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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...
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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 ...
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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...
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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...
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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...
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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 ...
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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...
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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...
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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...
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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...
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