cnemehmd.bsky.social
PCCM Fellow UChicago, T32 Researcher, MSCP Student, Interested in Interventional Pulmonology
Former Chief Resident in Quality and Patient Safety - BCM/MEDVAMC
Current Marathon Enthusiast (Abbott ⭐️⭐️)
Here for MedEd and Chicago Sports :)
118 posts
781 followers
602 following
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A little on the heavier side compared to what I’m used to, but comfort/support and a wide base exactly where I need it as a heavier runner. May have just found my new daily trainers!
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I tried using it for Chicago marathon prep since my coach at the time sent his plans out through the app. It was fine but I didn’t feel like it added much for me, personally, though some other people liked it. Eventually just went back to logging my miles on Strava after a couple weeks tbh
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I was literally just down the street with a new pair of trainers to break in, where was my invite, Pete?! 😂
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You say lunacy but idk I feel like “Cheetos at bedside” is pretty standard in my admission order set
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Them beating the Chiefs is just icing on the cake 🥳
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And just as bad a call on that clear make up call against the Chiefs for unnecessary roughness. Sky judge and review team PLEASE, NFL
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The problem with H/H is the pKa is not always 6.1 and can go up or down (a little) depending on lipids, temp, and pH.
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Agreed. I think the cost prohibitive nature makes the empiric challenge a little more difficult on our end sometimes though. Was able to get it easily approved at some hospitals, more logistical hurdles at others.
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I personally stopped using midodrine to spare pressor duration a while ago since the data is so uninspiring, but I haven’t heard of this! Excited to read more about it
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Something about the need for readily available/rapid renin assays and the effect that might have on us using angiotensin II more ubiquitously?
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These arbitrary freezes are done in the name of showing how we're "taking on big government in the name of transparency" but even temporary delays like these are like his defunding of the pandemic task force 8 years ago, ie a major reason we were a country with arguably the worst COVID outcomes.
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The assays themselves are more expensive up front, but one of the value based care exercises we performed as CRQS shows the up front cost is outweighed by a huge ROI on information returned/NNT since electrolyte disturbances aren’t necessarily always hypothesis driven tests.
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Triples is safe
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I’m very much a treat the patient not the numbers guy, and especially subscribe to less is more.
But there are plenty of asymptomatic patients with a K of 6.8, a phos of 0.7 or a Mg of 0.5 until they’re not.
If anything going out of my way to order what I consider routine lytes is more fatiguing.
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I would agree with you if we weren’t talking about electrolytes we check a baseline on 90%+ of admits anyway, but the separate orders just cost more.
Imbalances are insidious and the benefit to knowing a level is low can be the difference between preventing torsades or getting somebody off the vent
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There’s absolutely an argument to be made about utility of chasing electrolytes and replacing them to arbitrary levels.
But there isn’t a good one against including two electrolytes commonly ordered separately when you look at the clinical ROI vs a test that would cost less overall if included.
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Electrolyte imbalances beget other electrolyte imbalances. Refeeding syndromes or persistent hypoK due to hypoMg are exceedingly common conditions in the acute care setting.
From a QI/value based standpoint, it saves money/improves diagnostic accuracy in the long run vs ordering separate tests.
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Btw you still owe me a rain check on a catch up call! Maybe we can find time later this week?
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The only appropriate response imho