ππ€π¨π πππ§π ππ¨ π
@PulmCrit
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zentensivist π§ββοΈ FOAMite π diuresis jedi π¦ leader of the rebel alliance βοΈ resuscitationist π writer with aweful speling π¬ no COI π°
University of Vermont π
Joined October 2012
1st, I review the resident note: itβs disorganized but OK 2nd, I review the med list. Every drug is perfectly dosed, timed, and routed. Totally optimized, tidy med list.
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go home pharma, youβre drunk
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amp-gent-clinda? the 1990s are calling and they want their antibiotics back yes it will work, but we have simpler & less toxic options now you could get the same coverage from a single agent (eg piptazo) with far fewer side effects
What do you think about the typical combination of ampicillin + gentamycin + clindamycin for G&O infections? Iβm not sure about gentamycin as monotherapy for gram negative outside the urinary tract and clindamycin seems unreliable for anaerobes. @BradSpellberg @DrToddLee
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when I use etomidate, I generally add fentanyl (analgesia) & midaz (prolongs sedation >5 min & reduces risk of awareness) I wonder what the BP difference is between ketamine vs an etomidate-midaz-fent cocktail?? π€ my guess would be: not much donβt use pain as a pressor
@SkylerLentz my preference during ketamine shortage is a cocktail πΈ 1) 5 mg midaz 2) 50 mcg fentanyl 3) roc 4) etomidate give them all in sequence w/o flushes inbetween & they all hit at about the same time midaz/fent keeps patient amnestic & comfortable when the etomidate burns off
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Looks like Andexxa is going the way of Xigris. One advantage of a big pharma company with multiple drugs is that they will cut off a drug if it seems like a loser. A small pharma company with fewer products is more likely to hang onto a failing drug until the bloody end.
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Inpatient pharmacology pearl: Infusion durations for IV iron & bisphosphonates were designed to be *short* to improve patient throughput at *outpatient* infusion centers For inpatients, slowing down the infusion rate may reduce infusion reactions/toxicity with *same* efficacy
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NO, ALL DECISIONS IN CRITICAL CARE ARE BINARY, APPLY EQUALLY TO EVERY PATIENT, AND MUST BE MADE VIA A MULTICENTER RCT. THOSE ARE THE RULES. π
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Traditionally a ketamine first guy, but I let my trainees choose their med most of the time and donβt see apparent hemodynamic differences I do push the MAP to ~75 with pressors regardless of agent And I do give fent with etomidate Overall agree with @PulmCritβs take
It's honestly hard to know how to interpret this data due to statistical power limitations. This is an important trial that should change practice. But I don't think we should all jump on the bandwagon that ketamine is a bad RSI drug. fresh blog: https://t.co/BZOj01qT5v
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It's honestly hard to know how to interpret this data due to statistical power limitations. This is an important trial that should change practice. But I don't think we should all jump on the bandwagon that ketamine is a bad RSI drug. fresh blog: https://t.co/BZOj01qT5v
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π₯Fresh blogπ₯ Hot take on RSI trial of ketamine vs etomidate RSI & EvK trials both show *more* BP instability with ketamine *but* lower mortality with ketamine BP drops with ketamine may relate to less pressor before intubation and/or superior analgesia... #1/2
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ferritin hipster: writing about anakinra for hyperinflammatory sepsis phenotypes before it was cool this is from 2016 https://t.co/YEUWdmdAIN
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neurosurg: WHAT IS THE GCS? me:
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updating the IBCC chapter on ECMO any recent advances or important articles I should include? please share any recent practice-changing insights youβve had about ECMO π (itβs one of the harder chapters to update due to high volume of new research)
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this article is so unserious it feels satirical whole-body MRI for worried well is horrifically low-value they find incidentalomas leading to downstream costs & iatrogenic harm a better newspaper would work harder explaining why this is a terrible idea https://t.co/FRtgXsDpoj
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one more reason not to use sevoflurane for status asthmaticus π my main objection is that you generally need to use an anesthesia circuit, which nobody in the ICU knows how to operate safely (eg if you dont keep refilling it with CO2-absorbing beads it wonβt clear any CO2 π³)
π«New in #CriticalCare: Sevoflurane for refractory status asthmaticus: balancing bronchodilation with hepatic safety https://t.co/MChHFXNl0W
#CritCare #BronchodilationResearch #ICU #Asthma
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EMCrit Wee - EVERDAC RCT on Arterial Line Placement in the Medically Critically Ill--Let's hear from the lead author, Gregoire Muller. I love having arterial lines on my crashing patients, but is there any evidence that it makes a difference on outcomes?? [#FOAMed for now]
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so the front-line treatment for anaphylaxis to sugammadex is just standard therapy in a situation of refractory anaphylaxis to sugammadex, maybe you could try giving *vecuronium* (under the assumption that a vec-sug complex wouldn't interact with a roc-sun complex) ???
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anaphylaxis to roc can be treated with sugammadex. this is simple and really neat. anaphylaxis to sugammadex is more complicated: - if rxn to sugammadex *alone* --> giving roc will make things BETTER - if rxn to [sugammdex-roc] *complex* --> giving roc will make things WORSE
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in thyroid storm, treating sinus tach with a beta-blocker will occasionally cause death many patients have reduced LVEF & compensatory tachycardia (borderline cardiogenic shock) beta-blockers push them over the edge what data supports B-bl in thyroid storm? why do this?
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