CoCo

7K posts

CoCo

CoCo

@Coco_MD_

MD🩺 |optimist |non-conformist|

Katılım Temmuz 2022
143 Takip Edilen163 Takipçiler
CoCo
CoCo@Coco_MD_·
@WrldEhmperor it’s not valid at all that’s why i find him saying tough and valid call statement laughable and based off ignorance or ego. the so called consultant pharmacist doesn’t know what he’s doing cos why make a clinical judgement without empirical clinical facts? it’s surreal
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Nezha
Nezha@WrldEhmperor·
@Coco_MD_ For proper pain management, how is withholding pain killer valid and how is it unnecessary therapy?
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Equipe de France ⭐⭐
Equipe de France ⭐⭐@equipedefrance·
🇫🇷 @nglkante a porté contre la Colombie le brassard de capitaine de l’Équipe de France pour la 6e fois de sa carrière 💙
Equipe de France ⭐⭐ tweet media
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CoCo
CoCo@Coco_MD_·
@Softmedic @ecmbah not at all. i stopped being a house officer a very long time ago.
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Biom-X
Biom-X@Softmedic·
@Coco_MD_ @ecmbah Out of curiosity are you in UBTH doing Housemanship? I know one coco
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Biom-X
Biom-X@Softmedic·
There are outliers of which I’ve witnessed. I was the MLS that handled that case of a paediatric patient with very low PCV but clinically he wasn’t looking so. Reg rejected results multiple times. I got pissed off, walked to the ward to see who was rejecting the results.
Yisheng@YishengMD

Tests do not exist in isolation of the true clinical picture. Quote me anywhere on this. Sometimes a test may be positive, but the clinical state of the patient is what will determine whether anything should be done or the patient should just be left as they are. Do you get me?

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Biom-X
Biom-X@Softmedic·
@Coco_MD_ @ecmbah No lab investigation don’t exist in isolation but it points out what might not have manifested clinically (to the visible eyes). That’s the beauty of it
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama you’re missing things up please. it is studies that influence guideline following adoption . some studies are experimental at best and are never adopted. the study i quoted aligns with the current use of opioids for acute pains per guidelines. that’s the difference
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Chim drag
Chim drag@ChimDrag·
@Coco_MD_ @chokolat_mama There is a diff between STUDY and GUIDE LINE.i think n i quoted the study for u to go check it up. The topic on discuss here,i also think,is why Nigerians are aversive towards OPIOIDS.. And you brought a STUDY,that's me analysing the study . And showing u other studies
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Dr. E
Dr. E@chokolat_mama·
To be honest, I don’t get the reason why you’d be withholding opioids from HbSS patients in acute crisis. “Is it really necessary?” “Can we try NSAIDS first?” No. Pain is no joke. Give them the damn medication…at least, until the acute crisis is over.
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama children and young adults(>18y/o) are more prone to acute pain in hbss so yeah using a <19 for the study is not a conflict of interest at all. i don’t even understand why you’d say it is whe weight is a more significant factor than age with administering medication
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Chim drag
Chim drag@ChimDrag·
@Coco_MD_ @chokolat_mama -Paediatric patients aren't the only pxts with SCD voc -CONFLICT OF INTEREST is a thing , and it's very valid. A recent case of spike in OUD was led by Studies sponsored by a particular Pharma group,cant remember d name.dt s y papers have 2 be critiqued. -quoted a review f 11yrs
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama the questions have been answered for now and it’s meritorious, the current guidelines agree with it. every single author stated their grant but you decided to pick on the one that has a pfizer grant for no reason. that’s an unnecessary subjective bias.
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Chim drag
Chim drag@ChimDrag·
@Coco_MD_ @chokolat_mama In all, It's not about invalidating a study,it's about telling you the basis on which some interpretations cannot be directly follow through. I think research shd b analysed in its merit nd not on extrapolation without further research. Science grows by questions.
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CoCo
CoCo@Coco_MD_·
@Softmedic @ecmbah i literally said someone actually missed something and it’s those that clinically evaluated the patient and not you. also nobody in their right senses ignores pcv of 8% wether hbss or not. also lab investigation are never exist in isolation
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Biom-X
Biom-X@Softmedic·
@Coco_MD_ @ecmbah You assume I don’t know all this? Will you ignore a PCV of 8% be it Hbss or a non Hbss?
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CoCo
CoCo@Coco_MD_·
@Softmedic @ecmbah you can’t just tell a patient clinical state from a blood sample, you actually need to see the patient. a steady state pcv for an hbss patient is a symptomatic pcv for a non hbss patient. test never exist in isolation of clinical state, someone definitely missed something
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Biom-X
Biom-X@Softmedic·
@ecmbah I understood his reason when I saw the kid. But I trusted my results 100% and I didn’t budge. That action saved the kid. We don’t need to see the patient to know something is wrong, we’ve been trained to work with patient sample to tell if there’s a problem or not
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama nobody said there shouldn’t be hesitation for use. triage your patient and individualize care but most importantly manage the patient as fast as possible with the medication the managed it.
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Chim drag
Chim drag@ChimDrag·
@Coco_MD_ @chokolat_mama AROUND THE CLOCK would mean that agents be given not waiting till the pain Occurs but giving something always (before pain, different agents interspersed) From Mohammed's study we can see a pointer that the hesitation towards OPIOIDS is not really a NIGERIAN thing.Fear seems WW
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama i don’t even get your point with all these? used for pediatric patients invalidates the study? because an author gets a grant from pfizer invalidates the study? because it’s a 2-3 years review invalidates the study? what are you talking about?
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Chim drag
Chim drag@ChimDrag·
@Coco_MD_ @chokolat_mama Thanks .. 1.The study is a cross sectional study...no control was done to see a statistical signif from a null hypothesis. 2. It was used for Paediatric pxts 3.O.R not very signif as regards the discuss 4.C.O.I , author has grants from Pfizer... 5. It's a 2-3yr review ..
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama please let’s be mindful of the information we put in the internet in defense of our points. there’s no guidelines that have standardized the use of ketamine for the mgt of acute pain in voc, at best, it’s an adjunct to opioid which still remain the first line for acute pain
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Chim drag
Chim drag@ChimDrag·
@Coco_MD_ @chokolat_mama In a study done by Mohammad Eltorki Et al in 2024.. on Trends in Hospital Analgesia..SCD v.O Hospitalised patients were given increased doses PCM and KETAMINE than increasing dosing with Opioids. Moreover W.H.O pain protocol is about AROUND THE CLOCK , up the LADDER.
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CoCo
CoCo@Coco_MD_·
@chokolat_mama it’s actually disappointing and funny cos why would you have such exaggerated concerns talking about dependence and addiction with less than 3 days use of tramadol or df118 not morphine or fentanyl oh(which is still unlikely)but weak ass tramadol. comical
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Dr. E
Dr. E@chokolat_mama·
@Coco_MD_ The takes I’ve been seeing on this matter make me disappointed.
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CoCo
CoCo@Coco_MD_·
what i’ve noticed from this tweet is that a whole lot of hcw do not know how to manage acute pain and it’s quite unbelievable. your patient should not still be having pains after 30-60 minutes of presenting to you. anything short of this is weird practice
Dr. E@chokolat_mama

