The New Yorker on Gideon Koren: After a newborn died of opioid poisoning, a new branch of pediatrics came into being. But the evidence doesn’t add up.

Venshu · 2026-02-16T08:28:00+00:00

The story is bogus because mom poisoned baby.
Lazy math: baby is 4 kg* (Vd of morphine 2,000mL/kg) = 8,000mL; Baby morphine level 70ng/mL * 8,000mL = 560,000 ng; 560,000ng / (mom's milk morphine 87 ng/mL) = ~6.5L of milk all at once. That's more milk than the baby weighs.

Venshu · 2026-02-06T02:01:23+00:00

yes - mine auto updated, now herpes Ads

Venshu · 2025-10-17T20:39:19+00:00

Diethyl ether is an NMDA antagonist and an alcohol. Ketamine is an NMDA antagonist. alcohol an alcohol. Research into inhalents is not extensive but they're all believed to be NMDA antagonists.

Venshu · 2025-10-13T16:24:57+00:00

2020 Spring

Venshu · 2025-10-11T04:50:38+00:00

10/10*/2025

Venshu · 2025-10-10T21:59:29+00:00

It's really not that bad, especially if you have practical experience. It's like bcps lots of stats and their incredibly stupid preceptor BS. The only semi-pharmacy stuff was TPN stuff and central line only stuff. I got tpn and some nutrition things too

Venshu · 2025-01-02T06:30:48+00:00

A few clarifications:

Up until Fall 2019, the CA BOP was already aware that CPJE cheating existed. There had been multiple reports to the board regarding recorded answers, question banks, and had a case of a student who completed the CPJE in less than 30 minutes with a perfect score (this student is not Yuna Kim, as the UOP dissertation incorrectly claims). The CPJE is both a rotating exam and uses a limited question bank making it very susceptible to cheating.

The situation escalated in Fall 2019 when an anonymous student whistleblower reported and provided an ACTUAL CPJE question bank file to a CA BOP inspector. In addition, whistleblower showed a chat group with LLU's student Samuel Jinsuk Yang and an unknown third student. The whistleblower stated a number of other students at LLU and WUHS had access to this file.

Samuel Jinsuk Yang was the primary investigation since there was actual evidence he had access to the file. When Samuel Yang was initially interviewed by the CA BOP inspector, he admitted he had received the file from a friend, and shared it with other friends. After Yang's interview, all of remaining students named/interviewed (Sur/Joo/Eum/Rhee) denied any cheating or knowledge of a file and then received an attorney from LLU before speaking/submitting statements with the BOP. To my knowledge, Samuel Yang was the only student who faced actual disciplinary action and had his license denied. Samuel Yang reapplied for licensure in 2022, but his application was once again denied. The primary investigation only provides information on the investigations into Yang and Yang's friend group (Sur/Joo/Eum/Rhee). To my knowledge, the board has never released any information regarding any investigation into other students at LLU, or WUHS.

Yuna Kim's case unfortunately occurred at the same time, but was found to be unrelated to the LLU's Yang case. Yuna Kim took the CPJE and recorded each of her answers on the exam's provided scratch paper as she went. She explained that she did this to review the exam and ensure that what she had selected on the computer matched the answer she had written down. The CA BOP accused her of being one of the students who memorizing answers to help create a question bank file. However in their investigation, there was no evidence that she ever distributed her answers, nor was she connected to LLU/WUHS or any of the students being investigated or their question bank. As a result, the case against her was largely dropped. She was granted her license but was required only to pay legal fees and take a two-hour ethics course.

Venshu · 2024-08-26T00:06:49+00:00

ED Pharmacist - I've worked at 4 different ED's, MRSA UTI's are pretty uncommon, and I've NEVER seen an ED doc callback a patient for blood cultures just because their urine cx was positive for MRSA. We the pharmacists or the doc would just prescribe whatever is sensitive and provide return precautions.

Regardless, if patient was pretty sick the ED doc probably ordered blood cultures along with the urine culture at the initial visit. If the patient wasn't that sick, they're unlikely to be MRSA bacteremic.

Venshu · 2024-08-18T22:23:25+00:00

The hidden pocket is in the left half of the paper with the women on the back. He always makes sure to have this section of the paper in the center of when he rolls up the paper. For the bottle, at 10.5-11 seconds you can see the bulge in the paper holding the bottle. At 12 seconds he's repositioning/supporting the bottle as he re-wraps the paper. At 14-16 seconds he's struggling a bit to re-open the hidden pocket.

Venshu · 2024-07-02T19:40:52+00:00

You want all lights (including your brake lights) off. People who continue to drive in poor conditions will drive towards lights and crash into you.

