Ari Filip

185 posts

Ari Filip

Ari Filip

@AriFilipMD

Toxicologist and ER Doctor. Medical Director, Arkansas Poison Center. Opinions are my own ≠ my employer’s. Not medical advice.

Beigetreten Ağustos 2022
255 Folgt148 Follower
Ari Filip
Ari Filip@AriFilipMD·
@nickmmark I prefer succ. in the ED. Boils down to these 2 groups: Trauma/stroke: loss of neuromuscular exam/most reflexes, in ICH for 1h+ non-hyperthermic agitated patients: risk of prolonged undersedation (find the right RASS early w/ succ) Do you modify based on patient/indication?
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Nick Mark MD
Nick Mark MD@nickmmark·
🤩 ICU education board: sux cs roc. I truly hope no one is voting for - or even worse still using - sux.
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Ari Filip
Ari Filip@AriFilipMD·
@allisonoconn Snakebite antivenoms too (we suspect) as these are equine and ovine derived. Adverse drug reaction rates here in Arkansas as high as 30% to some antivenoms (orders of magnitude higher than elsewhere).
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Allison Fitzgerald, MD, PhD
Allison Fitzgerald, MD, PhD@allisonoconn·
I learned that a significant percentage of the population, particularly in the southeast US (and Martha’s Vineyard), are allergic to cetuximab. This is because it contains the alpha-gal structure, and allergy can be triggered after being bitten by a lone-star tick.
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Keith Siau
Keith Siau@drkeithsiau·
😅
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Ari Filip
Ari Filip@AriFilipMD·
@Kaminski4Dorian @IM_Crit_ Yes, no kidding! I also have to tell people that if they aren’t willing to concentrate past the standard insulin drip concentration of 1U/mL, don’t bother (stability studies show safe to 16U/mL). Otherwise pts will drown at 1-10U/kg/hr
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Dorian Kaminski, MD
Dorian Kaminski, MD@Kaminski4Dorian·
@AriFilipMD @IM_Crit_ CCB overdose definitely makes one throw many assumptions out the window… fortunately we have pharmacists and nurses that are comfortable with ultra high dose/concentrated pressors, insulin etc. but the doses needed in the most severe cases still raise eyebrows (for good reason!)
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IMCrit
IMCrit@IM_Crit_·
ICU Facts: There is no way you can work in a 🇺🇸 ICU without hearing the expression "the patient is maxed out on pressors". This means that the pt is on the maximal dose of pressors (usually norepi) allowed by the institutional protocol Even though the “maximum dose” of pressors
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Ari Filip retweetet
Erin
Erin@eeryan22·
All (most) octreotide doses for sulfonylurea poisoning are beautiful and valid but you don’t have to poke people with extra needles just because it was trendy in the 90s. rdcu.be/d6xTj
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Ari Filip
Ari Filip@AriFilipMD·
@willyhfrick getting some I-64 nostalgia, drove right by my former apartment complex on your left. Stay safe!
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Willy Frick
Willy Frick@willyhfrick·
Battling through the snow to get to my hospital shift.
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Ari Filip
Ari Filip@AriFilipMD·
@ThommyTox @MikeMullinsMD An RCT would be nice — there is probably enough clonidine (and other imidazoline) toxicity to study it at this point.
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Ari Filip
Ari Filip@AriFilipMD·
@ThommyTox @MikeMullinsMD And while bradycardia, AMS, hypoTN aren’t well documented or good patient centered outcomes since they are transient and resolve with stimulation, they do often prompt unnecessary intervention, so they do matter in this instance
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Thom “NAC” Mack
Thom “NAC” Mack@ThommyTox·
Toxicology Pearl of the Day: ❌Don’t give high dose naloxone for clonidine overdose. It’s 🗑️. ✅Do give low/regular dose naloxone for opioid toxicity. It saves lives. #MedTwitter #TwitteRx ☠️
GIF
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Ari Filip
Ari Filip@AriFilipMD·
@ThommyTox “It’s like the sex panther of antidotes ‘works 60% of the time, every time’” -@MikeMullinsMD -Run Burgundy
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Ari Filip
Ari Filip@AriFilipMD·
@ThommyTox Whoa — a rare disagreement from me here. I don’t think my experience has been as good as the Seger paper below, but I think high dose naloxone is worth the risk… especially in kids: pubmed.ncbi.nlm.nih.gov/29544366/ Best I ever saw it work was tizanidine. Felt like a party trick.
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IMCrit
IMCrit@IM_Crit_·
In fact, carbapenems have been used in the treatment of valproic overdose/toxicity!
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IMCrit
IMCrit@IM_Crit_·
ICU Stories: Middle-aged pt w many co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/a.fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/hypotension. Urine was purulent. CT A/P: hydronephrosis & bladder wall thickening:
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Ari Filip
Ari Filip@AriFilipMD·
@eeryan22 @ThommyTox I wonder what important core life memories facts like these are replacing
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Ari Filip
Ari Filip@AriFilipMD·
@AllenGreenMD1 @ThommyTox Welcome the debate, I don't mean to insinuate PFAS are don't potentially cause adverse health outcomes. I just worry about people putting the cart before the horse, with some of these interventions, especially where there is money to be made.
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Ari Filip
Ari Filip@AriFilipMD·
@AllenGreenMD1 @ThommyTox Yup -- we'll probably agree to disagree here. I mean, this is America, he is welcome to do it. I do think it's a bit irresponsible to post about it and suggest benefit, with such a wide audience. I wonder if he understands the risks of TPE, but I'd be outside my lane here.
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Thom “NAC” Mack
Thom “NAC” Mack@ThommyTox·
Toxicologist here, having plasma exchange as a fountain of youth treatment to remove “toxins” (he had no toxins to begin with) is what rich people do to waste money/resources for no damn good reason. Full circle from balancing the humors via blood letting🤡 #MedTwitter #TwitteRx
Bryan Johnson@bryan_johnson

