Doctors of golden hour

Blue zones_where people are speculated to live longer than average.

coagulation panel myths
#1: Coagulation testing is necessary in the evaluation of all chest pain.

#2: Coagulation testing is necessary for perioperative or pre-procedure assessment.

#3: Coagulation testing is necessary in patients being admitted as screening for coagulopathy.

Literature suggests that coagulation panels obtained on these patients does not change management.

Coagulation testing should not be used for screening purposes in admitted patients, especially with the infrequency of bleeding disorders in asymptomatic patients.

For those on antiplatelets and not anticoagulants, a coagulation panel is not helpful.

Indications for a coagulation panel:

1. Evident bleeding
2. h/o unexplained bleeding
3. Liver disease, sepsis, cerebrovascular accident, DIC, preeclampsia/HELLP, cholestasis, poor nutrition
4.about to receive thrombolytics, or those taking anticoagulants.

Tomato flu outbreak in India
Vivek P Chavda
Kaushika Patel
Vasso Apostolopoulos Published:August 17, 2022DOI:https://doi.org/10.1016/S2213-2600(22)00300-9

Due to the high volume of distribution, tigecycline achieves poor serum concentrations (approximately 0.6 mg/L). For this reason, tigecycline should not be used for endovascular infections, such as bacteremia or endocarditis.

KURU, a deadly disease of fore people of new guinea, once very prevelant, nearly disappeared after people stopped consuming brains of there dead relatives (ritualistic cannibalism)
Prions are the only known transmissible pathogens that are devoid of nucleic acid

In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo.

Clinical Probability Adjusted D-Dimer: The PEGeD Study NEJM 2019

Prospective study, 2017 patients presenting to the ED with symptoms of pulmonary embolism

7-item Wells clinical prediction rule used to delineate low (0-4), moderate (4.5-6) or high (>6.5) risk of pulmonary embolism

Low risk group (n=1,752): discharged without CTPA if d-dimer below 1,000 ng/ml FEU

Moderate risk group (n=218): discharged without CTPA if d-dimer below 500 ng/ml FEU

High risk group (n=47): sent directly for CTPA
Zero patients discharged without CTPA based on adjusted d-dimer cutoffs had a pulmonary embolism at 3 months

17.6% reduction in CTPA use with adjusted d-dimer cutoffs compared to a universal cutoff of 500 ng/ml FEU

CONCLUSION_ consider using clinical probability adjusted d-dimer cut offs if your ED has a typically low risk population

Takuo Aoyagi, Ph.D., inventor of pulse oximetry, noted the influence of Dr. Yoshio Ogino, Nihon Kohden’s founder, on his work. Ogino said “a skilled physician can treat only a limited number of patients. But an excellent medical instrument can treat countless patients in the world.”

This is something, we wish wasn't true
HAT protocol in question again

Place yourself in such a way that both are easy to glance
Having the monitor behind you is equivalent to driving your car while looking at back seat

PERAMPANEL vs TOPIRAMATE

Although perampanel shares a mechanism of action with topiramate and both take approximately one month to titrate to the recommended dose, perampanel may be preferred in patients who have a history of closed-angle glaucoma, kidney stones, or metabolic acidosis.
Also while PERAMPANEL is indicated only as an adjunctive AED for POS and PGTC seizures,TOPIRAMATE may be used as monotherapy

PATHOGENS

Situation is highly critical for healthcare-associated infections caused by the Gram-negative ESKAPE pathogens Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae (including Klebsiella pneumoniae, Escherichia coli, Enterobacter spp., Serratia spp., Proteus spp., Providencia spp., and Morganella spp.). These bacteria are resistant to carbapenems, which are the only remaining therapy that is often considered as antibiotics of last resort