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Josh Farkas
Lives in Burlington VT
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Josh Farkas

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Brief rant: Still no evidence that azithromycin increases mortality
Introduction It has long been known that some macrolides (e.g.
erythromycin) cause torsade de pointes.   However, azithromycin has a much lower affinity for cardiac potassium
channels than erythromycin, so it has less effect on the heart.   For many years i...
Introduction It has long been known that some macrolides (e.g. erythromycin) cause torsade de pointes. However, azithromycin has a much lower affinity for cardiac potassium channels than erythromycin, so it has less effec...
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Josh Farkas

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Treatment of hemodynamically stable new-onset AF in critical illness
Introduction with a clinical question A 50-year-old woman with no prior medical problems was
admitted to Genius
General Hospital with severe influenza pneumonia and acute kidney injury.   She was transferred to the ICU and treated
with high-flow nasal cannu...
Introduction with a clinical question A 50-year-old woman with no prior medical problems was admitted to Genius General Hospital with severe influenza pneumonia and acute kidney injury. She was transferred to the ICU and ...
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2015 ACLS Guidelines: What happened to VSE?
Introduction In 2008 and 2013, two prospective RCTs from Greece reported
benefits from the combination of vasopressin, steroids, and epinephrine (VSE)
for in-hospital cardiac arrest.   However,
other studies investigating the addition of vasopressin alone t...
Introduction In 2008 and 2013, two prospective RCTs from Greece reported benefits from the combination of vasopressin, steroids, and epinephrine (VSE) for in-hospital cardiac arrest. However, other studies investigating...
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The SPLIT trial: Internal vs. external validity
Introduction Resuscitation with large volumes of normal saline (NS)
causes hyperchloremic metabolic acidosis.   Some evidence suggests that hyperchloremic metabolic acidosis may impair
renal function, but the clinical relevance of this remains
unclear .   I...
Introduction Resuscitation with large volumes of normal saline (NS) causes hyperchloremic metabolic acidosis.  Some evidence suggests that hyperchloremic metabolic acidosis may impair renal function, but the clinical relev...
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Unconventional therapies for hyponatremia: Thinking outside the collecting duct
Case: An unusual ICU
referral Some years ago at Genius General
Hospital , the ICU was asked to accept a patient from the medicine ward with
cirrhosis, confusion, and hyponatremia (Na 125 mM) for hypertonic saline
therapy.   There was concern that the
patien...
Case: An unusual ICU referral Some years ago at Genius General Hospital, the ICU was asked to accept a patient from the medicine ward with cirrhosis, confusion, and hyponatremia (Na 125 mM) for hypertonic saline therapy.  ...
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Emergent treatment of hyponatremia or elevated ICP with bicarb ampules
Introductory case A young 70-kg man was transferred to the Genius General ICU for management of stupor.   He had
been diagnosed with aortic valve endocarditis due to heroin abuse two weeks
earlier, but left the hospital against medical advice.   Shortly aft...
Introductory case A young 70-kg man was transferred to the Genius General ICU for management of stupor.  He had been diagnosed with aortic valve endocarditis due to heroin abuse two weeks earlier, but left the hospital aga...
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Investigation Bias: The freakonomics of industry-sponsored trials
Background:  Publication bias Over the last several years, publication bias has received a considerable amount of
attention.    In its most blatant form,
this is when a drug company may sponsor several trials, but only publish
results from the trials which ...
Background: Publication bias Over the last several years, publication bias has received a considerable amount of attention. In its most blatant form, this is when a drug company may sponsor several trials, but only publ...
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Magnesium infusions for atrial fibrillation & torsade
Introduction:   Perpetual
controversy The use of magnesium for AF has been a controversial topic
for decades.   Magnesium is a normal
electrolyte, so it is cheap and has an excellent safety profile.   Ironically, this is also magnesium's Achilles
heel, beca...
Introduction: Perpetual controversy The use of magnesium for AF has been a controversial topic for decades. Magnesium is a normal electrolyte, so it is cheap and has an excellent safety profile. Ironically, this is also...
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Phenobarbital monotherapy for alcohol withdrawal: Simplicity and power
Case example   A middle-aged man was admitted to the ICU for refractory
alcohol withdrawal.   Prior to arriving in
the ICU he had been treated aggressively with an escalating regimen of IV
diazepam, without any improvement.   Upon
arrival in the ICU he had ...
Case example A middle-aged man was admitted to the ICU for refractory alcohol withdrawal. Prior to arriving in the ICU he had been treated aggressively with an escalating regimen of IV diazepam, without any improvement...
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Recognizing & treating paradoxical reactions from benzodiazepines & propofol
A perplexing case A young man with a history of seizures and alcoholism presented
with a generalized seizure.   His seizure
responded to lorazepam, but he was intubated for airway protection and was
transferred to the Genius General ICU.   He was also loade...
A perplexing case A young man with a history of seizures and alcoholism presented with a generalized seizure.  His seizure responded to lorazepam, but he was intubated for airway protection and was transferred to the Geniu...
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Taking control of severe hyponatremia with DDAVP
Introduction with a
case Imagine an elderly patient presenting with hypovolemic
hyponatremia (sodium of 115 mM) and moderate confusion.   How would you treat this patient? The typical approach might be a slow infusion of 3% sodium
chloride.   The presence o...
Introduction with a case Imagine an elderly patient presenting with hypovolemic hyponatremia (sodium of 115 mM) and moderate confusion.  How would you treat this patient? The typical approach might be a slow infusion of...
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10 Pearls from the Levitan Airway Course
Introduction Last week I attended Dr. Levitan's airway course in
Baltimore.    It was a teriffic course, which
I would recommend to anyone looking to improve their airway management
skills.    For those of you unable to
attend the course, here are some poin...
Introduction Last week I attended Dr. Levitan's airway course in Baltimore.   It was a teriffic course, which I would recommend to anyone looking to improve their airway management skills.   For those of you unable to atte...
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Burlington VT
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