Clay Josephy
@cjosephy.bsky.social
Emergency Medicine | Critical Care Medicine | U of Washington SOM | U of Arizona Emergency Med | UCSF ACCM
First thought: neuro twaves. But sounds like i was wrong…darn it.
April 29, 2025 at 4:56 AM
First thought: neuro twaves. But sounds like i was wrong…darn it.
what Swami is referring to here is a “bolus” but given as a slow infusion over a period of time. Theres RCT evidence that says it reduces psychomimetic rxns versus pushing it over a few minutes
April 25, 2025 at 1:10 AM
what Swami is referring to here is a “bolus” but given as a slow infusion over a period of time. Theres RCT evidence that says it reduces psychomimetic rxns versus pushing it over a few minutes
Interesting question and context. In the ED i tend to give a bolus then start a drip. In the ICU i just start the drip. No particular reason, you just made me self reflect 🤷🏻♂️
Important to be clear what “infusion” means bc even giving a single dose of 0.3 should be done over 15-20 mins to reduce SE
Important to be clear what “infusion” means bc even giving a single dose of 0.3 should be done over 15-20 mins to reduce SE
April 25, 2025 at 1:10 AM
Interesting question and context. In the ED i tend to give a bolus then start a drip. In the ICU i just start the drip. No particular reason, you just made me self reflect 🤷🏻♂️
Important to be clear what “infusion” means bc even giving a single dose of 0.3 should be done over 15-20 mins to reduce SE
Important to be clear what “infusion” means bc even giving a single dose of 0.3 should be done over 15-20 mins to reduce SE
Oh buddy!
This job is just a maze of booby traps. Crazy
This job is just a maze of booby traps. Crazy
March 23, 2025 at 10:04 PM
Oh buddy!
This job is just a maze of booby traps. Crazy
This job is just a maze of booby traps. Crazy
I love this. I see this from time to time with a bariety of triggers. Maybe an HLH spectrum phenomenon. Super interesting. Ive had some luck with Methylene blue or B12 on a couple occasions.
March 23, 2025 at 3:37 PM
I love this. I see this from time to time with a bariety of triggers. Maybe an HLH spectrum phenomenon. Super interesting. Ive had some luck with Methylene blue or B12 on a couple occasions.
Awesome stuff. Loads of great info here. Thanks!
March 16, 2025 at 6:05 PM
Awesome stuff. Loads of great info here. Thanks!
Im just gonna leave a little chuckle here bc this is so true and so common 🤣
March 16, 2025 at 2:42 AM
Im just gonna leave a little chuckle here bc this is so true and so common 🤣
This cannot be over emphasized. If you just titrate this slowly to your goal it takes forever.
March 16, 2025 at 2:41 AM
This cannot be over emphasized. If you just titrate this slowly to your goal it takes forever.
Dude totally agree. I wqs a little tachycardic during that scene. ive seen this twice now. This is not the EPi and high fives scenario. This is put the tube in and wait it out. This goes badly fast.
March 16, 2025 at 1:10 AM
Dude totally agree. I wqs a little tachycardic during that scene. ive seen this twice now. This is not the EPi and high fives scenario. This is put the tube in and wait it out. This goes badly fast.
I like this. At least by ultrasound. You can get away with using inotropes +\- diuretics but honestly if things dont turn around real quick (lactate, UOP, etc) i strongly believe you need some data. Whether thats pocus or PAC or even Ficks w an ScV02 whatever. I agree with you here.
March 16, 2025 at 1:07 AM
I like this. At least by ultrasound. You can get away with using inotropes +\- diuretics but honestly if things dont turn around real quick (lactate, UOP, etc) i strongly believe you need some data. Whether thats pocus or PAC or even Ficks w an ScV02 whatever. I agree with you here.
Agree wholeheartedly 💪🏼
March 1, 2025 at 8:41 AM
Agree wholeheartedly 💪🏼
Well. I think i hear ya.
But Flu = CAP. Many (most?) CAP is viral, flu is a common pathogen.
So youre saying lobar consolidations, elevated procal etc youre using steroids, but diffuse GGOs, lower procal, but still sick, no.
Thats reasonable honestly, just seems like a lot of overlap.
But Flu = CAP. Many (most?) CAP is viral, flu is a common pathogen.
So youre saying lobar consolidations, elevated procal etc youre using steroids, but diffuse GGOs, lower procal, but still sick, no.
Thats reasonable honestly, just seems like a lot of overlap.
February 26, 2025 at 4:28 AM
Well. I think i hear ya.
But Flu = CAP. Many (most?) CAP is viral, flu is a common pathogen.
So youre saying lobar consolidations, elevated procal etc youre using steroids, but diffuse GGOs, lower procal, but still sick, no.
Thats reasonable honestly, just seems like a lot of overlap.
But Flu = CAP. Many (most?) CAP is viral, flu is a common pathogen.
So youre saying lobar consolidations, elevated procal etc youre using steroids, but diffuse GGOs, lower procal, but still sick, no.
Thats reasonable honestly, just seems like a lot of overlap.
Very rational. I mean, theres quite a few observational studies that are consistent, despite the fact that none are controlled. Not exactly cause and effect type science but consistent observations in various settings strengthens a hypothesis, right?
February 26, 2025 at 4:25 AM
Very rational. I mean, theres quite a few observational studies that are consistent, despite the fact that none are controlled. Not exactly cause and effect type science but consistent observations in various settings strengthens a hypothesis, right?
So not up front huh? Just when things are getting worse despite standard treatments? Reasonable.
February 24, 2025 at 3:53 AM
So not up front huh? Just when things are getting worse despite standard treatments? Reasonable.
Right? I mean pooled data on very heterogenous groups of lung injury seem to benefit and until theres some prospective data or at least a tested mechanistic hypothesis (?innate immunity to recurring exposure to seasonal flu?) as to why its different I cant imagine it would be exempt 🤷🏻♂️
February 24, 2025 at 1:01 AM
Right? I mean pooled data on very heterogenous groups of lung injury seem to benefit and until theres some prospective data or at least a tested mechanistic hypothesis (?innate immunity to recurring exposure to seasonal flu?) as to why its different I cant imagine it would be exempt 🤷🏻♂️
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February 23, 2025 at 10:01 PM
So during this bad flu year with the many people we are putting on IMV and even VVECMO, knowing that theres no updated evidence for FLU+ patients specifically….
Are we using steroids for severe CAP or ARDS in FLU+ patients?
Disclosure: I have been 🤫 🤐
Are we using steroids for severe CAP or ARDS in FLU+ patients?
Disclosure: I have been 🤫 🤐
homer simpson is standing in a grassy field
ALT: homer simpson is standing in a grassy field
media.tenor.com
February 23, 2025 at 10:01 PM
So during this bad flu year with the many people we are putting on IMV and even VVECMO, knowing that theres no updated evidence for FLU+ patients specifically….
Are we using steroids for severe CAP or ARDS in FLU+ patients?
Disclosure: I have been 🤫 🤐
Are we using steroids for severe CAP or ARDS in FLU+ patients?
Disclosure: I have been 🤫 🤐
IDSA/ATS still recommends against steroids in FLU+ patients.
CAPECOD excluded FLU+ pts.
Yet many severe CAP and ARDS are caused by FLU and a non trivial number of them are c/b bacterial PNA.
CAPECOD excluded FLU+ pts.
Yet many severe CAP and ARDS are caused by FLU and a non trivial number of them are c/b bacterial PNA.
February 23, 2025 at 10:01 PM
IDSA/ATS still recommends against steroids in FLU+ patients.
CAPECOD excluded FLU+ pts.
Yet many severe CAP and ARDS are caused by FLU and a non trivial number of them are c/b bacterial PNA.
CAPECOD excluded FLU+ pts.
Yet many severe CAP and ARDS are caused by FLU and a non trivial number of them are c/b bacterial PNA.