Sam Black

Just a hospitalist

[Sam Black @samblack]

@PulmCrit Difficult to know what to *do with an ionized calcium. Most guidance and certainly most medical education sets thresholds for various interventions based on serum calcium, and are silent about how to interpret iCa.

[Sam Black @samblack]

@ChestradRoy @thats_bone I’ve seen protocols like this routinely used in shock trauma.

[Sam Black @samblack]

@nickmmark Asking for a friend?

[Sam Black @samblack]

@AZviman @IM_Crit_ I dread the inevitable future when “do everything” includes tracheostomy, TPN, dialysis, and ECMO.

[Sam Black @samblack]

@AlanYuNeph https://t.co/88jUnYkIRE

Raises the question, is this really new, is the score just now 7:3 instead of 7:2?

[Sam Black @samblack]

@AlanYuNeph … Seven of the ten RCTs reported a reduction in recurrence rate in treated patients (9–12,14–16). Two trials that showed no difference in outcome were limited by their short follow-up duration of <2 years (17,18).”

[Sam Black @samblack]

@EMPoisonPharmD @Rick_Pescatore @AnnalsofEM Where I can see this being useful is basically only for methadone or (maybe) OxyContin/morphine ER overdose. Which is not nothing…

[Sam Black @samblack]

@RobertHermanMD @BaoGTran @smithECGBlog @PendellM I can’t wait until this tech makes it into daily practice. My hypothesis is that modern machine learning can read an EKG as well as or better than any cardiologist (it’s not a “hard” problem from an AI perspective). Meanwhile we’re relying on interpretation algos from the 90s.

[Sam Black @samblack]

@Emedwebb @PulmCrit The physical exam is a vitally important screening tool; and should be used to raise or lower pre test probabilities to guide diagnostic testing. With exceptions, it’s *not a diagnostic test.

[Sam Black @samblack]

@Emedwebb @PulmCrit It’s astounding how poor the physical exam usually comes out when it’s scientifically tested for accuracy. We can lament the death of the physical exam all we want, but if the pre test concern for a life threatening problem is high, it’s not good enough.

[Sam Black @samblack]

@IM_Crit_ One of issues that definitely contributes to this is (from the Hospitalist side) an expectation that until you’ve tried flooding the patient with IV fluids, you shouldn’t consult the ICU.

[Sam Black @samblack]

@Dr_Oubre A word which used to mean a state of severe illness in which the inflammatory response itself has become life threatening. It has been bastardized to mean any infection which if untreated might becoming life threatening in the near term.

[Sam Black @samblack]

@JSwiney171 @medrants @BradSpellberg Or “patient is subjectively dyspneic with minimal exercise tolerance requiring further inpatient diuresis.” Something to get around the fiction that there’s something magical about intravenous drugs.

[Sam Black @samblack]

@JSwiney171 @medrants @BradSpellberg Have no idea if this works or not, but I will often document something along the lines of “patient is grossly volume overloaded requiring large volume diuresis with close monitoring of drug tolerance, electrolytes, and kidney function.”

[Sam Black @samblack]

@joshmcgoo One of my favorite things to point out is that if the LFTs are up, so you stopped the amiodarone, and a few days later the LFTS are better, it wasn’t because you stopped the amiodarone.

[Sam Black @samblack]

@joshmcgoo I also enjoy informing students that, having rote memorized the pharmacology of 15 different antiarrhythmics, unless they are going into EP, the only one they will ever (likely) personally prescribe is…

[Sam Black @samblack]

@adamcifu Meanwhile the ICD/SNOMED updates are near instantaneous, which I think tells you something.

[Sam Black @samblack]

@adamcifu What drives me nuts is that this is about the easiest thing conceivable to build into an EMR, but instead we all have to do it manually (it’ll be in a patch coming in 2024).

[Sam Black @samblack]

@mitchthegasman @IM_Crit_ Not familiar with the nomenclature, is the implication that in the UK this patient would be declined intensive care due to comorbidity?