The BICAR-ICU-2 trial just dropped!
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
Replacing physician roles with non-physicians is never the solution. CRNAs work in an American hospital system where volume equates to profit. Doesn’t translate here where we need independent anesthesia practitioners in rural or remote locations to increase access.
Beautiful! Where’s that figurine from? What a wonderful addition to the bookshelf.
One hundred percent. Having someone keep time is important. Furthermore using sufficient opioid also allows for greater depth on induction with less hemo consequence, and likely helps facilitate success alongside paralysis.
doi.org/10.1016/j.jc...
Intravenous steroids improve quality of recovery post operatively across QoR dimensions.
People often talk about the time critical nature of sepsis. But it may surprise you to hear that the evidence to support “early” antibiotics actually isn't a settled debate. Why is that? The key question is “early in relation to what”? 🧵 1/n
#liversky #medsky
Hepatorenal syndrome is a hemodynamic renal injury
Cirrhosis is a Precarious balance: driving with two feet
1. The gas pedal (output): gut pooling 🔽return; output preserved by catecholes
2. The tank: To🔼return, we🔼ADH,Aldo
3. The brakes: RAAS/catechole good till they aint
Empty tank▶️all brakes▶️HRS
So would not use it in everyone, as I think a lot of people who need it will have already been trialed on it (AECHF, AECOPD), and some may find it distressing and certain patients (ie. sepsis) I cannot see its advantages over other techniques (HFNO) which can stay on for the entirety of intubation.
Like the review - agree that in some patients it’ll improve preoxygenating through improving resp. mechanics. However you can give 100% FiO2 through a BVM (the trial used a NRB I believe), and it is difficult to remove the BiPAP mask at times if you need to place the ETT quickly (1/2)
Skytorial: Five pearls on olanzapine 😁
Between agitation and nausea/vomiting, olanzapine has a wide range of use.
Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....
Happy to hear if you use it in conjunction with other agents.
Anyone have any experience with Dexmetomidine conscious sedations for procedures? Loading dose, rate, patient selection? Looking particularly for IR related procedures we’ve been asked to cover. Appreciate any insight!
#Ansky
How should patients be positioned for optimal intubating conditions?
@chrimesy.com & @doctimcook.bsky.social describe the combination of flextension with torso elevation to 'ramp' the patient.
Check out the infographic!
#AnSky #AirwaySky
https://buff.ly/4eSw2Yo
My favorite conference is coming this May thinkingcriticalcare.com/2024/06/05/h...
#emimcc
Why do people wear shoe covers in the operating room?
💥 The reason may surprise you!
A 🧵 about the #HistoryOfMedicine and the dangers of blindly following traditions.
onepagericu.com/blog/cx1l66q...
1/
The original study was benchtop using a test lung.
We then did a lesser cited follow up clinical study.
Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries.
High FiO2 negates any potential environmental benefits.
www.bjanaesthesia.org/article/S000...
This great lab study from 2020 surprised me at the time - challenging our assumptions about fresh gas flow rates and economic/environmental costs. #AnSky
[ Higher FGF (~6L/min) during TIVA reduces costs without sig environmental impact. ]
Summary → www.metajournal.com/articles/103...
1/
So much of medicine is about telling a story 📖
Like anything, building your story and presenting it is a skill that comes with practice 🎖️
🧵 - Here are 5 common mistakes I see when trainees are presenting consults 👩⚕️⚕️🩺
#emimcc
In our shop they also have to go to a monitored bed, which is highly coveted.
Title slide
Summary of recommendations
#Ansky: who here is doing intrathecal morphine instead of thoracic epidurals for post op pain management? The Spring ASRA meeting had a compelling lecture on how many institutions are abandoning thoracic epidural analgesia in favor of ITM. @ropivacaine.bsky.social @dr-rajgupta.bsky.social
Ileus is the main reason we abandoned it. Surgeons want patients up and walking. I’m surprised in my small sample size how well it has worked.
Still looking for the winning combo of blocks for HTOs. Anyone out there have a recipe, our group would love to hear it!
🚨 Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections
BALANCE trial publication is here !
#IDsky #Medsky
@idjclub.bsky.social
www.nejm.org/doi/full/10....
You've probably heard that Bicarbonate has to turn into CO2 to raise the pH.
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
So I’m a trauma anaesthetist and I do a lot of these for rib fractures.
I think people miss the point. The block chosen depends on anticoagualtion, injury pattern, concurrent injuries (e.g. spine), mobility, surgical trajectory etc.
The block you want to do is not always the block you can do.
I remember spring 2020 heading in to the hospital thinking "I wonder if I'll die from this"
If you are new to #RegionalAnaesthesia #RegionalAnesthesia and are looking for some content on YouTube to learn some Sonoanatomy, please do check out my channel.
All the Plan A Blocks, plus more!
@rauk.bsky.social #AnSky #RAsky
youtube.com/@dramitpawa?...
Check out the OAA ‘s new app: Quick Reference Handbook for Obstetric Emergencies :
apps.apple.com/us/app/quick...
Combined spinal-epidural (CSE) vs dural puncture epidural (DPE) for labour analgesia
Conclusion: No statistically significant differences in the quality of analgesia between the CSE and DPE techniques.
#AnSky #MedSky #ObSky
https://buff.ly/3O2C7Xb
Combined spinal-epidural (CSE) v dural puncture epidural (DPE) - which is superior?
Block quality was assessed by the following:
• Poor block quality composite
• Asymmetric block
• Top-up intervention
• Catheter adjustment
• Failed catheter/epidural
#AnSky #Medsky #ObSky
https://buff.ly/3O2C7Xb