Bryan Cotton
@bryanacotton1
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Professor of Surgery/Surgeon at busiest trauma center in US/Father of 6/Libertarian/Major Star Wars geek/Sometimes wrong, never in doubt
Houston
Joined January 2014
Dig again for the win. In pts with HF and ⬇️ E.F, digitoxin led to ⬇️ ☠️ from any cause or hospitalization for worsening HF compared to placebo. Digitoxin in Patients with Heart Failure and Reduced Ejection Fraction | New England Journal of Medicine
nejm.org
The therapeutic efficacy of the cardiac glycoside digitoxin in patients with heart failure and reduced ejection fraction is not established. In this international, double-blind, placebo-controlled ...
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In RCT 1200 pts, keeping K+ 4.5-5.0 (vs.std care) ⬇️ sustained VTach, hospitalization 4 arrhythmia/HF, ☠️ from any cause (22.7 vs 29.2%). Increasing the Potassium Level in Patients at High Risk for Ventricular Arrhythmias | New England Journal of Medicine
nejm.org
Hypokalemia and even low-normal plasma potassium levels increase the risk of ventricular arrhythmias among patients with cardiovascular disease. An assessment of a strategy of actively increasing p...
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Whatever they’re paying you for night>day >night call disruption…It’s not enough. ⬆️ cardiac events…and adequate 😴 after doesn’t fix it. Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults
jech.bmj.com
Background This study examines the associations between device-measured sleep regularity and the risk of major adverse cardiovascular events (MACE), and aims to determine whether sufficient sleep...
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August 29th. The day that SkyNet became self-aware. But there you are. Playing on the robot, like @docmartin22 …letting Intuitive capture every swipe, every movement. Be like Sgt, Kyle Reece. #resistance
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PIV vs CVC initiated pressors🟰90d 💀 on adjusted analysis (⬇️ 💀 on univariate). PIV pressors >6h had <1% complication rate w/ 0 cases of ulceration/tissue injury. CVCs 4% complication rate. Peripheral Vasopressor Use in Early Sepsis-Induced Hypotension
jamanetwork.com
This cohort study examines factors associated with central vs peripheral vasopressor route selection and assesses safety and clinical outcomes of peripheral vasopressor administration in early sepsis...
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As a child" of the 100+ hour work weeks, I can fully attest that that was true! Waiting, even post-call, to do afternoon rounds w/ chief because they were operating late. 😂😂😂.
@rbarbosa91 @bryanacotton1 What about a graduated scale? We give graduated responsibility and autonomy throughout training. Why not progress in the number of hours you can work as you advance? I’ll bet a lot of hours 80-110 was waiting for the chief to finish a case to round.
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Exactly! 👊👊👊.
@bryanacotton1 @rbarbosa91 Right—was attempting to point out arguments are made that some of training, from pre med all the way through residency, is unnecessary. But Eliminating subjects, lessening requirements, shortening residency isn’t going to work out . Western medicine has been pretty remarkable.
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Word. Nailed it again. The stuff my daughter felt compelled to do as undergrad and now as MS4 applying for residency echoes this.
We lament the time that it takes to finish training. Yet we demand of our pre-meds that they spend extra time other than the normal college experience jumping through hoops to gain admission. Then we do it again for residency and fellowship. Shorten these things instead.
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Great work looking at rapid infusers/warmers for plts. Similar to what we found with plts in WB and cry. Same function if not better. Impact of a rapid blood warmer on the quality and function of cold‐stored platelets -Vox Sanguinis - Wiley Online Library
onlinelibrary.wiley.com
Background and Objectives Pre-hospital critical care faces challenges in carrying platelet concentrates (PC). Cold-stored platelets (CSP) may offer improved haemostatic function over room temperatu...
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As usual, @rbarbosa91, a thoughtful/incredible educator, has nailed it. Drop to 80-hrs ⬇️ time in 5yr surgery training by 5-10k hrs. Recent data: 60% graduating chiefs are practice ready. Pass/fail tests, now 3yr med school? .The road to hell they say is paved w/ good intentions.
If you push these efforts too far - shorten the schooling, shorten residency, get rid of the standardized tests, eliminate this and that…. Eventually, there is a point at which people will come to believe your job isn’t that special, and could be done by anyone.
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Can't say I agree with # rather than functional status, but here are PLT transfusion recommendations:.Central line (compressible), <10k.IR, <20k (low risk), <50k (high risk).Major (non-neuro) surgery, <50k.Non-op ICH, <100k.Platelet Transfusion Guidelines
jamanetwork.com
This Special Communication discusses the updated Association for the Advancement of Blood and Biotherapies and the International Collaboration for Transfusion Medicine Guidelines international...
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Pre-admission cognitive impairment predicts poor outcomes in sepsis pts. Nice work from my friend, @amikopter.
cureus.com
Background The importance of long-term outcomes after sepsis has been increasingly emphasized in recent years; however, little is known about the relationship between pre-sepsis patient chara...
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While multiple approaches needed, another option for those prehospital systems that can't get blood to the scene of injury. Supplying whole blood with drones for prehospital transfusion at trauma sites in Finland: A simulation - Erästö - Vox Sanguinis
onlinelibrary.wiley.com
Background and Objectives Prehospital transfusion is now increasingly used in civilian and military medicine. Blood products are, however, perishable and rarely needed in civilian settings. Given...
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Not 2 disrupt 🌎 too much, but agreeing w/ Matt again. More worthless than packing on way in, is overpacking on way out. U need ribs 2 replace hands 2 apply pressure. Besides RUQ (maybe PPP if u do that), the rest is ineffective. If you’re doing LUQ for spleen, just take it out.
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Erry. Damn. Time. It's exhausting. And most TQIP queries are patients level datamining, completely missing the point of TQIP. #StackingTheirCVs.
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In 2016, we started handing out these gifts to our graduating fellows w/ the Man in the Arena speech & photo of someone who was TRULY in the arena. #NoSONOS.#BulletProof #InTheArena
🎙️ Inspired by “The Man in the Arena” quote by Theodore Roosevelt, EAST In The Arena features EAST Members sharing the why and how of their unique trauma & acute care practices. Listen now: #EASTInTheArena #TraumaSurgery #AcuteCare #Podcast
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Ya telling me there’s a chance!. “Some superagers followed all healthy recommendations. Others didn’t eat well, enjoyed 🚬 & 🥃, shunned 🏃, suffered stressful life, & didn’t 🛌 well. “. The first 25 years of the Northwestern University SuperAging Program
alz-journals.onlinelibrary.wiley.com
During late life, “average” does not mean “intact.” For example, cross-sectional data from a common word list learning test show that average delayed word recall raw score at age 80 (5/15) is...
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Pts w/ 2 or > vasc. risk factors had worse cognitive performance @ 2 weeks, but similar improvement in cognitive performance 1-yr post-TBI. Biggest driver poor risk: Diabetes. Vascular Risk Factors and 1-Year Cognitive Change Among Individuals With TBI
jamanetwork.com
This cohort study examines cognitive function among individuals with traumatic brain injury with vs without comorbid preinjury vascular risk factors.
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For those that miss the 4h window, there's still hope with alteplase (haha, HOPE trial) up to 24hrs. Improved functional outcome @ 90 days, but small risk of ICH conversion. Alteplase for Acute Ischemic Stroke at 4.5 to 24 Hours
jamanetwork.com
This randomized clinical trial examines the safety and efficacy of intravenous alteplase administered 4.5 to 24 hours after stroke onset in patients with salvageable brain tissue.
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