@jv-l.bsky.social
Reposted
In a retrospective cohort of 273 pts with HSV encephalitis:
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
Herpes Simplex Virus Encephalitis With Initial Negative Polymerase Chain Reaction in the Cerebrospinal Fluid: Prevalence, Associated Factors, and Clinical Impact - PubMed
In severe herpes simplex encephalitis, initial negative CSF HSV PCR occurred in 4% of cases and was independently associated with worse neurologic outcome at hospital discharge. In these patients, a s...
pubmed.ncbi.nlm.nih.gov
December 29, 2024 at 9:24 PM
In a retrospective cohort of 273 pts with HSV encephalitis:
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
Reposted
Fresh blog: the ADAPT and SCREEN trials are full of sound & fury, signifying little
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
PulmCrit: ADAPT and SCREEN trials are full of sound and fury, signifying little
I think ICU docs may have developed a bit of an RCT problem; not an addiction, but perhaps a dependency. It all started off fine at first. RCTs are the
emcrit.org
December 13, 2024 at 6:28 PM
Fresh blog: the ADAPT and SCREEN trials are full of sound & fury, signifying little
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
Reposted
The #Renovate Trial was just published. Kudos to the authors for this large trial.
HFNO was non-inferior to NIPPV in 1776 patients with acute respiratory failure. I have some comments and discussions; feel free to join in. 👇 1/n
#emimcc #ccr
HFNO was non-inferior to NIPPV in 1776 patients with acute respiratory failure. I have some comments and discussions; feel free to join in. 👇 1/n
#emimcc #ccr
High-flow nasal oxygen was noninferior to noninvasive ventilation for rates of endotracheal intubation or death within 7 days in 4 of the 5 patient groups with acute respiratory failure.
#CCRdownunder @criticalcarereviews.com
ja.ma/41s0Lbx
#CCRdownunder @criticalcarereviews.com
ja.ma/41s0Lbx
December 11, 2024 at 8:34 PM
Reposted
Skytorial: pH management in DKA!
I've been following debates about this for a *long* time
(eg wrote this blog in 2016, which stands up pretty darn well: emcrit.org/pulmcrit/bic...)
after years of arguing, lemme break down my take on this 😁
I've been following debates about this for a *long* time
(eg wrote this blog in 2016, which stands up pretty darn well: emcrit.org/pulmcrit/bic...)
after years of arguing, lemme break down my take on this 😁
a cartoon of donald duck with the words " do you want to fight lets get it on then "
ALT: a cartoon of donald duck with the words " do you want to fight lets get it on then "
media.tenor.com
December 6, 2024 at 8:55 PM
Skytorial: pH management in DKA!
I've been following debates about this for a *long* time
(eg wrote this blog in 2016, which stands up pretty darn well: emcrit.org/pulmcrit/bic...)
after years of arguing, lemme break down my take on this 😁
I've been following debates about this for a *long* time
(eg wrote this blog in 2016, which stands up pretty darn well: emcrit.org/pulmcrit/bic...)
after years of arguing, lemme break down my take on this 😁
Reposted
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.
🤔 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.
November 28, 2024 at 2:40 AM
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.
🤔 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.
Reposted
Tons of NEW DATA about andexanet, presented as part of FDA hearing last week. If you couldn’t make it through the short 6h meeting, GOOD NEWS, I’ve watched it and highlighted the important points.
A🧵
A🧵
November 25, 2024 at 11:03 PM
Tons of NEW DATA about andexanet, presented as part of FDA hearing last week. If you couldn’t make it through the short 6h meeting, GOOD NEWS, I’ve watched it and highlighted the important points.
A🧵
A🧵
Reposted
Hypertensive "urgency" is so very rarely urgent... and treatment has real consequences.
Treat pain, withdrawal, anxiety, and delirium. Stop mIVF. Help patients sleep.
No more IV hydral. #medsky
Treat pain, withdrawal, anxiety, and delirium. Stop mIVF. Help patients sleep.
No more IV hydral. #medsky
I remember as an intern getting calls in the night to give unfamiliar patients intravenous hydralazine for their asymptomatic elevated blood pressure.
Decades later, I'd have thought we know this is harmful and nonsensical, but apparently not entirely. #medsky
jamanetwork.com/journals/jam...
Decades later, I'd have thought we know this is harmful and nonsensical, but apparently not entirely. #medsky
jamanetwork.com/journals/jam...
One-Time and As-Needed Blood Pressure Medication and Adverse Outcomes in VA Hospitals
This cohort study evaluates the risk for acute kidney injury and other adverse effects from as-needed and 1-time blood pressure medications in hospitalized veterans.
jamanetwork.com
November 26, 2024 at 8:03 PM
Hypertensive "urgency" is so very rarely urgent... and treatment has real consequences.
Treat pain, withdrawal, anxiety, and delirium. Stop mIVF. Help patients sleep.
No more IV hydral. #medsky
Treat pain, withdrawal, anxiety, and delirium. Stop mIVF. Help patients sleep.
No more IV hydral. #medsky