Dr Maureen Bolon talking about COVID. She remarked we used to call it the "novel coronavirus" - I forgot about that. In all seriousness, we asked her to talk about covid thinking it would be over by now. #MHM20@midwesthospmed
Why process for research in US is flawed, compared to UK/RECOVERY trial:
*UK pushed enrollment of all pts; we treat pts outside of trials in fragmented system
*EUA discourages trial enrollment
*Trials have inequitable enrollment
*Data collection in US is cumbersome and elaborate
I'm tired of admitting patients who got/spread #COVID19 at indoor gyms, some even masked. All didn't realize the risk. Dr Bolon shared this nice summary of approx risk for lay folks: bmj.com/content/370/bm…
Nice graph about transmission and why so infectious prior to symptoms. Doesn't address the asymptomatic spreaders who are difficult to study. acpjournals.org/doi/10.7326/M2…
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Tried to channel my inner @tony_breu when presenting 3 hospitalist controversies yesterday:
- Normal saline vs Lactated Ringer's
- Risk of contrast-associated nephropathy?
- Routine K+ supplementation
NS vs Balanced IVF (e.g. usu LR as cheaper):
FYI LR has lactate, not lactic acid. quickly metabolized by liver to HCO3. caveat - cirrhosis pts can't metabolize as effectively so measured serum lactate can ⬆️(not harmful, not lactic acid). Can use D5W+3ampNaHCO3 if want buffer./2
NS vs LR: the SALT-ED and SMART ICU trials:
- ⬇️rate of major adverse kidney events (persistent renal dysfxn, new dialysis, death) with LR/plasmalyte. NNT around 100 for both floor and ICU pts
- Trend towards ⬇️ inpatient mortality in ICU with LR
- avoid LR in TBI 3/