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grepmeded's profile
GrepMed
GrepMed
GrepMed
@grepmeded

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GrepMed

@grepmeded

Image Based Medical Reference: Sharing crowd-sourced checklists, algorithms, decision aids, #PhysicalExam #POCUS, and more - by @GeraldMDMD + @k00bideh

Sacramento, CA
grepmed.com
Joined March 2018

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    1. Segun Olusanya‏ @iceman_ex 23 Apr 2019
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      Replying to @dr_supradip @fluidloading and

      This is an evidence free zone. Why not include tamiflu and add Vit c?

      1 reply 0 retweets 3 likes
    2. Dr Supradip Ghosh‏ @dr_supradip 23 Apr 2019
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      Replying to @iceman_ex @fluidloading and

      Have huge respect for @PaulMarik . But can’t say, I’m great believer of his cocktail. But may be in future with more evidence.

      1 reply 0 retweets 2 likes
    3. Jonny Wilkinson‏ @Wilkinsonjonny 23 Apr 2019
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      Replying to @dr_supradip @iceman_ex and

      I have to say...being the ‘naughty one’ here..just because you don’t have any evidence for something you see anecdotally works, doesn’t mean you should stop that practice if outcomes seem better. As long as there is no harm as a result....🤔

      2 replies 0 retweets 7 likes
    4. Dr Supradip Ghosh‏ @dr_supradip 23 Apr 2019
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      Replying to @Wilkinsonjonny @iceman_ex and

      You have a point. Especially if the treatment is not a very costly one and you have some biological plausibility to justify your treatment. I’m not sure about the biological plausibility of Marik Cocktail.🤔

      1 reply 0 retweets 4 likes
    5. Nitin Arora #WashYourHands‏ @aroradrn 23 Apr 2019
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      Replying to @dr_supradip @Wilkinsonjonny and

      Biological plausibility has been a big problem in the past, though! EGDT seemed to have physiological basis; as did Short Synacthen, Tight glucose, and Xigris Most important people lesson for me: Single centre enthusiast led trials need bigger confirmation studies

      2 replies 1 retweet 5 likes
    6. GrepMed‏ @grepmeded 24 Apr 2019
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      Replying to @aroradrn @dr_supradip and

      is EGDT the right comparison? it’s rapid adoption transformed usual care in sepsis...

      1 reply 0 retweets 0 likes
    7. Nitin Arora #WashYourHands‏ @aroradrn 24 Apr 2019
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      Replying to @grepmeded @dr_supradip and

      Changed its Cinderella status. But the magic bullet of EGDT was never replicated. Early recognition of sepsis & treatment is not the same as EGDT. IMO

      1 reply 1 retweet 6 likes
    8. GrepMed‏ @grepmeded 24 Apr 2019
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      Replying to @aroradrn @dr_supradip and

      right- EGDT worked for the wrong reasons but wasn’t it’s rapid, premature adoption the impetus for early recognition and treatment, and subsequently significant improvements in mortality? (before my time to be honest)

      1 reply 0 retweets 1 like
    9. Nitin Arora #WashYourHands‏ @aroradrn 24 Apr 2019
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      Replying to @grepmeded @dr_supradip and

      tight glucose control- because now we do try and keep glucose under better control than the 90s The key is that EDGT conclusions were never replicated. Between them these studies show that flawed studies and wrong interpretation sometimes helps people

      1 reply 0 retweets 3 likes
    10. Nitin Arora #WashYourHands‏ @aroradrn 24 Apr 2019
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      Replying to @aroradrn @grepmeded and

      In other words, EGDT did not work. But having people interested in sepsis treating patients did.

      1 reply 0 retweets 3 likes
      GrepMed‏ @grepmeded 24 Apr 2019
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      Replying to @aroradrn @dr_supradip and

      glucose control is a great comparison as a cheap, “harmless” intervention. But I wonder how many lives might have been lost waiting for validation studies on EGDT? IMO cheap, non invasive interventions with ? high upside should be given some benefit of the doubt.

      7:32 AM - 24 Apr 2019
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      • GeraldMD Thomas Dolven Nitin Arora #WashYourHands
      3 replies 0 retweets 3 likes
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        2. Dr Supradip Ghosh‏ @dr_supradip 24 Apr 2019
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          Replying to @grepmeded @aroradrn and

          Science evolves slowly and unfortunately cannot keep pace with our desire to achieve the desired outcome. Classical example is EGDT. Great trial. Taught us the need for early intervention. Unfortunately we jumped into a conclusion and tried to replicate every aspect of Rivers’.🤫

          2 replies 0 retweets 4 likes
        3. Dr Supradip Ghosh‏ @dr_supradip 24 Apr 2019
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          Replying to @dr_supradip @grepmeded and

          But slowly over a period of time, we have learned that ScvO2 may not be the best target for every patient or too much fluid is harmful. Probably it’s better to follow a middle path. I don’t think as of now harmlessness of VitC is proven beyond doubt neither is it’s efficacy🙏

          1 reply 0 retweets 4 likes
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        2. Nitin Arora #WashYourHands‏ @aroradrn 24 Apr 2019
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          Replying to @grepmeded @dr_supradip and

          Possibly... Liberal sprinkling of salt. And always remembering this is totally unproven.

          1 reply 0 retweets 2 likes
        3. Philippe Rola‏ @ThinkingCC 24 Apr 2019
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          Replying to @aroradrn @grepmeded and

          As is much of what we do in cc...

          1 reply 0 retweets 2 likes
        4. 2 more replies
        1. Dr Damien BARRAUD‏ @fluidloading 24 Apr 2019
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          Replying to @grepmeded @aroradrn and

          Harmless ? Are you sure ?

          0 replies 0 retweets 1 like
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