Completed my first total plasma exchange (TPE). Removing all the plasma in my body and replacing with Albumin. This is different from what I did last year: removing 1 L of plasma from my body and then replacing it with 1 L of plasma from my blood boy @talmagejohnson_ . I gave my one liter of plasma to my father. This time around there's no blood boy involved. TPE removes all of my body’s plasma and replaces it with Albumin. The therapy objectives are to remove toxins from my body. The evidence is emergent. Others use TPE for autoimmune disorders, blood disorders, neurological conditions, transplant-related complications, and replacement of missing plasma components. As we normally do, we completed a bunch of baseline measurements before this therapy including toxins but other things too such as speed of aging, organ ages, microplastics and many other biomarkers. I'll do six total treatments. The operator, who’s been doing TPE for 9 years, said my plasma is the cleanest he’s ever seen. By far. He couldn’t get over it. When we finished, he couldn’t bring himself to throw it away. He was imagining all the good that it could do in the world. On people’s face as PRP therapy. In their body, rejuvenating organs. There is probably a path to auction off or donate my plasma on this next go around. Liquid gold. Remember that when my father received 1 L of my plasma his speed of aging dropped by 25 years and stayed that way for six months. We don’t know if it was from my super plasma or if it was from removing his plasma, but the results are interesting nonetheless. The whole procedure took just under 2 hours.

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Ari Filip
Ari Filip@AriFilipMD·
@AllenGreenMD1 @ThommyTox You are correct -- I checked to see if there was an acknowledgement of the conflict on guidance/levels. To be fair, I didn't thoroughly read the other two papers either -- my point being that the area of study is littered with conflicting evidence and commentary.
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Allen Green, MD
Allen Green, MD@AllenGreenMD1·
@AriFilipMD @ThommyTox Respectfully, I posted this 10 minutes ago and it's 50 pages long. You didn't thoroughly read it. It does highlight where evidence is lacking or contradictory. It also highlights multiple situations where there's likely a very strong link with consistent findings across models
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Ari Filip
Ari Filip@AriFilipMD·
@AllenGreenMD1 @ThommyTox I agree with you that it is not too early to raise concern and demand further study. My main issue is the troublesome support for unproven interventions based on arbitrary thresholds of exposure. This is something we are already seeing in the tox-world.
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