebrae on the spinal cord 🧠 obstruction of the epidural vein plexus
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
MSCC is most commonly caused by metastasis to the vertebrae caused most commonly by the following cancers: Adults 🧠 Lung 🧠 Breast 🧠 Prostate 🧠 Less common: renal cell carcinoma, myeloma, lymphoma, GI cancers, melanoma Children 🧠 Sarcomas 🧠 Neuroblastomas 🧠 Neuroectodermal tumors
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David Warner (he/him) @davidwarner2.bsky.social · 07/03/2025
Malignant spinal cord compress (MSCC) is an oncologic emergency that impacts about 5% of patients with cancer, leading to pain, weakness, and paralysis. Let's explore the physiology, anatomy, presentation, workup and treatment. A 🧵 #PhysiologyFriday #MedStudentSky #OncSky
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David Warner (he/him) @davidwarner2.bsky.social · 05/03/2025
Just completed a module on lead reversals as part of my M4 EKG elective, which has suddenly unlocked a series of trust issues I didn’t know I had 😳 #TrustButVerify @fuqekgs.medsky.social
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Reposted by David Warner (he/him)
NPR @npr.org · 04/03/2025
Harrison, whose plasma contained a rare antibody, rolled up his sleeve 1,173 times from 1954 to 2018. The Australian is credited with helping 2.4 million babies and advancing scientific research.
npr.org
James Harrison, whose blood donations saved over 2 million babies, has died
Harrison, whose plasma contained a rare antibody, rolled up his sleeve 1,173 times from 1954 to 2018. The Australian is credited with helping 2.4 million babies and advancing scientific research.
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Reposted by David Warner (he/him)
NephMadness @nephmadness.bsky.social · 03/03/2025
#NephMadness 2025 is live on the #AJKDBlog: bit.ly/WelcomeNM25 Topics include: - Resistant Hypertension - Obesity - Green House - Minimal Change Disease - Disaster Nephrology - Genetics - Hemodialysis - CAR-T for Kidney Disease Looking forward to the fun and learning with all of you!
buff.ly
Welcome to #NephMadness 2025
Here it is, the 13th edition of NephMadness!  Whether you’re new to the competition or just want to relive past glories, we have all the info you need for NephMadness 2025: What is NephMadnes…
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Reposted by David Warner (he/him)
Matthew Sparks @nephrosparks.bsky.social · 01/03/2025
Can't wait to hear all of these podcasts covering #NephMadness topics
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Sources: 1. 2023 Umbrella review by Shah, et. al: buff.ly/3DCwnkJ 2. Overview of Etiologies, Manifestations, and Treatments by Quencer: buff.ly/41ZXIrs 3. Excellent Youtube video by Dr. Strong: buff.ly/4gVG1gP 4. Amboss (Oncological Emergencies)
youtube.com
SVC Syndrome (Oncologic Emergencies)
An overview of the clinical presentation, etiologies, diagnosis, and treatment of the superior vena cava syndrome - a serious complication of non-small cell ...
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Summary: 🫀SVC syndrome is a medical emergency most commonly caused by malignancies (NSCLC, SCLC, NHL) 🫀Increasingly caused by thrombosis from catheters or pacemakers 🫀Oropharyngeal, respiratory, or cerebral involvement are red flags 🫀Stenting is now the treatment of choice for symptomatic pts
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Treatment for catheter-associated thrombosis 🫀Catheter-directed thrombolysis or thrombo-aspiration 🫀If severe symptoms, mechanical thrombectomy 🫀Anticoagulation for at least 3 months
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Management 🫀If severe symptoms present, emergency endovascular stent 🫀If laryngeal edema present, intubate! 🫀Steroids may be beneficial for laryngeal edema, as well as lymphoma and thymoma (but biopsy first!) 🫀Treat underlying malignancy
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Scoring systems have been created to guide management: 🫀 The Kishi scoring system - Score >3 indicates need for stenting 🫀 The Yu grading system - Score of 3 or 4 indicates need for stenting 🫀The Stanford Method - Venography used to identify patients at risk for airway or brain involvement
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Workup: Unstable patients 🫀Invasive venography Stable patients 🫀CXR 🫀CT chest with CT venography (MRI with MRI venography if contraindicated - e.g. pregnancy) 🫀Doppler US for pacemaker or catheter-associated thrombosis
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Clinical Features: 🫀 Facial, neck, and arm swelling 🫀 Non-pulsatile JVD 🫀 Dysphagia 🫀 Dyspnea 🫀 Stridor 🫀 Cough 🫀 Hoarseness 🫀 Symptoms worse when lying down or bending forward Red flag symptoms: 🫀 Laryngeal edema 🫀 Hemodynamic instability 🫀 Increased ICP 🫀 Confusion 🫀 Blurry vision
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
🫀 The drainage of dilated chest wall veins to the left portal vein via the veins of Sappey can lead to perfusion changes and a "hot quadrate sign" around the falciform ligament, seen on this CT.
