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josh farkas
intensivist • US & EKG nerd • FOAMite • skeptic • caffeine & iphone addict • leader of the rebel alliance • writer • resuscitationist • feminist
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josh farkas 13h
more evidence that freezing sick patients isn’t always a teriffic idea. indirectly supports the use of TTM36 for post-arrest patients.
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josh farkas 21h
reintubation clearly correlates with badness, but unclear to what extent reintubation *causes* harm vs. merely selects out the sickest patients. agree with Omni - shooting for 15% reintubation is reasonable.
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Matt Siuba 23h
Now that we’ve got Josh, Brendan, and Omni behind it, can spread far and wide!
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josh farkas 23h
love it. most extubation-prediction metrics created before routine extubation to HFNC, so they may be too conservative.
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josh farkas May 25
agree, the trial is underpowered to reach any conclusion. It's quite possible that ECMO saves lives (with a mortality benefit of ~10-15%, which would still be quite meaningful). Or the whole thing is a statistical anomaly.
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josh farkas May 24
yep, this trial fell victim of our fixation on p=0.05 and a single primary endpoint. expecting to find a 20% absolute mortality difference was prob wishful thinking, so the trial was likely doomed from its inception ().
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josh farkas May 24
3% is probably fine for peripheral use, see #9
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josh farkas May 24
Replying to @OrenFriedman
should add though that it's possible that epinephrine's effect on lactate could improve cardiac function, so there are some theoretical advantages of symmetric stimulation of beta-1 and beta-2 receptors together.
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josh farkas May 24
Replying to @KestlerMD
good question (no evid that NE better than epi). IMHO NE, vaso, or epi are all reasonable front-line pressors depending on the patient. For patients who are have a slow-ish heart rate and reduced LVEF I will sometimes use epinephrine as a first-line agent in septic shock.
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josh farkas May 24
Replying to @WesAPierce
great point. it's a nice example of textbook (which describes *average* response) vs. individual patient in front of you (who may not obey textbook). according to standard teaching, epinephrine *should* cause tachycardia... but in this individual patient it might not.
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Scott K Aberegg MD MPH May 24
How your day starts when you admit a guy protocoled into obtundation and you give one dose of and he straightens right up - right after you high five the intern, the family shows up with 3 dozen donuts for the staff
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josh farkas May 24
Replying to @OrenFriedman
have found epinephrine to be more effective than dobutamine for septic shock, it is my go-to inotrophic agent in sepsis. dobutamine makes more intellectual sense (more of a pure beta-agonist), but in practice epi just seems more powerful.
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josh farkas May 24
epinephrine challenge: one of my favorite hemodynamic moves. strangely satisfying.
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Brooke Denis May 23
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josh farkas May 23
sorry i dont feed trolls
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josh farkas May 22
congratulations to my department chair Polly Parsons on becoming president of the American Thoracic Society! 🎉🎊
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Salim R. Rezaie May 22
10 Dubious Beliefs in Neurocritical Care via My Personal Fav Debunked Myths on this Post: 1. 3% Saline MUST be Infused into a Central Vein 2. GCS 8 = Intubate 3. Systemic Thrombolysis is Essential Therapy for Ischemic Stroke
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the EMCrit Crew May 21
Ten dubious beliefs in neurocritical care -by
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josh farkas May 21
Replying to @First10EM @emcrit
thanks, glad you approve. your post on lytics for CVA was pretty epic.
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Manpreet Singh - ‘Manny’ May 20
LITFL Review 332 out now - Highest highlights, sneakiest sneak peeks and loudest shout-outs in via Review Team Ripper from and &
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