Observational study of n=786 #COVID pt who received treatment dose #anticoagulation (AC) vs n=1987 who did not. AC associated w/ decreased mortality, particularly in intubated patients (29.1% vs 62.7%).
Before getting too excited about this *observational* study remember two key points: 1. Mount Sinai made therapeutic AC their standard of care for ICU pt w/ COVID. Therefore among intubated pt comparing AC vs not is really just comparing AC to people where AC was contraindicated.
2. As @DrToddLee points out, this is an example of immortal time bias. A median of 2 days (range 0-5) elapsed b/w admit and beginning AC & much mortality occurs in the first 2 ICU days; thus early mortality is disproportionately counted in non-AC group ➡️bit.ly/3bbAa4N
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Damn. Under Trump the White House Medical Unit was a pill-mill. Thousands of ambien & provigil per month.
Worse, for a clinic that doesn’t typically do procedures w/ moderate sedation they sure are they ordering prodigious quantities of morphine, fentanyl, versed, & ketamine…?
Honestly, this reminds me of Norman Ohler’s Blitzed.
The AG report was largely concerned with the enormous cost of prescribing these non-genetic meds.
It’s worth pointing out that dispensing prescription meds without documentation is malpractice. In the case of controlled substances it’s also likely a crime.
The long awaited #COVIDOUT RCT is now in @TheLancet:
- high risk adults randomized to either metformin (MET), ivermectin (IVM), fluvoxamine (FLV) or placebo.
- MET reduced the risk of long COVID (6.3% vs 10.4%; NNT = 24)
- no benefit with IVM or FLV
Pulmonary teaching case: you are called to the bedside of a 60yo man who was admitted for pneumonia a week ago. You were called because “he coughed and now his chest is PULSATING!”
This is what you see at the site of a previously removed chest drain:
EN is a rare complication of an infected pleural effusion where purulent fluid “escapes” the pleura and erodes into the chest wall, causing an extrapleural fluid collection that communicates with the pleural space.
Because Empyema necessitans communicates with the pleural space, fluid can move back & forth with respiration, as seen here:
With inspiration, negative intra-thoracic pressure pulls the fluid into the chest. With expiration, positive intra-thoracic pressure pushes fluid out. 3/ twitter.com/i/web/status/1…