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Review of anatomy: 🫀SVC drains blood from the brachiocephalic veins, which receive blood from the head and upper extremities 🫀Collateral supply is important in SVC syndrome 🫀Upper/mid esophageal veins drain into the esophagus, causing "downhill esophageal varices"
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
SVC syndrome can be intraluminal (neoplastic invasion, thrombosis) or extraluminal (Pancoast tumor, mediastinal mass) and has malignant and benign causes. Most common malignancies: 🫀 NSCLC 🫀 SCLC 🫀 NHL Benign causes 🫀 Thrombosis from pacemakers or central line 🫀 Mediastinal fibrosis
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David Warner (he/him) @davidwarner2.bsky.social · 28/02/2025
Superior vena cava syndrome is a medical emergency caused by obstruction of blood flow to the SVC with malignancies causing ~60% of cases. However, with the rising use of central lines and pacemakers, the incidence is increasing. A🧵 #PhysiologyFriday #MedStudentSky #MedSky #Skytorial #OncSky
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
What are some of the common and rare indications and complications of therapeutic plasma exchange? Find out in our new study published in BMC Nephrology! 🩸https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-03970-2#citeas @gudnephron.bsky.social #NephSky #MedStudentSky
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Sources: 1. 2012 Blood Review by Ganzel et al.: buff.ly/3Dy6nXJ 2. Review by Bewersdorf/Zeidan: buff.ly/4a4hzrb 3. Grading scale: buff.ly/3W4In4S 4. Amboss (Oncologic Emergencies)
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Summary: 🩸Leukostasis = symptomatic hyperleukocytosis (WBC >100,000) 🩸Clinical features = respiratory and neurological symptoms 🩸May cause falsely high K, low O2, and high platelets 🩸Definitive treatment = induction chemo but perform bone marrow bx first 🩸Use hydroxurea while awaiting studies
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Treatment: 🩸Induction of chemotherapy = definitive 🩸Perform bone marrow biopsy before chemo 🩸Hydroxyurea = bridge therapy while awaiting studies or if chemo contraindicated 🩸Leukapheresis (Grade III recommendation per ASFA, contraindicated in APL) 🩸Prevent TLS: fluids + allopurinol/rasburicase
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Some caution is needed when interpreting labs in patients with leukostasis as it can cause 🩸Pseudohyperkalemia (WBC destruction after sampling) 🩸Pseudohypoxemia (high uptake of O2 by blasts, pulse ox is a better measure of O2) 🩸Pseudothrombocytosis (leukocyte fragments mistaken as platelets)
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Initial workup: 🩸CBC with peripheral blood smear 🩸BMP (BUN, Cr) 🩸ABG and CXR in dyspneic patients 🩸Blood cultures if infection suspected 🩸CT/MRI Head if neurological changes 🩸Fundoscopy
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Leukostasis is a clinical diagnosis that should be suspected in patients with leukemia who develop 🩸Respiratory distress 🩸Neurological changes 🩸Other end organ damage 🩸Hyperleukocytosis Novotny et. al (2005) created the attached grading score to predict the probability of leukostasis.
