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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · May 16

We do more than rise and shine ☀️ We caffeinate and intubate! Thank you #SESCCM for the new, blue coffee machine! ☕️☕️☕️
#critcaremonth
#SCCM

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

sccmcriticalcare.bsky.social @sccmcriticalcare.bsky.social · May 16

Today's the day to turn your ICU blue! 💙 Show off your blue scrubs, decorations, treats, and all the other ways you're celebrating today using #critcaremonth
#SCCM

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 13

💫 Practical advice for intraventricular meds (Part 5):
Flush with PF saline? Sure. But what if it’s not compatible with your drug, like amphotericin B? Simple—just flush with the CSF you definitely took out before giving the drug (right?). Who needs saline when you got the good stuff? Problem solved

Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 11

💫 Practical advice for intraventricular meds (Part 4):
🐌 How slow can you go? Administer drug slowly over a couple minutes. Drug should be prepared in smallest size syringe 💉 that can hold the drug volume—>helps provider better control the admin rate = less pressure and gentler administration

Reposted by Kat Chester, PharmD, BCCCP, FNCS

Tony Breu @tonybreu.bsky.social · Nov 28

1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.

And yet, it isn't.

Let's examine why.

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 5

We need in-house free VPA levels everywhere, STAT for our SE pts. With total levels, what you see 👀 is NOT what you get 👺📈

Andy Webb @ajwpharm.bsky.social · Dec 5

For those of you attending #AES2024, be sure to check out our poster on the effect of ketogenic diet initiation on free valproate fraction in three patients with SRSE (abs 2.105)!

We found that free fraction increased by ~28% after keto started. Total VPA levels ⬇️, but free levels ⬆️!

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 5

💫 Practical advice for interventricular Meds (Part 3):
Volume of CSF removed prior to administration = drug volume. In the cranial vault, small volumes can have big impact especially when ICPs are of concern. In this case, every drop really does count 💧⚖️💧

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 5

#neurocrit #pharmsky

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 5

Intrigued by the PROPHY-VAP trial? Don’t miss this interview with author Claire Dahyot-Fizelier, MD, Ph.D. Great insights including this key takeaway: it’s not a blanket approach—consider inclusion/exclusion criteria for application in practice. Tune in for the full conversation! bit.ly/4eYuwUs

Neurocritical Care Society Podcast: HOT TOPICS: The PROPHY-VAP Study

In this episode of Hot Topics, Dr. Nicholas Morris interviews a professor of anesthesia and intensive care at the University of Poitiers, to explore the groundbreaking PROPHY-VAP trial published in ...

bit.ly

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

Eric C. Lawson, MD @ericclawsonmd.bsky.social · Dec 4

⬆️ ICP means avoiding central catheterization of internal jugular due to ⬇️ venous return, right?

Wrong, according to work by my colleagues! @emoryneurocrit.bsky.social

"Contrary to classic teaching ... IJ CVC placement was not associated with increased ICP"

pubmed.ncbi.nlm.nih.gov/39592540/

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 4

💫 Part 2:
Best to keep intraventricular meds < 2-3 mL/dose, ideally. Preservatives? No thanks! 👎 They can cause ADEs in the 🧠 Some are probably safer than others, but until we get better data, the rule of thumb is to avoid them in intraventricular meds and use preservative-free flush 💦

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 4

Yes! 👍

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Dec 3

💫 Practical advice for intraventricular meds (Part 1):
🔎 Determine the volume of the EVD lumen, from med access site to catheter tip. That’s your flush volume. It’s like a small chaser (usually 2-3 mL) to ensure the entire dose goes in smoothly. 💉🧠
#Pharmsky #Pharm2Table #neurocrit

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Nov 30

📣 🛑 Don’t combine these two drugs! More VPA levels & higher doses won’t solve the issue. It’s often easier to choose a different antibiotic than adjust a patient’s AED regimen, which may need EEG—hard to get in resource-limited settings. Neuro, ID, & Pharm must collaborate. #IDsky #Pharmsky #Medsky

Anthony Lau, PharmD BCPS @alaurx.bsky.social · Nov 30

⚠️Carbapenem antibiotics+valproate combo not advised. VPA levels ↓ markedly & persistently (up to 2 weeks), risking uncontrolled seizures. Even higher doses may not fully counteract this. Carbapenems inhibit key GI enzyme, boosting VPA elimination. See skeetorial👇 #medsky #pharmsky #EMsky #HMsky

@IM_Crit_ @imcrit.bsky.social · Nov 29

ICU Stories:

Middle-aged patient w multiple co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/atrial fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/ hypotension. Urine was purulent. CT showed hydronephrosis & bladder wall thickening:

