I recently covered our inpatient service for a couple of days. The phrase I never use and I dislike hearing:
“I’m just covering.”
To a patient, you’re their doctor that day. Own the responsibility & privilege.
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Can epinephrine cause hypotension?
A patient is transferred the ICU with hypotension on 4 mcg/min (.05 mcg/kg/min) epinephrine. Thought to be a GI bleed, resuscitated but was still hypotensive with a HR in the 60s, BP100/40 (60)
Takes carvedilol
Epi stopped MAP 60->90 🤯
How
📄 20 studies that Internal Medicine Residents should read in the first year 👇
1/ 🏃♀️ RACE II trial: Lenient resting HR < 110 was non-inferior to a strict HR < 80 in patients with atrial fibrillation.
🧵
🚩 Fludrocortisone & hydrocortisone vs hydrocortisone
➡️ 88,275 pts with septic shock receiving noradrenaline
➡️ retrospective, multicenter cohort study
➡️ death in hospital or discharge to hospice
➡️ 47.2% vs 50.8%; P < 0.001
CCR Journal Watch
https://t.co/Sp06oA7gte
@NephroP 1. AF with RVR causes a different pressure with each beat. Notice whenever diastole is longer the pressure is higher on waveform, mimicking pulsus alternans.
2. Failing RV compresses LV, exaggerates “preload dependence.” Hence the diastolic hypotension and wide pulse pressure.
As a Cardiology fellow, we get a lot of consults for HFpEF.
Part 3: Therapy
*Not to use as medical advice, just tips, and always discuss with your fellow/attending*
-thread 🧵-
#MedTwitter#MedEd#Cardiotwitter#IMG
1/
My top trials, AHA 2022
1. TRANSFORM-HF: torsemide vs furosemide in hosp. HF
2. RESPECT EPA: EPA 1.8g/d + statin vs statin alone in stable CAD
3. ISCHEMIA-EXTENDed: interim mortality analysis of ISCHEMIA & ISCHEMIA-CKD at longer f/u
4. EMPA-KIDNEY: empagliflozin vs pbo in CKD