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josh farkas ๐Ÿ’Š
intensivist๐Ÿ˜ท FOAMite๐ŸŒŠ pocus nerd๐ŸŽ› coffee & iphone addictโ˜•๏ธ leader of the rebel allianceโš”๏ธ writerโœ’๏ธ resuscitationist๐Ÿ’‰ feminist๐Ÿ‘ฉโ€โš•๏ธ aweful spellur๐Ÿ˜ฌ no COI๐Ÿ’ฐ
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josh farkas ๐Ÿ’Š Aug 23
don't think there's any obligation to eat the fish or.. for that matter, the um... booger.
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josh farkas ๐Ÿ’Š Aug 23
Replying to @dfellerk @iBookCC
perfect illustration & commentary for the chapter on hemoptysis, thanks, I'm going to steal this ๐Ÿ‘‡
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josh farkas ๐Ÿ’Š Aug 23
if after review of films and discussion with patient you're really *genuinely* on the fence, checking a Ddimer could be helpful as a tie-breaker. a negative Dimer would support this being old or artifact rather than genuine active thromboembolic dz.
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josh farkas ๐Ÿ’Š Aug 23
first step would be look at images & discuss with radiology or have a second radiologist review films. these are often borderline calls and an over-read they sometimes disappear. in low-risk patient the best thing may be watchful waiting
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josh farkas ๐Ÿ’Š Aug 23
I don't see a lot of isolated subsegmental PEs these days, but for whatever it's worth here are my 2 cents. first thing to realize is that this is most likely an incidental finding. isolated subsegmental PE without lung infarction shouldn't cause pain or SOB.
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josh farkas ๐Ÿ’Š Aug 22
insulin/glucose will push K intracellularly but only lasts a couple hours. realistically by the time you have a HD catheter and dialysis is running, this will be wearing off anyway. main thing is to keep the patient alive, you can worry about dialytic efficiency later.
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josh farkas ๐Ÿ’Š Aug 22
Replying to @ercowboy @iBookCC
great question. not aware of any solid evidence on when to give Ca in hyperK in general so this is overall a hazy topic. would probably hold calcium in this situation, treat aggressively (e.g. IV insulin/dextrose/lasix/fluid etc), give IV Ca if arrhythmia/worsening
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josh farkas ๐Ÿ’Š Aug 22
4 concepts to understand tumor lysis syndrome ๐Ÿงฌ๐Ÿงจ (fresh chapter: )
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josh farkas ๐Ÿ’Š Aug 21
Replying to @ChrisCarrollMD
yep med students are a natrual form of energy that we tap into
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josh farkas ๐Ÿ’Š Aug 21
looked this up a few months ago, the studies investigated patients with gi bleeding and cirrhosis (no distinction about precise source). donโ€™t think the exact site matters.
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josh farkas ๐Ÿ’Š Aug 20
great stuff, just did a little update to the IBCC based on this. the HALT-IT trial has finished recruiting so hopefully we will have an answer soon.
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josh farkas ๐Ÿ’Š Aug 19
awesome, will be looking out for it so I can update the IBCC accordingly. I was a bit torn about writing the chapter with so little known, but I figured being aware of the disease is important & can revise as more info emerges.
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josh farkas ๐Ÿ’Š Aug 19
this is a great choice, I managed to procure these for my shop as well.
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josh farkas ๐Ÿ’Š Aug 19
super interesting, I'm going to insert your tweet into the chapter. maybe ESR is higher in the lipoid pneumonia type? It would be nice if there were some marker (?CRP) to sort out VAPI vs. vasculitis, but maybe that's wishful thinking ?
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josh farkas ๐Ÿ’Š Aug 19
Replying to @LWestafer @NEJM
it appears that NEJM didn't have enough space to publish *any* letters about that article ?!? oh well... what's more important, academic dialogue or pharma cash?
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josh farkas ๐Ÿ’Š retweeted
Lauren Westafer Aug 19
Not all contrast is associated with PC-AKI and I wrote a letter to the editor in response to apparently they didnโ€™t have enough space to publish this, despite having enough space for dozens of paid advertisements
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josh farkas ๐Ÿ’Š Aug 19
Replying to @JasonMordino
my pleasure, given that pharmacists improve outcomes and cut costs this shouldn't really be a tough sell
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josh farkas ๐Ÿ’Š Aug 19
yeeeeah... I don't think the concept of safe vaping is going to age well.
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josh farkas ๐Ÿ’Š Aug 19
Replying to @awraynor
inhaling hundreds of chemicals into your lungs... what could possibly go wrong?
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josh farkas ๐Ÿ’Š Aug 19
Replying to @jwwiningernp @iBookCC
yep, we weren't trained to ask about vaping. once folks start looking for it systematically I think it will start coming out of the woodwork.
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