Cardioembolic stroke just waiting to happen…😬 Importance of atrial fibrillation anticoagulation to prevent this clot from forming!

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In a strained healthcare system w/ ↑ ED crowding, the concept of a pt self-directed CHF action plan could ↓ hospitalizations & ED visits. May be helpful in rural areas with limited healthcare access & resources. #FOAMed #MedTwitter #MedEd #TwitterRx canadiem.org/patient-direct…

🔥off the press! EPIC-SR: Paxlovid failed to ↓ covid symptom duration among pts at standard risk & among fully vaccinated pts w/ ≥1 risk factor for severe disease. Hence, paxlovid benefits those who are unvaccinated or immunocompromised/high risk. #MedEd #Medtwitter #FOAMed

Fun fact #2: When a pt on E infusion becomes hypoglycemic, there will be no tachycardia, therefore diabetic pts on esmolol should be closely monitored. Fun fact #3: E is metabolized to methanol, so if it is administered in large doses for a prolonged time,

methanol toxicity should be suspected, especially if the pt develops an otherwise unexplained high anion gap/osmolar gap metabolic acidosis... 🤯

5. Myoclonus is a very frequent side-effect of etomidate (E) administration, complicating 50-80% of cases. The only reason we don’t see it often in the ICU is that we perform RSI & follow E with a paralytic. But, if you start using etomidate alone,

for example to sedate a patient in rapid atrial fibrillation prior to electrical cardioversion, you will see it frequently. Personal bias: I use ketamine for intubation... 😊

8. In cases of unexplained hyperkalemia in hospitalized pts, please do not overlook the role of heparin (H). H can inhibit aldosterone synthesis even at low doses & lead to ⬆️ Na excretion & ⬆️ K retention. This is more pronounced in elderly pts w renal dysfunction & diabetes 🧐

9. Speaking about unexplained electrolyte abnormalities: If you manage end-stage renal disease pts w difficult to control hyperphosphatemia, please take a look at their medications list. Many of them can contribute substantial amounts of inorganic phosphate to a pt’s daily phos

burden, and this varies significantly among manufacturers. If a patient receives just 4 drugs - amlodipine, lisinopril, omeprazole, diclofenac - the added burden is almost 800 mg of phosphate/day, very close to the recommended daily phosphate intake for dialysis patients 🤫

When we published our study <evidence.nejm.org/doi/10.1056/EV…> of ODS and hyponatremia we were pummeled for including people at low risk of ODS because we included Na levels between 120 and 130. They said it is well known "that ODS is incredibly rare/non-existent at those levels." 1/4

🅾️ Blood products contain citrate, an anticoagulant, that binds to calcium leading to hypocalcemia. #twitterx #medtwitter Calcium plays an essential role within the lethal triad during MTP. 👇

Lots of amazing pharmacology pearls! Will for sure keep these handy!💎✨ #FOAMed #MedTwitter #MedEd #twitterrx #MedRx #pharmacy

New study looking at mild tICHs (GCS 14-15) on Xa's and reversing (w/ 4PCC) vs not. No difference in hemorrhage progression or neuro outcomes btwn groups (some baseline diff in ISS) I'll be discussing prior lit @EMPRx24 on this controversial topic bit.ly/3U3BH5n

Dakota Joshua!! 💪🏻🔥🔥🔥 Clutch performance and player!!! 🙌 Go #Canucks go!!

Unbelievable!!! What a comeback!!! #canucks

Wow!!! Game-tying goal with 6 seconds left in the game! Go #canucks go!

Game 5…Canucks!!! Go #Canucks go!!

🔥The BLING III RCT🔥 The most anticipated trial in infectious diseases! The use of continuous compared w intermittent infusions of β-lactam antibiotics in critically ill patients w sepsis DIDN'T meet statistical significance in reducing mortality at 90d jamanetwork.com/journals/jama/…