Miracle

🇳🇬 | Physician| PGY-1| Internal Medicine @bpthosp| #IMStrong

[Miracle @sirlucem]

It’s a matchhhhhh😭😭😭😭😭😭

[Miracle @sirlucem]

@hajra642 Uworld + amboss + anki

[Miracle @sirlucem]

@asemota For driving in the us>>>>

[Josh Farkas MD 💊 @PulmCrit]

ARISE-FLUIDS has arrived and it's awesome 🥳

For over a decade, the Surviving Sepsis Guidelines recommended that septic patients get at least 30 cc/kg fluid. In the United States, these guidelines were weaponized into performance metrics, pressuring clinicians to prescribe arbitrary volumes to every patient.

Evidence-based clinicians have LONG known that this guideline lacked evidentiary support. For example, I've attached a picture of a blog I wrote about this back in 2017. Despite the lack of evidentiary support and some evidence of harm, the Surviving Sepsis Guidelines INSISTED on perpetually recommending 30 cc/kg fluid resuscitation.

We finally have a prospective RCT demonstrating that mandating early administration of 30 cc/kg fluid (as compared to early vasopressors) doesn't help and may actually cause harm.

It's important to note that all of the hard endpoints in this trial were neutral (e.g., mortality, days free of organ support).

I still think that 30 cc/kg fluid is a pretty reasonable volume of fluid for *most* patients. But the study does suggest that giving too much fluid may promote edema - so we should be *thoughtful* about this intervention rather than mandating it for every septic patient.

Based on the subgroup analysis, the fluid-conservative strategy may have helped the subgroup of pneumonia patients the most. This is statistically nonsignificant but aligns with my expectation. ARDSy patients often don't respond well to fluid. (In contrast, I really doubt that a liter of fluids in either direction matters for most urosepsis patients.)

This is a great example of the over-reach of guidelines and protocoled medicine. People get all upset about practice variation, so sometimes they try to stomp it out using guidelines and protocols. But these guidelines are highly fallible, so what may occur is that you standardize care in a way that harms everyone equally. 🤦‍♂️

[Nick Mark MD @nickmmark]

Lots of misunderstandings here.

First, this isn’t peer reviewed science. This is a press release. The level of evidence is essentially “trust me bro”

Second, sepsis early warning systems have been around for decades. This isn’t new. Most hospitals have systems like this.

Third, and most importantly, the way this intervention reduces the mortality *rate* probably isn’t actually saving any lives. What it’s doing is generating a ton of false positives. These people don’t need antibiotics but get them anyway, leading to side effects and resistance. But if you double the number of people with “suspected sepsis” in the denominator you make the mortality *rate* appear to drop. This is why in an actual published scientific paper we’d look at the number of deaths per year not just a rate. That’s also probably why this is press release and not an actual scientific publication…

[Miracle @sirlucem]

lol. That how it starts, next thing, you’re 50 and trying to play catchup. Then you’re 65 and a Walmart greeter …

[UNRULY LUCIAN 🇱🇨 @dontasktolink]

You can be 25 and down to 2 nickels, no place to stay and no food & ppl will tell you don’t use your money in your 401k. You got like 40 years to make that shit back just use the money man

[Sai Ishaya @Sai_Ishaya_]

For context, during a 1957 high school debate in the USA, a white SA student was asked about her stance on segregation in the USA, the only student on the panel who called her out for her hypocrisy was the Nigerian, Boniface Offokaja(rose to bcm one of our greatest broadcasters).

[Miracle @sirlucem]

Why have we been taxiing for 17+ minutes after landing at O’Hare?! Big ass airport 😭

[Miracle @sirlucem]

Thought I was in enemy territory for a bit

[cold eba @coldeba_dgaf]

Calling your age mate “mommy” because she has big fair breast is completely valid btw

[Miracle @sirlucem]

If e reach your turn, keep the fetus naa

[joseph anya @josephanyaa]

this idea of killing a child in the womb because of an impending life of difficult is 50 naira keke to euthanasia

[Miracle @sirlucem]

Capacity = 2+ volumes
Then continue

[Miracle @sirlucem]

😂😂

[Nanyo 💋🖤 @Nanyo_sae]

@elaunireMD Still don't give, do everything else to stay within your boundaries.

[Mide @MhideBanks]

The TBA woman who rushed a desaturating neonate she mismanaged to my centre by 3am, asked me that can she use cooking gas as oxygen source in case she has another similar case.

I’ve never been more dumbfounded.

This is someone pregnant women trust with their lives.

[SubprimeDirective @S_Directive]

Take away my Good Liberal card and call me a trad if you must. But withholding sex in a marriage while demanding monogamy should be indeed considered emotionally abusive. Sorry.

[Miracle @sirlucem]

“Made the call”😂

[USAGI-Rx is painfully employed. @JORMUNGAND_rr]

I spoke to an emergency medicine pharmacist working in the US and it was eye opening.
He told us about a patient's case with intense tachycardia and how he made the call on the dosing of the drug with the nurse and doctor following his lead and I realised the Nigerian healthcare system is apocalyptic because it is controlled by Nigerian doctors.

In the Nigerian hospital setting the doctor wants to do everything, they don't let any other profession specialise and increase the depth of their knowledge.

We need to do better for our patients, everything can't rely on one profession.

[Miracle @sirlucem]

Oga sit one place

[Dantala @Docfrosh]

@Dr_Afo It’s a give away question to me it depends on the person answering it, if you school in UNN this would be a giveaway question for you

[Horus Lupercal @XVIthPrimarch]

New Trailer just dropped for 11th edition. Alongside many things it inculded an animated depiction of the Emperor of Mankind. This may in fact be the first canonical, non fanart depiction of him we got since the old Artwork all these years ago. Huge!

[Miracle @sirlucem]

Pretty sure I can click chart review >>>procedures/micro faster than the time it takes this tool to pull this information (without the risk of ai hallucination)

[Epic @HeyEpic]

@UCDavisHealth implemented an AI tool into their electronic health record to automatically analyze colonoscopy reports and identify the number of precancerous polyps detected. Physicians can review their ADR compared to national and department averages and determine opportunities for improvement with their peers, helping improve clinical outcomes.

[Miracle @sirlucem]

Every pgy-1 has been there. Cardiovert and they’re back in afib within the hour, if they cardiovert at all😭

Neo or levo + amio gtt + sepsis rx + pocus guided fluid resus

[Antonio @toniovillamizar]

@jasonryanmd just had an ABIM question about this, shame answer

[SundayShort @sunday_short94]

@MorrellMDmph GTFOH you tiny dick m'fer🤭 Better be ready to sue them too👇🏾
https://t.co/NaB0ZfWr1T
https://t.co/cTGFm0Pmbw
MyCatholicDoctor
https://t.co/M3XhnHN5Us
Hispanic Physicians IPA / HPIPA Provider Directory
Latinx Therapy
https://t.co/ZFSMrUewpD
Indian Health Service Physicians🤷🏽‍♀️

[Miracle @sirlucem]

- Die of something stupid because no ambulance, electricity, cath lab, ventilators, O2, diuretics, poor systems…