Patrick Bafuma PA-C

Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial - PubMed French Ministry of Social Affairs and Health.

And throw in a dose of ceftriaxone....

pubmed.ncbi.nlm.nih.gov/38262428/

Not sure what to take away from said trial, except *maaaaaybeeee* there's an signal of "dont miss sepsis induced cardiomyopathy" as evidenced by giving more inotropy/dobutamine in CRT arm.

I'm slightly concerned bicar2 is going to push a lot more bicarb drips to save a few HD days....

Teaching machines the language of biology: Scaling large language models for next-generation single-cell analysis

@albertvilella.bsky.social how does Google's offering affect 10x Genomics, it at all?

Possibly help by increased awareness/curiosity? Is there a chance it pulls business away eventually?

research.google/blog/teachin...

Effectiveness of Ampicillin-Sulbactam Versus Ceftriaxone for the Initial Treatment of Community-Acquired Pneumonia in Older Adults: A Target Trial Emulation Study - PubMed In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone.

Plus there's this ....

pubmed.ncbi.nlm.nih.gov/40134633/

Staph aureus bacteremia

Thoughts on nuc med studies for SAB? Thought there was supposed to be a multi center trial out of Europe due last year but not published yet....

Seems like it might be a "you pick up more, but doesn't seem to matter much/doesn't frequently change management" scenario?

Yep. Still, ICU patients that find it beneficial for pain control are the exception. Overwhelming majority of patients we've had on it more often find it deleterious than helpful. This study kind of confirms that bias.

Putting pts in a partial K hole is probably a suboptimal idea in the ICU. Tubes and lines in weird places + delirium+ drawing labs = whoa buddy.

Over last few years, have started to feel ketamine for pain probably a rescue tactic at best. Lots of better options.

If I can't block, precedex >>>> ketamine for pain control.

journals.lww.com/anesthesia-a...

#EMIMCC

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Way to go, San Francisco!! 👏👏

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my taste for ketamine has swayed over the last 5ish years. Precedex as part of multimodal in difficult to control situations anecdotally works more often plus less trippy. Especially if combined with regional anesthesia.

Survival to DC. 1/21 vs 1/11. 🫣🤷‍♂️🫣

Odds that it will travel stateside next summer?

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This is so wild and I wonder what the back story is.

Prasad is out at FDA

Agree 99% - but it's not just cruelty. Some portion of it is broken window fallacy amplified by underlying biases/prejudices.

We see people missing the big picture all the time in healthcare. Locums / travel assignments exist mostly because we don't want to take care of our own.

Summer time = powered up ground type
Winter time = powered up max power water types

... 👀👀👀🤯🤯🤯

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Shift one as an attending intensivist in the books. Thanks for the encouragement y'all. Shout out to @pbafuma.bsky.social for putting up with the new shift jitters and orienting.

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Accredited is probably an overstatement. Just training. Would reach out to HM, EM, or ICU colleagues.

Def do not need "certification" from merit badge online courses. But CME from hands on workshops totally reasonable.

Omg yes.

Up next:
-PO = (or better) than IV in the ICU
-Push dose meds (CTX)
-Continuous infusions(?)- seemingly good at reducing amount of drug given, but most recent bling suggests probs not necessary
-Actual trial of early vaso or early SDS or early MB for septic shock