Top Tweets for #rantorial
Do ketamine infusions increase delirium? This study suggests that they do, but we need to look into this a bit more deeply... read at the abstract and see what you think! #Rantorial 1/8
https://t.co/EC3mOBFHEv
Might as well have my rant. Do not EVER on my acute take record the words "lives with family" in the medical record. You might as well have written that they like cheese or house music. @acutemedicine
@docpro89 My 9 part tweetstorm (#rantorial") is important bc this is IMO the most misunderstood concept in ICU acidbase thinking and teaching. I'm sensing a new "anion gap can be your friend" (lactate in this case) advocate. Could this be the beginning of #TeamRodbyProvenzano?
@captainchloride @NephroGuy @askrenal @NephJC 1) So let's get something straight. "Lactate" that you measure is NaLactate and is NOT a bad thing to have, Lactate is NaLactate and is the end product of lactic acid buffered by NaHCO3. Na lactate gets converted back to HCO3 by a healthy liver (nl person ~1300 mmol/d)
one RCT showed that delayed feeding was OK... in a population with mostly *mild* illness. the authors wrongly extrapolate this to *all* patients. esp for an intubated patient, there is no reason to delay feeding for 72 hours! #rantorial 2/4
https://t.co/qXkA0S4otd
a fresh review article on pancreatitis in the Lancet is some hot garbage. as Eduardo rightly pointed out 👇, the bit on fluid resuscitation is nuts. but there are more errors, which merit a short #rantorial... 1/4
The Lancet: Acute Pancreatitis (https://t.co/qeP4soJTAw)
🤯 350-700 ml/hr of crystalloid!!! It's 2020!
How 'bout: First do no harm
Can't say it better then @PulmCrit on the IBCC:
"THIS IS INSANITY" https://t.co/wTF7J04KSP
Can someone point me to the best #Rantorial or #MedThread dissecting this #COVID19 RCT?
Effect of Colchicine on Biomarkers and Clinical Outcomes in Patients Hospitalized With COVID-19 https://t.co/zWlPM6WtTk
the NIH guidelines now recommend remdesivir for anyone with COVID-19 who is hospitalized with a saturation <94%. these recommendations are broader than the NIAID trial inclusion criteria- so even if the trial is very positive, this still seems like an over-reach (#rantorial 2/4)
Thread worth reading…
“@PulmCrit: finally read this article on ”acute severe hypertension“ in NEJM and it’s even worse than I was expecting… 🤯 (#rantorial 1/4)
https://t.co/hOVLsSebZV”
Another @NEJM clinical review that misses the mark
1) Perpetuates myth of hypertensive urgency
2) Supports acute BP⬇️ in epistaxis, headache & atypical chest pain
3) Promotes an aggressive BP target <160/100 in essentially asymptomatic pts
#NotSupportedByEvidenceOrGuidelines
to try to further dispel nonsense about emergent therapy for asymptomatic hypertension, I've added the following figure to the IBCC chapter, with links to the guideline. (#rantorial 4/4)
for a review which is consistent with guidelines & not awful, take a look at the @iBookCC chapter (#rantorial 3/4)
https://t.co/SP13PrHF13
the NEJM article directly contradicts established guidelines & practice regarding hypertensive urgency (#rantorial 2/4)
finally read this article on "acute severe hypertension" in NEJM and it's even worse than I was expecting... 🤯 (#rantorial 1/4)
https://t.co/6p4ZIyevPl
Another @NEJM clinical review that misses the mark
1) Perpetuates myth of hypertensive urgency
2) Supports acute BP⬇️ in epistaxis, headache & atypical chest pain
3) Promotes an aggressive BP target <160/100 in essentially asymptomatic pts
#NotSupportedByEvidenceOrGuidelines
summary:
(1) start with post-hoc observational data
(2) divide into 3 subgroups
(3) apply multivariable modeling to all 3 subgroups, which drops p-value by 85x in one
(4) reach broad conclusion
read the study & see what you think, but I'm not too impressed (#rantorial 4/4)
a multivariable model is used to massage the p-value in the lactate >12mm sub-groups from 0.42 down to 0.005. that's an 85-fold decrease! I'm no statistician, but this seems pretty shady (how can you get p=0.005 from a small raw sample size of 4/31 patients?) (#rantorial 3/4)
the post-hoc study stratifies post-arrest patients on the basis of lactate level (<7, 7-12, >12). TTM33 vs. TTM36 doesn't make a difference in *any* of three strata. the p-values aren't anywhere close to statistical significance (#rantorial 2/4)
recent study suggests that post-arrest patients with lactate >12 mM might benefit from TTM33 (as opposed to TTM36). some folks on twitter are getting excited about this, but the study has very weak methodology (#rantorial 1/4)
(study: https://t.co/5o2S5lQjnO)
this fresh review article in NEJM on acute upper airway obstruction is the most horrifically wrong & dangerous piece of literature I've encountered in a while 😳 (#rantorial 1/6)
https://t.co/sDCY53cWkn
Must-read thread ahead:
#FOAMed
“@PulmCrit: this fresh review article in NEJM on acute upper airway obstruction is the most horrifically wrong & dangerous piece of literature I've encountered in a while 😳 (#rantorial 1/6)
https://t.co/ETtIPm0oE8”
@PulmCrit So glad you took the time to publish your #rantorial and get us to critically think. For folks who are novices with airway management *eeeep, me* I am not certain all/we would have navigated that article well enough to identify its potential dangers.
and finally the airway section finishes up with this bizarre discussion of emergency front of neck access. no mention of finger-scalpel-bougie cricothyrotomy... instead the article seems to be promoting surgical tracheostomy for emergency airway management ? (#rantorial 5/6)
Last Seen Hashtags on Sotwe
fuck videos
Seen from United Kingdom
snapchat video
Seen from Turkey
valko
Seen from France
boynuz
Seen from Turkey
royalteeth
Seen from Mexico
momson() +filter:videos
Seen from Turkey
gopay1rupiah
Seen from United Arab Emirates
fundomme
Seen from United States
wc26gr
Seen from Greece
stablediffusion
Seen from Indonesia
Most Popular Users
Elon Musk 
@elonmusk
240.6M followers
Barack Obama
@barackobama
119.2M followers
Donald J. Trump
@realdonaldtrump
111.7M followers
Cristiano Ronaldo
@cristiano
110.4M followers
Narendra Modi
@narendramodi
107M followers
Rihanna
@rihanna
97.6M followers
NASA
@nasa
92.2M followers
Justin Bieber
@justinbieber
90.9M followers
KATY PERRY
@katyperry
87.6M followers
Taylor Swift
@taylorswift13
81.4M followers
Lady Gaga
@ladygaga
72.9M followers
Virat Kohli
@imvkohli
69.7M followers
Kim Kardashian
@kimkardashian
69.7M followers
YouTube
@youtube
68.7M followers
Bill Gates
@billgates
63.8M followers
Neymar Jr
@neymarjr
62.5M followers
The Ellen Show
@theellenshow
62.5M followers
CNN
@cnn
61.9M followers
X
@x
60.8M followers
Selena Gomez
@selenagomez
60.7M followers