ps - here's the link https://t.co/Vv2doQyGmf

the IBCC now has a ChatBot 😁 created by Joshua Faber, EM resident in NYC it's kinda like OpenEvidence, just for the IBCC answers seem pretty good & it links you to the most relevant chapters it can be used like an index, but it's way better than a traditional paper index

Fresh chapter: Cannabis use & complications 🌿Legalization, higher %THC, & edibles are making this an increasingly common issue 🌿Cannabis withdrawal is an overlooked cause of misery & patient-directed discharges 🌿Cannabinoid hyperemesis syndrome https://t.co/30Yd0vPGQl

Nalbuphine is the Diet Coke of opioids: fresh blog 🥤Multimodal mechanism: partial mu-opioid agonist (like buprenorphine) & kappa-opioid agonist 🥤 Reduced incidence of mu-opioid agonist side-effects (respiratory suppression, emesis, abuse potential) https://t.co/uC7iJUByBm

Triple-threat strategy for using LLMs to answer a medical question: 3️⃣ Have your own opinion & use conventional sources 3️⃣ OpenEvidence: looks at highest quality sources, but has blinders 3️⃣ Broad-spectrum LLM gives 3rd opinion fresh tiny blog: https://t.co/zl1gpxHnuP

🚨Medetomidine withdrawal: Serious new toxidrome (fresh IBCC chapter)🚨 💣Illicit fentanyl is increasingly adulterated with (dex)medetomidine 💣Combined withdrawal from fentanyl & medetomidine is disastrous 💣Requires specific tx strategy https://t.co/lUJXSBzrp7

Humanism-first structure for family meetings (fresh blog) 🗣️ 1st part of the meeting explores who the patient is, quality of life, & goals 🗣️ Spend more time talking about the person & less time focused on the disease blog: https://t.co/dy1412NSoc

fresh blog: Loading Infusion Auto-Titration (LIAT) for infused meds with intermediate half-lives ⚖️start gtt at max rate ⚖️when therapeutic effect is reached, drop to maintenance gtt ⚖️maintenance rate calculated based on *time* to optimal effect link: https://t.co/dQmTYJQHSO

fresh blog: Loading Infusion Auto-Titration (LIAT) for infused meds with intermediate half-lives ⚖️start gtt at max rate ⚖️when therapeutic effect is reached, drop to maintenance gtt ⚖️maintenance rate calculated based on *time* to optimal effect link: https://t.co/dQmTYJQHSO

EMCrit 397 - Philosophy of Arterial Lines in the ED - A Debate in Absentia A discussion of some arterial line philosophy, accuracy, and ease of placement. https://t.co/8GNFZQlUAz

PulmCrit blog: Michelin Chest Syndrome A shallow pigtail chest tube straightens out & lacerates the lung… Side-holes in the chest wall function as a conduit, pushing air into the subcutaneous tissue… Massive subcutaneous emphysema occurs. blog: https://t.co/D74gJH7Fp1

Fresh IBCC chapter: Measles in the adult hospitalized patient 🤒 tx = mostly supportive but there are important nuances 🤒 viral pneumonia has parallels to COVID 🤒 encephalitis appears to be ADEM (not neuroinvasion), treatable with steroid chapter: https://t.co/MjUw4jurTU

Why do I care? Phenobarbital is commonly maligned as an incredibly dangerous drug, leading to underutilization where it could be uniquely helpful (e.g. alcohol withdrawal). But ultimately the dose makes the toxin. High enough doses can absolutely kill someone, but not 260 mg.

For more context, the landmark VA-Cooperative trial on status epilepticus gave patients 15 mg/kg of phenobarb (~1000 mg). This dose was generally well tolerated (despite the presence of active brain injury rendering patients vulnerable). https://t.co/jTyXf48Tg4

But we can be more precise about this. Phenobarb level varies linearly with cumulative dose level ~ 1.5(dose in mg/kg) Assuming an average wt of ~70 kg, 260 mg of PB should yield a level of ~6 ug/ml That's *subtherapeutic* and nowhere close to a dangerous level.

The most common cumulative phenobarb dose was 260 mg. 260 mg isn't anywhere close to a lethal dose of phenobarbital. As a rough benchmark, a lethal dose is probably >10x higher in the range of several thousand mg (although obviously there's not solid data on this).

I want to discuss an error in a recent article in @propublica by @davidmcswane The article alleges that an oncologist euthanized several patients with phenobarbital. Evidence from the article is shown below. Can you see the error? https://t.co/yo6ZCPpQzS

~1 month after moving to bloo ski, I want to report back that it’s freaking great. 😃 algorithm picks up nice stuff 😃 feeds concentrate high-yield posts 😃 no ads or trash (twitter is becoming NSFW 😬) 😃 getting better every week how-to guide here: https://t.co/DkN8COQv0F

In case you’re starting use that new app everyone is talking about… Give us a follow: https://t.co/xbjdgTBtrS 🦋

how to quickly set up a useful MedSky account! 🦋 It’s blown up over the past week and it’s increasingly fun & useful. 🦋 This isn’t about politics; it’s a legitly better platform. blog: