Joscha von Rappard
@jovora.bsky.social
60% Internal Medicine 40% Nephrology 100% POCUS
Reposted by Joscha von Rappard
discussion of it and an online calculator:
emcrit.org/squirt/vanco/
the clearance of vanc is proportional to the GFR as discussed here:
pmc.ncbi.nlm.nih.gov/articles/PMC...
I'll build a formula embed to calculate GFR from two vanc levels into the IBCC when I get a chance
we should do this more
emcrit.org/squirt/vanco/
the clearance of vanc is proportional to the GFR as discussed here:
pmc.ncbi.nlm.nih.gov/articles/PMC...
I'll build a formula embed to calculate GFR from two vanc levels into the IBCC when I get a chance
we should do this more
Vancomycin PK project: Nuts & Bolts guide
Emerging evidence shows the benefits of using pharmacokinetics to adjust vancomycin dosing. What follows is a guide about how to do it. I will keep this up-to-date, so please let me know if you find...
emcrit.org
December 16, 2024 at 4:46 PM
discussion of it and an online calculator:
emcrit.org/squirt/vanco/
the clearance of vanc is proportional to the GFR as discussed here:
pmc.ncbi.nlm.nih.gov/articles/PMC...
I'll build a formula embed to calculate GFR from two vanc levels into the IBCC when I get a chance
we should do this more
emcrit.org/squirt/vanco/
the clearance of vanc is proportional to the GFR as discussed here:
pmc.ncbi.nlm.nih.gov/articles/PMC...
I'll build a formula embed to calculate GFR from two vanc levels into the IBCC when I get a chance
we should do this more
Reposted by Joscha von Rappard
Do you remember #TopNephrology stories in 2023? 👇Here is the recap
💡 #NephSky #MedSky any proposals for 2024?
www.nephjc.com/news/2024/1/...
💡 #NephSky #MedSky any proposals for 2024?
www.nephjc.com/news/2024/1/...
December 2, 2024 at 12:29 PM
Do you remember #TopNephrology stories in 2023? 👇Here is the recap
💡 #NephSky #MedSky any proposals for 2024?
www.nephjc.com/news/2024/1/...
💡 #NephSky #MedSky any proposals for 2024?
www.nephjc.com/news/2024/1/...
Nicely explained!
1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
November 28, 2024 at 5:20 AM
Nicely explained!
Reposted by Joscha von Rappard
Rant #5 Please don't tell me what the PaO2 is...
Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.
What is the SpO2 I genially ask? In our target range? Well that's fine then.
Staff member shifting uneasily, "but the PaO2..."
Here we go...
Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.
What is the SpO2 I genially ask? In our target range? Well that's fine then.
Staff member shifting uneasily, "but the PaO2..."
Here we go...
Over the years I've developed a number of "rants" (aka teaching) that seem to resonate with trainees on #ICUsky ward round.
This pedogogical style might make educationalists wince but keeps me and (crucially) trainees, interested
Interested in any counter rants, refined rants or rant affirmation
This pedogogical style might make educationalists wince but keeps me and (crucially) trainees, interested
Interested in any counter rants, refined rants or rant affirmation
November 25, 2024 at 9:16 PM
Rant #5 Please don't tell me what the PaO2 is...
Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.
What is the SpO2 I genially ask? In our target range? Well that's fine then.
Staff member shifting uneasily, "but the PaO2..."
Here we go...
Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.
What is the SpO2 I genially ask? In our target range? Well that's fine then.
Staff member shifting uneasily, "but the PaO2..."
Here we go...
I love this rant!
Rant #5 Please don't tell me what the PaO2 is...
Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.
What is the SpO2 I genially ask? In our target range? Well that's fine then.
Staff member shifting uneasily, "but the PaO2..."
Here we go...
Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.
What is the SpO2 I genially ask? In our target range? Well that's fine then.
Staff member shifting uneasily, "but the PaO2..."
Here we go...
Over the years I've developed a number of "rants" (aka teaching) that seem to resonate with trainees on #ICUsky ward round.
This pedogogical style might make educationalists wince but keeps me and (crucially) trainees, interested
Interested in any counter rants, refined rants or rant affirmation
This pedogogical style might make educationalists wince but keeps me and (crucially) trainees, interested
Interested in any counter rants, refined rants or rant affirmation
November 26, 2024 at 5:32 PM
I love this rant!
Well done 👍
You've probably heard that Bicarbonate has to turn into CO2 to raise the pH.
