Shai

nigel farage tweet: The Bank of England is replacing Winston Churchill with a picture of a beaver on our bank notes. This is the definition of woke.

i, for one, am delighted that we finally have a definition of “woke”

Glad you are physically ok Bob. Hope the mind is dealing with it well too.

Thinking of you and thanking the safety profile of your steed that you’re still with us. X

The move of “moderate” mainstream politics to rabidly anti-immigration focused started with May and Cameron in 2010, accelerating with Rudd and has maintained trajectory to where we are now.

New JAMA review attempts to equate pulmonary congestion with systemic congestion ("volume overload")

This is sloppy & often wrong

Pts w/ LV failure often have pulmonary congestion w/o systemic congestion

Pts w/ RV failure usually have systemic congestion w/ dry lungs

CVP isn't PCWP

#EMIMCC

Martha’s rule may have saved 400 lives so far in England, figures show Exclusive: System brought in after death of 13-year-old is helping ‘transform culture’ of NHS, says patient safety director

Martha’s Rule certainly improves communication between patients (their loved ones) & medical professionals.

Has it truly led to 400 lives saved?

This article makes a lot of assertions without clarity of outcomes.

“Martha’s Rule may have saved 400 lives so far in England, figures show.”

“The duty of candour is one of the fundamental standards below which care should never fall. It did with Laura" - This comment in a letter from the coroner to CQC has sparked a raft of new actions by regulators years after the family first raised concerns.

Scientific paper published in PubMed. Heading: Object personification in autism: This paper will be very sad if you don't read it. Authors: Rebekah C White et all. Autism, 2018 May. For those curious, here's the original paper: https://discovery.ucl.ac.uk/id/eprint/10053878/1/Personification%20in%20autism_final%20accepted.pdf

Nobel Prize For Titles. Right away.

Black alt is everything!

Black america made alternative culture and yet media erases us from goth, rock, grunge, and punk.

We established the hair and counterculture based in our resistance to fascism and racism

In a white mans world he created it all but in reality it was Black americans

We never signed up to use OUR judgement.

There blame lies.

The ESC 2019 risk-stratification system is imperfect, specifically it fails to parse out intermediate-risk patients who may benefit from tPA/embolectomy.

But this group of patients is currently undefinable due to inadequate evidence (so judgement is needed).

Blog: emcrit.org/pulmcrit/peg...

PERT activation worksheet 😁

trying to design a one-page sheet to collect info & guide the process

this is what I've got so far, please provide constructive feedback

#EMIMCC

The age adjusted rate is in the supplementary data.
Rising admissions rates in the older age groups - without increased incidence.

Link to the paper below;

bmjopen.bmj.com/content/bmjo...

I think Borthwick might be cooked. This is too talented a squad to be fighting to avoid the wooden spoon.

Interesting to consider that 45% of PEs have concurrent DVTs, and 30-50% of PEs should be homeable.

Yet data UK data suggests that more patients with PE are being admitted (and fewer DVTs are being admitted)

Is this better recognition of the sicker pt?
Or (my suspicion) less scope to manage risk?

😂😂

Agreed re ECG
It’s the next clot….

But they need to have some burden present. I.e sufficiently symptomatic, for the next clot to be BAD.

I will still talk about it and I will still screen for it when seeing a “sick” PE patient. If low borderline for tPA, it probably tips me into admitting to ICU, lining up and watching more closely.

So would I include it in @pulmcrit.bsky.social’s crib sheet?
Maybe. Prob not. It’s not as dangerous a CiT, but certainly has a theoretical risk.

The evidence is inconclusive.

In my practice, I am much more wary of the tachy/hypotensive/lactataemic pt who has a concurrent DVT proximal from the popliteal trifurcation.

But if small vol PE (low risk on 2019 ESC & therefore PESI) with a concurrent DVT - I would still send home with a safety net.

Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant DVT lacks clarity.

However the only SR&MA from 2016 I know of in Chest did.

journal.chestnet.org/article/S001...

But that’s what they are - anecdote.

The actual data on this is quite mixed re mortality.
Prevalence of concomitant DVT is approx 45%
More recent data states no impact on 30d death rates. But PE severity tends to be higher in this group.

Thanks Lars.

I teach often on PE to ED, acute med & ICU teams and always talk about the importance of acknowledging the next clot… cos that’s the one that’ll kill your patient. Whether it’s in transit in the RA/RV/IVC or prox deep vein.

I have a few anecdotes that I utilise to emphasise the point.

Re pay scale - does this not reflect all new starters?
One always begins at the lowest nodal point for their banding & increment at set years.

Do we know if there’s a disproportionate failure to increment?

I think we do know there is disparity in promotion & attainment. Esp in nursing/management.

23yrs… feels like 45mins.

I'm going to write a children's book called "My Child's School Uniform" where a child wears a school uniform and then sell the book to parents about two weeks before World Book Day.

Is 2003 really so long ago?

Huge congratulations Sethina.
So very impressed.

Downfall memes are phenomenal when done well.

This is top tier.

“It’s not what you look at that matters, it’s what you see”

#POCUS is a non-invasive tool, that allows us to see physiology in motion and track how our treatments transform it in real time.

#ER / #CriticalCare have lead the way, but how does it fit in nephrology?

#Nephmadness

4. Listen more, talk less

The devil (and the beauty) is in the details