ทวีตที่ปักหมุด
Today, I finished up 20 years of school/training on my last day as a critical care pharmacy resident.
Tomorrow, I start my dream first job as an ICU/ED clinical pharmacist at @The_BMC.
(1/x)
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Shyam Patel
505 posts
Shyam Patel
@ShyamLPatel
@the_BMC ICU/ED PharmD, BCCCP | @BMCPharmRes and @UConnHealthRx alum | @UConnPharmacy grad | he/him/his
Boston, MA เข้าร่วม Temmuz 2019
580 กำลังติดตาม697 ผู้ติดตาม
Shyam Patel รีทวีตแล้ว
Shyam Patel รีทวีตแล้ว
Shyam Patel รีทวีตแล้ว
UConn stands alone.
They’re the only program in college basketball history to win both the men’s and women’s NCAA championships in the same year.
And today, they added another milestone—becoming the first program ever to produce two WNBA/NBA Rookies of the Year in the same season.
A truly legendary program. 🐺💙✨
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Shyam Patel รีทวีตแล้ว
🎬 2nd chapter
...🧵This a thread about 1.3% sodium bicarbonate🧂 (aka isotonic bicarb drip) in critical care.
☝🏻 If you missed the first part about 8.4% bicarb, I would strongly recommend you to read it before moving on 🏃🏻.
x.com/jackdeliuc/sta…
Giacomo De Luca@jackdeliuc
...🧵This is a thread about 8.4% sodium bicarbonate (aka bicarb amp) in critical care. This the first part in a series of three about sodium bicarbonate 🧂in critical care: 🧐I will get in deep to complexities, benefits, risks and clinical implications of this (overused) drug.
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Shyam Patel รีทวีตแล้ว
How I Do It: Interpreting Clinical Trial Results
Read the full research in the December issue of #journal_CHESTCritCare: hubs.la/Q030phN_0
#MedEd #JournalCHEST
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Shyam Patel รีทวีตแล้ว
Top 10 Important ICU Papers: Second Half of 2024
From the ICU papers published between July and December 2024, I have selected the top 10 key ones, including RCTs, guidelines, and narrative reviews.
I hope you like this list.
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Shyam Patel รีทวีตแล้ว
Wow!!
Look at this new Annexa-I data! Those mRS numbers and VTE data do NOT look good to me….
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Shyam Patel รีทวีตแล้ว
There is an IV fluids shortage (0.9% MS & LR) due to hurricane Helene.
Because of the shortage everyone should stop ordering routine maintenance fluids for the next 2-4 weeks.
Because of good medical practice everyone should stop ordering routine maintenance fluids forever.
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Shyam Patel รีทวีตแล้ว
New SRMA on AA vs 4PCC showing no diff in mortality but increased thrombotic events. Not sure on the TE event numbers they entered from Annexa-I, but still, lots of data included in this open-access analysis
bit.ly/3W12wYW
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Shyam Patel รีทวีตแล้ว
New Letter to Editor re Dobesh et al's AA vs 4PCC review (showing AA's superiority) written by CA pharmacists questioning methodology and therefore results
Open access at bit.ly/3yGwY2l
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Shyam Patel รีทวีตแล้ว
I honestly don’t know how to interpret a study where 15% of the control group received no therapy.
And there is no subgroup analysis excluding these patients?
I guess given increased risk of ischemic stroke & no difference in overall NIHSS, maybe a neutral study ??? 🤷♂️ (1/2)
W David Freeman, MD, FRSM, FNCS, FAAN@freemanwd
A summary of "Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage" (ANNEXA-I) by Stuart Connolly et al NEJM: 1. 🔬 Study Purpose: Evaluated the effectiveness of andexanet alfa in controlling hematoma expansion in patients with intracerebral hemorrhage on factor Xa inhibitors. 2. 🧪 Methods: 530 patients were randomly assigned to receive either andexanet or usual care, with primary endpoints being hemostatic efficacy and safety endpoints like thrombotic events and death. 3. 📊 Results: Andexanet achieved better control of hematoma expansion (67.0%) compared to usual care (53.1%), but it increased thrombotic events (10.3% vs. 5.6%). 4. 💉 Treatment Efficacy: The median reduction in anti–factor Xa activity was significantly higher with andexanet (94.5%) compared to usual care (26.9%). 5. ⚠️ Safety Concerns: While effective in controlling hematoma expansion, andexanet was associated with a higher risk of thrombotic events, including ischemic stroke. #CODE #ICH nejm.org/doi/full/10.10…
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Shyam Patel รีทวีตแล้ว
It is finally published! Time to read ANNEXA-I, published in @NEJM today!
nejm.org/doi/full/10.10…
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Shyam Patel รีทวีตแล้ว
Now that ANNEXa-I is officially published, are you motivated to add andexanet alfa to your formulary or are you sticking with PCC as your primary reversal agent for factor Xa-inhibitor associated intracerebral hemorrhage?
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Shyam Patel รีทวีตแล้ว
The debate of milrinone vs. dobutamine will likely continue for the rest of our careers as there is rarely a one-size-fits-all strategy in the ICU. DOREMI-2 might help. This paper complements the chapter on the topic in my book. 🎩 tip to the authors.
eddyjoemd.com/foamed/
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Shyam Patel รีทวีตแล้ว
Interested in working at the busiest level 1 Trauma Center in New England? I’m looking for an ED 7-on/7-off overnight pharmacist to join our team @The_BMC!
shorturl.at/jGIL6
Feel free to reach out with any questions!
#TwitteRx
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Shyam Patel รีทวีตแล้ว
Our Letter to the Editor (and response) in @Neurology regarding @AANmember @SCCM @AmerAcadPeds Brain death guidelines.
#letters-section" target="_blank" rel="nofollow noopener">neurology.org/doi/full/10.12…
Determination of Brain death after overdose is complex and toxicologists should be involved. Five half lives not adequate.
#MedEd
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Shyam Patel รีทวีตแล้ว
This is a solid way to convince me to approve meropenem
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Shyam Patel รีทวีตแล้ว
Here’s a critical care puzzle & illustrates some important cardiopulmonary physiology:
These two pictures were taken just an hour apart. What intervention was done in between that changed the respiratory pattern? (Red box)
Multiple choice & answers in the 🧵.
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Hooray! We have migrated over to Instagram. While we won’t be posting on here any longer, we’ll be sharing quality content on IG. Come check us out at @bmcpharmres #TwitteRx #Out 🎤💊
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