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
November 19, 2024 at 5:52 PM
Well done 👍
Reposted by Joscha von Rappard
What’s the best examples of large observational studies that get their pseudocausal claims disproven by studies with careful causal inference methods or RCTs? The first that comes to mind is the apparent protective effect of moderate alcohol consumption vs abstinence. #metascience #statsky #medsky
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia
This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.
jamanetwork.com
November 19, 2024 at 4:57 PM
What’s the best examples of large observational studies that get their pseudocausal claims disproven by studies with careful causal inference methods or RCTs? The first that comes to mind is the apparent protective effect of moderate alcohol consumption vs abstinence. #metascience #statsky #medsky
Reposted by Joscha von Rappard
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia
This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.
jamanetwork.com
November 19, 2024 at 4:51 AM
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
Nice and impressive playing around with AI in the context of medical education
I am at the beginning of my AI journey of discovery, you know the place where you are still dumbfounded by what the machine can do. In this case it developed a pretty compelling electrolyte curriculum for nephrology fellows 😳
pbfluids.com/2024/11/ai-c...
pbfluids.com/2024/11/ai-c...
AI Curriculum
I am still in the “amazed by what AI can do” stage Here is me prompt i am teaching a class on electrolyte abnormalities for nephrologists. What would be good tricky things to teach I th…
pbfluids.com
November 17, 2024 at 8:13 AM
Nice and impressive playing around with AI in the context of medical education
Reposted by Joscha von Rappard
Interesting case of ANCA GN apparently triggered by COVID infection. Also showed concurrent membranous features with MPO+(IHC below) IgG (IF below) deposits as has been described: www.sciencedirect.com/science/arti.... #renalpath #nephrology #pathsky
November 16, 2024 at 4:09 PM
Interesting case of ANCA GN apparently triggered by COVID infection. Also showed concurrent membranous features with MPO+(IHC below) IgG (IF below) deposits as has been described: www.sciencedirect.com/science/arti.... #renalpath #nephrology #pathsky
Reposted by Joscha von Rappard
point-of-care electrolyte analyzers cannot detect hemolysis!
so point-of-care hyperkalemia may or may not be real.
in this case, the hyperkalemia was wholly artifactual.
think twice before unleashing therapy for hyperkalemia (the ECG is often the key)
(more: emcrit.org/ibcc/hyperka...) #emimcc
so point-of-care hyperkalemia may or may not be real.
in this case, the hyperkalemia was wholly artifactual.
think twice before unleashing therapy for hyperkalemia (the ECG is often the key)
(more: emcrit.org/ibcc/hyperka...) #emimcc
November 12, 2024 at 4:05 PM
point-of-care electrolyte analyzers cannot detect hemolysis!
so point-of-care hyperkalemia may or may not be real.
in this case, the hyperkalemia was wholly artifactual.
think twice before unleashing therapy for hyperkalemia (the ECG is often the key)
(more: emcrit.org/ibcc/hyperka...) #emimcc
so point-of-care hyperkalemia may or may not be real.
in this case, the hyperkalemia was wholly artifactual.
think twice before unleashing therapy for hyperkalemia (the ECG is often the key)
(more: emcrit.org/ibcc/hyperka...) #emimcc
Reposted by Joscha von Rappard
youtu.be/AWMiG_7PwbM?... In settings, you can allow YouTube videos to play in the Bluesky app. Let’s try it out. Here is one of my top 5 favorite skits.
Never Chart in the Emergency Department
YouTube video by Dr. Glaucomflecken
youtu.be
November 16, 2024 at 5:56 AM
Reposted by Joscha von Rappard
A randomized controlled trial evaluated the efficacy and safety of apixaban for prevention of recurrent thrombosis after thrombectomy of #hemodialysis #vascular access.
#nephsky #medsky
www.kidney-international.org/article/S008...
#nephsky #medsky
www.kidney-international.org/article/S008...
DEFINE_ME
www.kidney-international.org
November 16, 2024 at 8:54 AM
A randomized controlled trial evaluated the efficacy and safety of apixaban for prevention of recurrent thrombosis after thrombectomy of #hemodialysis #vascular access.
#nephsky #medsky
www.kidney-international.org/article/S008...
#nephsky #medsky
www.kidney-international.org/article/S008...
Reposted by Joscha von Rappard
It's up!!!! My Explainer video for BlueSky beginners.
I cover how to find your Twitter followers, Starter Packs, Feeds, Lists, some handy-dandy tools, and BlueSky etiquette.
Please watch and/or share with any newbies you know. I think it's helpful.
www.youtube.com/watch?v=m_V2...
I cover how to find your Twitter followers, Starter Packs, Feeds, Lists, some handy-dandy tools, and BlueSky etiquette.
Please watch and/or share with any newbies you know. I think it's helpful.
www.youtube.com/watch?v=m_V2...
BlueSky for Beginners
YouTube video by Machine Pun Kelly
www.youtube.com
November 15, 2024 at 1:18 AM
It's up!!!! My Explainer video for BlueSky beginners.
I cover how to find your Twitter followers, Starter Packs, Feeds, Lists, some handy-dandy tools, and BlueSky etiquette.
Please watch and/or share with any newbies you know. I think it's helpful.
www.youtube.com/watch?v=m_V2...
I cover how to find your Twitter followers, Starter Packs, Feeds, Lists, some handy-dandy tools, and BlueSky etiquette.
Please watch and/or share with any newbies you know. I think it's helpful.
www.youtube.com/watch?v=m_V2...