To be honest, I don’t get the reason why you’d be withholding opioids from HbSS patients in acute crisis. “Is it really necessary?” “Can we try NSAIDS first?” No. Pain is no joke. Give them the damn medication…at least, until the acute crisis is over.

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CoCo
CoCo@Coco_MD_·
@doktordandy @chokolat_mama it’s the job of the psychiatrist to manage their addictions, it’s your job to manage the pain and if you function as both, then you can as well do both.
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Nwabịalụije
Nwabịalụije@doktordandy·
@Coco_MD_ @chokolat_mama You manage pain adequately and refer for psychiatric care, "tomorrow" the patient comes back to you again in pain, what do you do?
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CoCo
CoCo@Coco_MD_·
@doktordandy @chokolat_mama very good question. using the DSM-5, patient should have to have exhibit signs(you can look them up) of these for a 12 months durations. please can you tell me how you’re going access these in a patient you’re just meeting or have met just a couple of times?
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Nwabịalụije
Nwabịalụije@doktordandy·
@Coco_MD_ @chokolat_mama And it's not an excuse, it's a question. At what point does that consideration come in, or does it entirely get thrown out of the window once a patient is in pain?
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CoCo
CoCo@Coco_MD_·
@doktordandy @chokolat_mama so if you’re assumption is that the patient already has access to opioids w/o prescription and a suspected addiction, please why exactly are you withholding it from them when they are in acute pain? aren’t you supposed to manage pain adequately then refer for psychiatric care?
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Nwabịalụije
Nwabịalụije@doktordandy·
@Coco_MD_ @chokolat_mama Are you assuming you are the first doctor managing the patient for VOC, are you assuming that SC pxs don't access opiod analgesics w/o prescriptions. And yes some pxs have shown traits suggestive of addiction within that time frame indicating likely prior exposure to opiates.
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CoCo
CoCo@Coco_MD_·
@chokolat_mama @ChimDrag NSAIDs are some of the worst medications for HBSS as studies have shown, i really do not even why i’m seeing people still talking about their use as first line and letting the suffer in pains cos of them. medicine is dynamic, we need to catch up
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Dr. E
Dr. E@chokolat_mama·
A patient came to the emergency complaining of severe bone pain. She was literally crying…she described the pain as being repeatedly hit by a hammer. But she was given an NSAID, which obviously would do nothing to relieve the pain. I don’t understand making patients suffer like that. It’s not right at all.
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CoCo
CoCo@Coco_MD_·
@ChimDrag @chokolat_mama a properly dosed max 48-72hrs of opioid analgesic for acute pain management have not caused addiction, dependence or tolerance to anyone. what studies have shown is that the risk increase with beyond 5 days of continuous use. so why the exaggerated concerns?
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Chim drag
Chim drag@ChimDrag·
@chokolat_mama Doesn't W.H.O have a Protocol for pain Management? The speed of opioid addiction is not one you want to see , also Treating Opioid addiction is not a pancake and jam job. Also what cohort study has been done to show a statistically significant benefit of opioid over NSAIDS.
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Keşfet

@WrldEhmperor @equipedefrance @nglkante @Softmedic @ecmbah @ChimDrag @chokolat_mama @elonmusk