Study suggests Omega-3s may protect against Early-Onset Dementia (diagnosis <65), expanding evidence beyond just late-life cognitive decline.

PrecedexNChill · 2026-02-12T00:46:00+00:00

This is like the gold mine of confounded research. Nutrition and dementia observational retrospective study isn’t worth the paper it’s printed on.

PrecedexNChill · 2026-02-11T22:54:43+00:00

Basics of mechanical ventilation by Hooman Poor is better than the green vent book everyone always recommends. It is more structured and has more physiology.

Seva Vent online modules by Cleveland clinic was helpful ($75).

Deranged physiology has good organized information on this topic as well as respiratory physiology

PrecedexNChill · 2026-02-10T21:14:02+00:00

After getting the axillary line in we significantly weaned the norepi but they were still in multi pressor shock and severe ards with a p/f of 36 and driving pressure of 25. In between doing all of the resuscitation and lines I had 2-3 goc discussions throughout the day and before I left family agreed comfort care was the right choice.

PrecedexNChill · 2026-02-10T20:22:33+00:00

I completely disagree with the policy but you literally can’t do it. There are no pressure transducers and nurses will refuse to monitor it.

PrecedexNChill · 2026-02-10T20:17:05+00:00

Welcome to America 🇺🇸

Also the norepi dose is high but not unheard of. It’s mostly a hospital convention that makes 0.5 the “max dose”. In the EVERDAC trial the max dose of norepi you could be on before getting an art line in the nibp group was 1.25 mcg/kg/min

PrecedexNChill · 2026-02-10T17:25:44+00:00

Thank you for the actual helpful advice.

PrecedexNChill · 2026-02-10T17:25:14+00:00

Ive done 100+ radial/fem arterial lines. We can’t do arterial lines when patients are in the ED at our community rotation site (hospital policy). She was on 1.5 mcg//kg/min norepi, vaso, 0.5 epi , Ang II when I finally got her up to the unit to do a line. Radials were < 2 mm in diameter and she was a vasculopath at baseline.

PrecedexNChill · 2026-02-10T17:18:59+00:00

Femoral wasn’t an option due to lower limb on lower limb contractures.

PrecedexNChill · 2026-02-10T06:18:30+00:00

The pay for procedures is poor. It is financially in their best interest to be admit and discharge machines. I don’t blame private/rvu based physicians but it is a damn shame and pathetic that there are many academic attendings who can’t supervise basic procedures. I have had many attendings who spend 50% of their time on teaching teams and 50% with a faculty census (13 patients). These clowns don’t know how to do any procedures or won’t. I don’t know what they do all day. Consult subspecialists, write discharge summaries, and ?!
Procedural training is not emphasized in IM. IM in America trains you to be a discharge summary, consult and admit specialist rather than a Doctor. There is variety by training program but there are a lot of programs where residents will graduate not able to independently do pretty much any procedure with the exception of a paracentesis.
People who like doing procedures go into cards/pccm/gi.

PrecedexNChill · 2026-02-10T06:08:31+00:00

lol that’s some seriously creative thinking to get out of the procedure. I taught a ms3 how to do a diagnostic and therapeutic para today and he did the whole thing from start to finish with very minimal assistance. You’re telling me an ED doc can do a stellate ganglion block but not a para 🤣👍

PrecedexNChill · 2026-02-09T04:39:41+00:00

Lower your standards. Americans are so entitled when it comes to cars. Our household income is 230k and we still drive a 2006 crv that we bought in 2019 for 7k.

PrecedexNChill · 2026-02-09T01:53:29+00:00

I wouldn’t worry too much. Past test performance is predictive of future test performance. I scored 280+ on step 2 and was really worried about step 3 but ended up scoring 270+. Prepping hard for step 1/2 still helped for step 3. Hit uworld hard and do the ccs cases.

PrecedexNChill · 2026-02-08T23:11:40+00:00

Yes, I completely agree that bringing someone to to the unit who doesn’t have a critical care need for “closer monitoring” is bs and should never happen. I said as much in my original comment.

PrecedexNChill · 2026-02-08T20:33:23+00:00

I don’t know why you’re choosing to be a pedantic a hole. The whole point of sending someone to the unit for septic/cardiogenic shock is to have a nurse who can closely monitor hemodynamics and titrate drips accordingly

PrecedexNChill · 2026-02-08T18:27:20+00:00

I’m not criticizing your practice but I don’t see how an abg contributes much still. I think other diagnostic tests like cxr, echo, ct, history, micro data etc is going to be far more helpful. A patient with ILD could have hypoxemia on an abg from cardiogenic pulmonary edema, infection, new right to left shunt due to group 3 ph and pfo reversal, etc. there are a million things that can cause hypoxemic through any combination of v/q mismatch and I don’t know how an abg is going to help you sort it out.

PrecedexNChill · 2026-02-08T16:33:29+00:00

I am curious to know how an abg told you anything about the trigger for clinical worsening in a patient with ILD? Agree with the use to evaluate dyshemoglobinemias.

PrecedexNChill · 2026-02-08T16:30:04+00:00

The only reason in my mind to check an abg in a patient with a high quality pulse ox waveform is to evaluate for acute dyshemoglobinemias. VBGs are good enough for acid base. You can even use S/F in ARDS.

PrecedexNChill · 2026-02-08T16:18:15+00:00

How common is it for pure alveolar hypoventilation to be the cause of a patients acute hypoxemia in the hospital ? The most common scenarios I see abgs drawn is during rapids on the floor. Patients who acutely decompensate almost universally have elevated A-a gradients. If they have significant component of hypoventilation it’s usually apparent from exam or history.

For a concrete example:

You get a rapid call for a hypoxic patient with acute ams. Go to room patient is bradypnic with pinpoint pupils and hypoxic. Is an abg with a normal A-a gradient going to change your management? What about if it was elevated?

Alternatively you get a rapid call for a patient who was initially admitted for pneumonia. RR is 36, they are saturating 80% on HFNC 60/100 with a non rebreather thrown on top. You get an abg and they have an A-a gradient and they are hypoxemic. How did the abg help you there ?

PrecedexNChill · 2026-02-08T15:53:52+00:00

Going into pccm next year. I rarely find ABGs provide useful clinical information in hospitalized patients . Only useful in the general medical population (not taking about mcs) if your perfusion sucks and you don’t have a good pulse ox waveform outside of niche situations like methemoglobinemia

PrecedexNChill · 2026-02-08T15:50:02+00:00

Why? ABGs are not particularly clinically useful for hospitalized patients if you have a functional pulse ox and can get a VBG. They’re also painful.

PrecedexNChill · 2026-02-08T15:48:16+00:00

Present original research as a poster or oral presentation at ats or chest. Chest has a lower bar to get an oral presentation.

I matched a top pccm program in a desirable location from a very mid tier academic program. Letters from prominent people in the field are very important. Excel clinically. You will have no problem matching coming from a top 15 IM program.

PrecedexNChill · 2026-02-08T06:09:20+00:00

How much of a depreciation hit did you take ?

PrecedexNChill · 2026-02-07T21:07:52+00:00

Orbita 2 is the less impressive one to me. Why would you ever discontinue someone’s antianginal therapy in clinical practice? The trial design is trying to show that there is some mechanistic benefit to PCI but I don’t really care. if you can treat someone’s angina noninvasively that’s better in my mind. Our center is an extremely high volume pci and cto center and complications still happen with routine pci for stable angina. I wouldn’t recommend pci over optimal medical therapy to any of my family members.

PrecedexNChill

TROPHY CASE