draashish.bsky.social
Internist, Educator, EBM enthusiast, photography hobbyist. #FOAMed #Medsky #IMSky
66 posts
1,352 followers
172 following
Prolific Poster
Conversation Starter
comment in response to
post
Dang! That's more than my whole year of running! Maybe, I need to pick up running. Could use the endorphin and the endocannabinoids boost.
comment in response to
post
Government funds account for more than *half* the R&D budget that US universities spend each year—in 2023, that was $60B out of $109B. The gov also does a lot of its own research at national labs like Oak Ridge & Los Alamos and agencies like NOAA and DoD.
What are the returns on that investment? 3/
comment in response to
post
Wow! That's mind boggling!
comment in response to
post
We emphasize the importance of the pre-rounds. If we do table rounds it cuts down most of the discussion during bedside rounds. Yeah, we still do bedside rounds as a team b'coz d thought is, the exam+pt/family interaction has learning value too. Try our best to be done by noon/early PM.
comment in response to
post
(Adult perspective only)Talking to colleagues who are nephro or ID, working as hospitalists,it boils down to reimbursement & # of hours required at work.Our residents see that too.How much ever we encourage them to pick a specialty based on their love of it,the current pay/work dynamics scare them.
comment in response to
post
This was fantastic! Loved all the inputs. Learned a lot of new things!
comment in response to
post
Sounds like, the HCO3 shift causing hypercapnia is by itself not a significant driver. Hwevr,if the pt has sig underlying 🫁 issues & is prob having a worse day, the hypercapnia cud potentially push them over,which might go unnoticed initially. Though,hard to correlate. Smthing to keep an 👁️ out for.
comment in response to
post
Yeah, She had multiple (3-4) admissions where the resp failure would present in 12-24 hours after HD. On Hx, seemed to progress from the time of HD completion. On a couple of occasions had assoc hyperkalemia and junctional Brady, which was thought to be 2° to acidosis.
comment in response to
post
Oh wow! Those are impressive pCO2 changes. Could most likely affect someone who has sub-optimal respiratory capacity to clear, due to OHS/COPD. Esp if already somewhat compromised due to other reasons.
comment in response to
post
True..we were curious as this was the 3rd post HD episode, requiring admission. PCO2s ranged from 78-60. PH ranged 7.19- 7.26
comment in response to
post
Could it be that, if the pt has significant OHS and/or COPD, the initial rise can persist/worsen due to lethargy induced from hypercapnia?
comment in response to
post
In the case we had, the pt had both COPD and OHS. This was her 3rd admission for post HD respiratory acidosis. In 2 of those she also had hyperkalemia. Which was thought to be from acidosis related shifts.
comment in response to
post
☝🏽This was one of the case reports that we were able to look up. Other was:
journal.chestnet.org/article/S001...
There was another case report which I can't find now.
An article that goes into slightly different but assoc process:
karger.com/bpu/article/...
comment in response to
post
The left one, with the blue sky. Gives a nice color contrast.
comment in response to
post
I have used both Chat GPT and Gemini, as a personal experiment, and noted that they frequently don't understand the context and give the wrong answer.
I have tried feeding them random HPIs (no identifiers) and had similar findings. They give a good differential but often miss the context.
comment in response to
post
Oh gosh! I may have to start keeping a count of my coffees 😅
comment in response to
post
Fantastic! I just threw money at Amazon! 😅