Allan Joseph

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Tremendously insightful. (Coincidentally, another peds-adult difference I'd love to explore...a HUGE portion of inpatient/ICU resources are spent on a small fraction of kids with medical complexity/tech dependence, but they are also unlikely to die. So there may be more persistence.)

As usual I recommend @emilymoin.com's ongoing and insightful thread on this RCT

I also bet that SICUs/transplant ICUs/trauma ICUs have better outcomes and the PICU is basically one giant mixed unit (though in large hospitals the congenital cardiac ICU is separate)

Ah my (old, heuristic-y) number was 30-50% mortality but those are probably more like tertiary/quaternary MICUs. (I think the general PICU population is like 2% on average but some of that is denominator inflation by admitting kids to PICUs whose equivalents never would have been in MICUs)

100% agree conceptually. The snarky (but correct) answer is "it depends on which rivets and why they crash!" Which is also true for our heterogeneous ICU patients. I also wonder about second-order effects. If we put fewer A-lines in...does our capacity to insert/maintain them worsen over time?

If you want to compare/contrast with the Peds ICU, let's chat. On the one hand, our mortality rate is an order of magnitude lower (so less has to go "right" to survive since 95% of patients do) but on the other my gut instinct is that individual interventions may have higher marginal benefit.

I actually emailed Joe when I published that 8-state version and included the screenshot. Absolute legend. #IYKYK

She's not kidding - here's a screenshot of notes I took in a class in 2016, in all likelihood followed by a text to Adrianna.

Super cool work which could unlock a whole new era of pediatric acute care research.

Oh the coffee at Constellation rules.

The @criticalcarereviews.com newsletter is a game-changer.

Some of my newest work - amidst everything going on, we're still trying to deliver excellent care to really sick children. But the system is under a lot of strain:

Maybe analogous: in '16 the Neonatal Resuscitation guidelines stopped routine intubation/suction for meconium. Delivery room intubations dropped a ton, and what was once a resident job became a fellow job...and I'd bet effective BVM training got worse too.

publications.aap.org/hospitalpedi...

One was a halfback pass, right? Because I think the stat would get more play if it was 5 straight INTs by the QB

The U.S. Open women’s final and the art of the Grand Slam runner-up speech Sabalenka and Anisimova met in the U.S. Open final. Earlier this year, they gave losing speeches that showed how difficult the art can be.

The athletic just did an article on this phenomenon!

www.nytimes.com/athletic/660...

Let me know if you want to think about peds inpatient/specialty care in this project

Very different population but this is something the neo and peds groups have tried to assess, and I'm sure someone will do after Oxy-PICU too. Two examples:

www.nejm.org/doi/full/10....

jamanetwork.com/journals/jam...

Our institution uses it as a very late pressor: journals.lww.com/ccejournal/f...

We try to stratify by direct renin levels if possible too

Thanks!

You have a citation re ketamine direct effects handy so I can share with my fellows?

Is there a real advantage to ketamine over parenteral beta agonists? Does ketamine have direct bronchodilation effects beyond catecholamine release?

Yes! Next time our protocol comes up for review I will push to add it but for now if I am on when such a patient is admitted I typically will order it

RFK Jr talking about the need for doctors to know how to treat measles for those who are unvaccinated.

“Only very sick kids should die from measles.”

No. They shouldn’t. That was the point of the vaccine. We eradicated the virus so children didn’t die.

Sick & disabled kids are not expendable!

Dye is a USC grad and member of the Pride of Troy, at that

Surviving Sepsis USA now recommends fluid boluses of 2.2 fl oz per lb

I know of (nameless) units that require the nurse to place the primary dressing instead of the proceduralist, in the name of CLABSI prevention. I don't know the data in preventing CLABSI but I bet the rate of "immediately re-dressed lines" plummeted.

<em>Health Services Research</em> | AcademyHealth & HRET Journal | Wiley Online Library Objective To assess the prevalence of patient administrative tasks and whether they are associated with delayed and/or foregone care. Data Source March 2019 Health Reform Monitoring Survey. Stud...

I study patient administrative burden. Here is a thread of studies/articles I share often and/or have been suggesting for the newly interested.

My first foray, with Austin Frakt. TL;DR ~1/4 people reported delayed/foregone care due to admin in past 12 mos. onlinelibrary.wiley.com/doi/full/10....

Giving a talk next month on the effective use of images/visualizations to communicate data. Target audience is clinical fellows.

Looking for examples of your favorite scientific figures/graphs/images! Please share and amplify! #PICUSky

How would you rank Williams, Estime, Adams, and Love? Even harder - where do those guys rank in all time ND RB rankings?

Honestly thought you tweeted this after the pick