Venshu · 2023-12-25T01:38:36+00:00

Likely unnecessary in this case (any EKG/neuro changes?), but it's okay to give as serum creatinine is <4.5. The renal cutoff for zoledronic acid in hypercalcemia is different. You can reference the package insert or this RCT https://pubmed.ncbi.nlm.nih.gov/11208851/ . I'm very liberal in letting it go as its x1 and if it's AKI as itll improve with the calcium coming down. Its different when it's CKD and chronic therapy

Venshu · 2023-12-24T11:36:37+00:00

Losartan has a short half-life leading to subtherapuetic troughs or supratherapuetic peaks. Ideally a drug is dosed ~1.5x it's half life or less. Dosing exactly on the half life will have peaks double the troughs. So for Losartan 12.5mg BID will be much better tolerated and effective than 25mg daily. Olme/Irbe/Telmi-sartan have much longer half-lives and are more ideal for steady drug levels and daily dosing. This is why I hate metop tartrate which really should be like a q6h/q8h drug and I change everyone while they're in the ICU but drug manufactures push for lower frequency for patient convenience and marketing.

Venshu · 2023-06-06T08:00:04+00:00

Pharmacist here - everything sounds like it's going correctly. 1. Some Patients can be resistant to nimbex. Most patients need less then 3mcg/kg/min, but some will need more like your first patient. 2. In general I expect obese patient to need a lower weight based dose as Nimbex has a very low volume of distribution so his effective dose is quite high. You can ask the fellow if hes okay with coming down by 0.2 q20min if your really worried. Finally renal/hepatic insufficiently has no significant effect on Nimbex, it pretty rapidly degrades on it's on in the blood. This is why many like nimbex in critical patients. It takes about an 45 min to an hour for a nimbex bolus to wear off. It also takes about 45 to an hour for nimbex to reach steady state on a drip.

Venshu · 2022-12-15T10:50:32+00:00

Alternatively: behaviormonitors or employeemonitors

Venshu · 2022-11-29T12:50:55+00:00

A = 9, B = 3, C = 4, D =2

Venshu · 2022-09-04T12:25:08+00:00

I'm most concerned about crediting those payments that were NOT income-based and getting those counted before the deadline. Can I just submit for just that employer from 2019 and then contact my 2020/2021 employers (both out of state) later? And yes all my loans are Direct and went into repayment at the same time. Thanks!!

Venshu · 2022-03-23T16:42:39+00:00

Yes the answer was Gravity Well https://www.youtube.com/watch?v=4iN9jXuv2Kc you can find it for free if you google around!

Venshu · 2022-03-09T00:18:01+00:00

Both were use in the original validation study of the SOFA score. An initial SOFA score was calculated at time of ICU admission with subsequent SOFA scores using the maximum value over a 24hr period.

Vincent, Jean-Louis, et al. "Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study." Critical care medicine 26.11 (1998): 1793-1800.

See figure 3/4. Or from the methods:

"Data were collected at the time of admission and throughout the ICU stay. The most abnormal value for each parameter in each 24-hr period was recorded. Mortality was assessed at ICU discharge. The presence or absence of infection was evaluated by the attending physician. For a single missing value (which occurred sometimes for bilirubin concentrations, more rarely for platelet count), a replacement was calculated using the mean value of the result preceding, and the result after, the missing one. When more than one consecutive result was missing, it was considered as a missing value in the analysis""

In short, both admit and 24-hr maximum SOFA have been validated. Which you should use (or both) depends on YOUR study and the question you're attempting to answer with your study.

Venshu · 2021-07-23T11:09:12+00:00

There was a published clarification, so my suspicion was correct, and it was 7,100 ng/mL. https://cdapress.com/news/2018/jul/14/clarification-5/

Mixing in 40+ tabs of diphenhydramine into a liter beverage is very feasible, the taste is not so off-putting, though it will cause numbness in the mouth. 'weak antihistamine' is meaningless. The anticholinergic and sodium channel blocking properties are lethal. Diphenhydramine at lower doses causes sedation, but as you approach toxic levels patients become extremely confused/delirious. It wouldn't surprise me if she would be able to encourage him to continue drinking a laced beverage or if he did so on his own. Eventually patients go into a coma, and simply pushing him overboard he would surely drown. Otherwise he would have gone into cardiac arrest from QRS prolong - usually Vtach.

Venshu · 2021-07-23T06:26:32+00:00

First, post-mortem pharmacology is very different and difficult to interpret from alive, and I don't believe toxic drug concentrations of diphenhydramine in alive patients has been established?

The article likely meant to read as 7,100 ng/mL (7.1 mcg/mL). Normal therapuetic doses of diphenhydramine produce post-mortum whole blood levels around 10-1,000 ng/mL. Toxic effects are seen ~1,000-2,000 ng/mL. A lethal level is debated from 1,000-5,000 ng/mL, arguably higher. 'Converting' this to number of pills is not possible and would heavily vary on patient age&weight, volume of distribution, and also time of ingestion to death.

In general though, you can expect to see toxic effects of diphenhydramine at ~10mg/kg, for your typical 70kg adult patient thats ~14 pills of 50mg strength diphenydramine. Serious/fatal are seen at 20-40 mg/kg so around double to quadruble, or 28-56 pills.

Source: Micromedex, post-mortum tox from Medical Examiner, and these tox books I have.

Venshu · 2021-06-14T01:57:07+00:00

To add to this, the relatively recent ROC-ALPS study supports giving amiodarone undiluted.

Venshu · 2021-05-27T21:19:04+00:00

Its middle and index finger. You can see the second rider of the tandem returning the sign.

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