Mike Jasumback

@Delta nice work on flight 759 today! Delayed first by a late flight attendant and then chose to delay more for “cosmetic maintenance”. Kinda like the absence of work on your website🙄 Not impressed

@Delta Need to get your website working. If you want everyone to use the website to do stuff. It has to actually work!!! I haven’t been able to access “My Trips” in MS Edge for months and now can’t in chrome Please Fix!

@IM_Crit_ I’d suggest one starts by actually reading the study 🙄

The recent NEJM study found cardiovascular collapse was more common with ketamine than etomidate after rapid sequence intubation, especially with the high ketamine doses used. Should we be more cautious about the hemodynamic effects of ketamine/propofol ("ketofol") as well? 🤔

@reverendofdoubt Better idea. Stop changing practice based on secondary composite outcomes in underpowered studies

#RSItrial should teach an important lesson: RCTs designed to answer the clinical question >>> meta-analysis of obs studies The ketamine/etomidate fetish in 2023-concern of mortality w/ etomidate in a KM curve that showed divergence / re-convergence @ day 28-had no face validity

@nickmmark And yet…. No Change in outcome. And oh, secondary composite outcome which the trial was underpowered for…. Hypotheses generated

💉 The results of the RSI Trial results are in and they are truly practice changing! By choosing etomidate over ketamine: NNT=20 to prevent cardiovascular collapse! 🪦RIP Ketamine for Endotracheal intubation induction! #CCRDownUnder

@slcairport What idiot thought closing all the men’s bathrooms on the A concourse simultaneously made sense ?

@Delta Really? A 4 hour delay and now you can’t get us off DAL1432🙄

@armyemdoc Probably BS for both

Wait, what? I'm so confused. Now it's head-up CPR but head-down stroke?!

@EBMgoneWILD So we have a massive trial showing no diff, a small trial showing massive diff. Hmmmm......... I guess we wait for pubs and look at methods. Getting more skeptical

Of note, HeadPoST was a negative trial with ~11,000 patients from 2017. nejm.org/doi/full/10.10…

Today in "things I did not know" This is an astonishing difference.

@EBMgoneWILD @embasic References please?

@embasic But if you go further down the thread, they've seen this association for over 50 years. It's just that...nobody does it. Until now I guess.

@EBMgoneWILD UGGGH!!! Stopped early, massive effect size for tiny N UGHH

@HandtevyMD Publish useful data. Not unverified abstracts. How many times do we have to do this. Science is a process not a news release 🙄

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@BCBSMT Hey I've got an idea, how about a functional website. Where one can login to Blue Access for Members? Or where your home page isn't a 404 error?

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@_JaceMullen Yeah. Showing a bit of bias on my part

@jasumback Shouldn’t it also be “no (cite source)”

Pressers don’t work in a low pH state

And by pressers I mean Pressors. I.e. epinephrine, Levophed, dopamine and other inopressors. We can forgo the vasopressin/angiotensin analogues🙄

@LeifRognas @UCAirCareDoc @GamutQI @AMPAdocs @ASTNA2 @ICAPParamedics I don't doubt it (although who was watching?). But in non MD systems with much more limited experience... I highly doubt they are doing as well.

@UCAirCareDoc @jasumback @GamutQI @AMPAdocs @ASTNA2 @ICAPParamedics Yes, I am telling you, that we (consultant anaesthesiologists in PHCC) are doing as well on the side of the road in the middel of the night (with McGrath VL) as the consultant anaesthesiologists in the OR you report; post-RSI FPS =94%. No BS :-) sjtrem.biomedcentral.com/articles/10.11…

.@jasumback: "Do you know what the reported @GamutQI FPS reported rate is across the board? 89%. You're telling me that you, on the side of the road in the middle of the night, are doing as well as anesthesiologists in the OR? BS." #CCTMC23 @AMPAdocs @ASTNA2 @ICAPParamedics

@cianmcdermott @DitchDoc14 Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):270-279. doi: 10.1001/jama.2022.9792. PMID: 35707974

@DitchDoc14 @jasumback Could you post reference for this? Very useful stat to keep in mind. Thx for sharing

If your blood pressure is 120 just prior to intubation, about a 20% chance of cardiovascular collapse 😳😳😳MUCH higher than the 90 that we commonly worry about as the inflection point for high risk patients. @jasumback #CCTMC23

@alex_iteen @DitchDoc14 @reverendofdoubt Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):270-279. doi: 10.1001/jama.2022.9792. PMID: 35707974

@DitchDoc14 @reverendofdoubt @jasumback What’s the source for that?

@Emedwebb @DitchDoc14 Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):270-279. doi: 10.1001/jama.2022.9792. PMID: 35707974

@DitchDoc14 @jasumback Yes, would like to see the citation. MAP and shock index seem the more likely predictors