War 🦅 going to War 🦅
28.02.2026 15:21
👍 0
🔁 0
💬 0
📌 0
War 🦅 going to War 🦅
The important caveat is that you're more likely to be wrong than right using this strategy even in run of the mill abd surg pts w/o lung/cardiac disease--- however you're about equally as wrong as using an empiric PEEP 10 for the chunksters. All assuming you accept Peso. Its the art of medicine.
but muh empiric interventions!
How dare they have consequences. Curious what your practice pattern is. I don't tend to lay on the vaso until I'm dealing with fragile afibers (Mitral stenosis) who I do want to avoid Afib.
Thank you!
neurologists making vague recommendations on things typically beyond their focus without much backing... i mean, actually I'm not sure what else I could have expected.
Jabs aside, i thought the guideline is actually otherwise decently written and coalesces opinion on some recent controversy
I was reading these guidelines earlier today and felt it was sorely lacking any meaningful discussion or defense of this recommendation... all the citations, none of them engaging safety of observation/angioedema management/etc. No PharmD authors (only 1 PharmD on peer review). interesting...
replace red stuff with red stuff (and yellow stuff)
Any recommendations for leadership courses that people have liked? There may be some upcoming opportunities for guiding/leading an intensive care unit and while I'm quite adept at the learn by doing... I feel there may be a better way to do things right the first time. #EMIMCC #ICUsky #medsky
easiest way is to ask your health information and quality people. They have all the backstage access and can build specific research data dredging tools that will build a report from a patient dataset. Very slick typically.
I'm glad to hear I'm not the only one. Septic cardiomyopathy is one of my favorite manifestations of MODS-- but it remains challenging to study in a robust ways as I'm unsure if we have the right tools.
"Continue supportive cares and expectant management"
but honestly.. I've been almost too afraid to ask how others weigh this situation and how they interpret these sorts of studies and reviews. I'm willing to believe that the data that acute decomp of HFpEF is bad and should be managed well. But so many patients in my practice have never had echos.
If our measures of diastology are NOT validated in acute critical illness, am I correct in saying that a TTE showing "diastolic dysfn" is clinically meaningless in a patient with unknown history? Should I trust studies using a form of measurement non-validated in my patients (esp AI)? Seems no...
Pseudo-PEA is the situation where a code is started due to underdetection of a pulse (fingers are notoriously bad at pulse detection). This is a patient with electrical and cardiac contraction-- but with significant hypotension. Pick any pressor. Push dose epi works.
Ah! I looooove pseudo-PEA. I doubt there is anything outcome changing magical about vasopressin other than that it avoids excessive catechols. The take home for me is that this is missed ROSC due to hypotension.
I cannot imagine the devastation this family is experiencing today. This statement is powerful and must be read.
Alex Pretti was a colleague at the VA. We hired him to recruit for our trial. He became an ICU nurse- I lover working with him. He was a good kind person who lived to help and these fuckers executed him.
White. Hot. Rage.
This is the moment to identify media accomplices, false-opposition democrats and those who are readily willing to ignore the truth of their own eyes and ears. I sincerely hope this will be a turning point. The schism between the federal fascists and law enforcement is increasing ever more.
come now... that's just the two we know about ;)
piggyback reminder to just flood these patients with oxygen - transferring long distances (or honestly any distance) for HBO is unlikely to be clinically useful if you're already treating with o2, and is not cost-effective. CO t1/2 on RA 300min, 15L NRB 90min, HBO 30min. Evidence severely lacking.
oh we notice ;) -- far more often than not we agree with it and just never want to give you the satisfaction of saying so
but by god will we fight like we're arguing from the correct half 100% of the time :P
yeah.... we're a bit special over here... and more often than not these days, not in a good way.
I love the hypotensive from excessive loading conditions diuresis-- they improve and everyone is gobsmacked... then they seem to immediately forget it ever happened and shvitz again when we end up back in this situation
I trained AnesCC-- I graduated with a coffee mug and Sudoku book. This is an acceptable alternative ;) But now what are the surgeons going to think I'm doing all day if I don't turn the abnormal labs normal?
I have to this day never seen an amp of bicarb pushed in slower than 2 minutes. The majority i've seen are pushed in less than 60s. Even in bad situations I like the drip and during sphincter tightening times I turn it up to the 999ml/hr rate.
one of the biggest differences is sodium load-- bicarb pushes in the states are 8.4% sodium which is a huge osmotic load. More to the point in acidosis, there is more dissolved pCO2 in the fast pushed amp than in the slow infusion (50meq/50cc vs 150meq/1000cc).
The major downside of that retrospective study is that it's not clear how patients were receiving bicarb. I much prefer bicarbonate drips over the amp slam. Probably not saving lives, but maybe reducing dialysis. I'm continuing the practice for now-- but very interested in what the next trials show
wholeheartedly agree...
Local practice patterns are interesting. One of my shops uses versed drips fairly regularly which was... something. I would love to have a short acting bzd in situations that I need it. I suspect however that bzd delirium will be a problem with this strategy. Hopefully the remi isn't uber-expensive