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

Dhanya Gorty, MBBS @localizationnerd.bsky.social · Nov 28

Thanksgiving is a cranial nerve celebration! 🦃🧠 #neurosky

CN I: Smell the turkey
CN Il: See the feast
CN III, IV, VI: Keep eyes on the pie
CN V: Chew the stuffing
CN VII & IX: Taste the flavors
CN VIII: Hear the laughter
CN X: Digest it all
CN XI: Lift the turkey platter
CN XII: Toast your thanks

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Nov 28

I’m so jealous 😟 🎁

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

Caitlin Brown @cbthepharmd.bsky.social · Nov 27

‼️🫀 Looking for a CV surgery/ECMO pharmacist job? Check out this opportunity at Mayo Clinic

💊 Work with some rockstar pharmacists
📖 Lots of research opportunities
👩‍⚕️ Collaborative multidisciplinary environment

❓Feel free to message me with questions!

www.healthecareers.com/job/Cardiova...

Cardiovascular Surgery / ECMO Critical Care Pharmacist | Mayo Clinic | Rochester, Minnesota

Mayo Clinic is hiring for Cardiovascular Surgery / ECMO Critical Care Pharmacist . Rochester, Minnesota · Apply on HealtheCareers.com

www.healthecareers.com

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Nov 26

I’m thankful for the glymphatic system that launders my brain each night. Time for a deep clean! Good night 😴

Jalees Rehman @jalees.bsky.social · Nov 19

The anatomy of brainwashing: Glymphatic-lymphatic brain cleansing may reveal new therapeutic strategies

www.science.org/doi/10.1126/...

The anatomy of brainwashing

Glymphatic-lymphatic brain cleansing may reveal new therapeutic strategies

www.science.org

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

Christine Bonarrigo, PharmD @cbonarrigo.bsky.social · Nov 25

The drug we all need: doxycontin

Dachshund wearing a prescription bottle costume saying “doxycontin: take 1-5 photos hourly as needed for puppy fever. Pet as directed. May cause serotonin syndrome”

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Nov 23

Any PGY1 Pharmacy residents on here?

💎💎💎
Grady’s Neurology Pharmacy Residency program isn’t just about learning—it’s about growing your expertise in a specialty few others get to master 🦄
💎💎💎
#Pharmsky
#NeuroPharm #PharmacyResidency

Reposted by Kat Chester, PharmD, BCCCP, FNCS

Eric C. Lawson, MD @ericclawsonmd.bsky.social · Nov 23

#NeuroCriticalCare enthusiasts be sure to add this to your feeds!

Pin it to the top of your profile and you can choose to scroll only #NeuroCritCare content at any time!

@vasisht.md @caseyalbin.bsky.social
@soojinpark.bsky.social
@ajwpharm.bsky.social

bsky.app/profile/did:...

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Nov 22

Can we use direct thrombin inhibitors or GPIIbIIIa inhibitors with thrombolytics for AIS? Dr. Morgan Daniel walks us through the literature

Andy Webb @ajwpharm.bsky.social · Nov 22

Next up: Morgan Daniel, PharmD, PGY2 neurology resident at Grady Health presents the MOST trial evaluating adjunctive argatroban or eptifibatide for ischemic stroke

How can we extend the effectiveness of thrombolytics after AIS? MOST aimed to assess this!

@katskript.bsky.social

#NCSPharmJC

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

Andy Webb @ajwpharm.bsky.social · Nov 22

First up on #NCSPharmJC: Medina Halimanovic, PharmD, PGY2 CC resident an IU Health is presenting the TRACE III trial on TNK up to 24 hours after AIS with LVO without thrombectomy

@neurocritical.bsky.social

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Kat Chester, PharmD, BCCCP, FNCS @katskript.bsky.social · Nov 22

✨Starting soon! ✨
Log in to learn and support our Grady PGY2 Neurology Resident, Morgan Daniel, PharmD

Andy Webb @ajwpharm.bsky.social · Nov 21

Join us for the @neurocritical.bsky.social November Pharmacy Journal Club TOMORROW, 11/22 at 2pm EST! DM me for Zoom information or find it on the NCS Pharmacy Connect page.

Two excellent articles on AIS care - TRACE III and MOST - will be presented!

#NCSPharmJC

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Reposted by Kat Chester, PharmD, BCCCP, FNCS

Andy Webb @ajwpharm.bsky.social · Nov 21

Join us for the @neurocritical.bsky.social November Pharmacy Journal Club TOMORROW, 11/22 at 2pm EST! DM me for Zoom information or find it on the NCS Pharmacy Connect page.

Two excellent articles on AIS care - TRACE III and MOST - will be presented!

#NCSPharmJC

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