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Clinical features: 🩸Dyspnea, tachypnea, pulmonary crackles 🩸Headache, confusion, dizziness, blurry vision, seizures, focal deficits, coma Complications: 🩸Stroke 🩸Myocardial infarction 🩸AKI 🩸Hypoxemic respiratory failure 🩸Priapism 🩸TLS
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Associated malignancies: 🩸 AML (most common) with WBC >150,000 🩸 ALL with WBC >400,000 🩸 CML accelerated phase or blast crisis 🩸 CLL with WBC >1,000,000
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Let's start with some definitions: 🩸 Hyperleukocytosis = WBC >100,000 🩸 Leukostasis = symptomatic hyperleukocytosis Physiology: 🩸 Increased blasts ➡️ release of cytokines that increase selectins and cell adhesion molecules ➡️ adhesion to endothelial cells ➡️ hyperviscosity ➡️ hypoxia
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David Warner (he/him) @davidwarner2.bsky.social · 21/02/2025
Leukostasis is another life-threatening complication of leukemia where extremely high white blood cell counts lead to blood vessel obstruction, leading to ischemia and organ failure. Immediate intervention is crucial. A 🧵 #PhysiologyFriday #Skytorial #MedStudentSky #OncSky
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
This is a great question. I'm an MS4 posting for my learning and would be interested to learn if there is evidence against this practice. I pulled this from the IDSA guidelines, which is an A-III recommendation.
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
Sources: 1. IDSA 2010 guidelines: buff.ly/41U9KCF 2. ASCO/IDSA 2018 updated outpatient guideliens: buff.ly/4j2W0M6 3. Review article: buff.ly/3BU0e7M 4. Amboss 5. Study on organisms: buff.ly/403iu6C. 6. Excellent video by Dr. Strong: buff.ly/4fPJ9tS
academic.oup.com
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
When to stop abx: 🌡️ Known source: usual duration + ANC is improving and >500 🌡️ Unknown source: no fever for >2 days + ANC is improving and >500 Prophylaxis: 🌡️ IDSA guidelines regarding prophylaxis are outlined in the attached table.
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
When to alter antibiotic course: 🌡️ Persistent fever in a stable patient is not a reason to broaden abx 🌡️ Use clinical/microbiology data to guide changes in abx 🌡️ D/c vanc after 2 days if no evidence for gram-positive organism 🌡️ Switch to oral abx if clinically stable + GI absorption intact
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
If hemodynamically unstable: 🌡️ Meropenem/imipenem 🌡️ Vancomycin 🌡️ Aminoglycoside or ciprofloxacin Only use vancomycin if: 🌡️ Skin/soft tissue infection 🌡️ Catheter-related infection 🌡️ Pneumonia 🌡️ Hemodynamically unstable Add antifungal if no response within 3-7 days.
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
Treatment: 🌡️ Once blood cultures are drawn, start empiric antibiotics within 1 hr Inpatient: 🌡️ Empiric cefepime, pip-tazo, or meropenem is recommended 🌡️ Severe penicillin allergy: ciprofloxacin + clindamycin 🌡️ Broaden if suspected MDRO Outpatient: 🌡️ Ciprofloxacin + Augmentin
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
A few risk scores have also been adopted in society guidelines: 1. MASCC Scoring System 📋 Score <21 = inpatient 2. Talcott's rules 📋 Groups I-III = inpatient 📋Group IV low-risk = outpatient 3. CISNE 📋 Used for stable pts receiving mild-mod chemo for solid malignancy 📋 Score >2 = inpatient
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David Warner (he/him) @davidwarner2.bsky.social · 14/02/2025
Outpatient vs. Inpatient Management High-risk (inpatient) 🌡️ Anticipated abx course >7 days 🌡️ANC <100 cells/uL 🌡️Active co-morbidities (hypotension, pneumonia, new abdominal pain, new neuro changes) Low-risk (outpatient) 🌡️ Anticipated abx course 7 days or less 🌡️ No or few co-morbidities
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