what is your best pearl, or most useful reference, about interpreting a complete blood count with differential?
The blood count is one of the most commonly ordered tests in clinical medicine, but its subtleties are woefully overlooked. #EMIMCC
Nicardipine: great for htn emergency but, can see transient hypotension even w/ slow titration
-Key is to load + drip
-Start 5 mg/hr + titrate up 2.5 mg/hr q5 min
-When reach target BP, drop dose back to 5 mg/hr +
retitrate infusion until get to steady state
youtube.com/shorts/2F0-1...
#EMIMCC
Is oseltamivir killing ICU patients?
The p-value for these results is NOT significant by traditional Frequentist benchmarks (p>0.05).
But Bayesian statistics yield strongly positive results!
Where does the truth lie? See what you think.
Fresh blog: emcrit.org/pulmcrit/rem...
ALT: Inception: We Need To Go Deeper Meme with Leonardo DiCaprio
Fresh Blog: Is oseltamivir assassinating ICU patients?
☠️ The REMAP-CAP trial has concluded with >98% certainty that oseltamivir is killing patients.
☠️ This is an extraordinary claim that requires extraordinary evidence.
#1/2... #EMIMCC
I'll start- the neutrophil/lymphocyte ratio (NLR) substantially outperforms the WBC for detection of infection
Using WBC as an indicator of infection made sense 50 years ago
It's 2026, we have better lab instruments, & its time to move on from the WBC
more on NLR here: emcrit.org/pulmcrit/nlr/
Proposal: for complex patients (eg ICU) we should *always* get CBC w/ differential (not a plain CBC)
- Same amount of blood
- Run by the same machine (it usually CHECKS the differential & just dumps the data!)
- Trivial cost difference
- Can be helpful (eg Eos 2/2 drug, NLR)
#EMIMCC
my key advice on bupropion XR intoxication:
if you intubate a patient for seizures, place a gastric tube & start whole bowel irrigation immediately
don't debate, just do it
irrigation reduces ongoing drug absorption, minimizing deterioration
more emcrit.org/ibcc/bupropi...
Stop using IGRA to test for active pulmonary TB!
this keeps coming up, so I summarized my take-home messages on this (with a link to the BlueSky discussion)
in hospitals that lack deep experience with TB, I think the best heuristic is simply not to use an IGRA to look for active pulmonary TB
we’ve integrated the PREOXI trial into our practice so well that there’s an entire cabinet in our ICU dedicated to it 😁
this improves intubation success & safety. I’vd wanted to do this for a decade but the RCT provided EBM backing to push it forward
more here emcrit.org/pulmcrit/bsi/
Anand Swaminathan
everyone learns about TCA overdose in med school, but not bupropion XR overdose
time to level up
bupropion XR overdose is increasingly common & VERY dangerous
ongoing drug absorption creates a "toxin bomb" wherein patients look OK initially, but deteriorate later on... (#1/2) #EMIMCC
josh farkas 💊
josh farkas 💊
introduction The neutrophil/lymphocyte ratio (NLR) has been gaining increasing attention across many fields of medicine within the past five years.
TB gurus: is there a role for using interferon gamma release assays to diagnose active TB?
guidelines & textbooks *don’t* generally recommend this (eg https://www.tandfonline.com/doi/full/10.1080/24745332.2022.2035638#appendixes)
but in practice I see this done a *lot* 🧐
#IDsky #pulmsky
