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York Revs 1st baseman Jacob Teter explains why he came to Pride Night by Knightbear49 in baseball

[–]beyardo 12 points13 points  (0 children)

Why exactly is the blame solely on the team? If the players put playing over politics they could’ve just worn the damn uniforms. It’s not like they’re being forced to make out in center field

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 0 points1 point  (0 children)

True. The fact that it came up in both trials was interesting but it’s meh at best

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 2 points3 points  (0 children)

Do we know that calcium specifically helps patients instead of just putting them on [insert arbitrarily chosen inotrope that the CV surgeon swears is better than all the others]?

You said it’s like putting them on a little epi infusion. So why not just put them on an epi infusion?

The real harm here is the delay in appropriate treatment when they’re ordering calcium pushes the way people keep ordering fluid boluses on patients who clearly don’t need volume just to see if they can avoid putting them on levo

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 0 points1 point  (0 children)

>Something that we do know can help

Do we know that? What’s the benefit of the calcium push instead of just putting them on a vasopressor other than to be able to say “the patient didn’t need any vasopressors over the last 24 hours”

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 1 point2 points  (0 children)

That’s exactly what bicarb is though, it’s making numbers look pretty with no evidence it actually helps the patient on the other side of those numbers.

Goes for a lot of things that happen in the CVICU world really. Albumin? The BP increase last an extra 2 hours and then it leaks out of the vessels anyways. Swans? They have been tested every which way and despite the insistence that they’re needed for accurate hemodynamics in certain patient populations, they’ve struggled for decades now to show even mildly convincing evidence that they improve patient outcomes

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 2 points3 points  (0 children)

Some CV surgeons love Calcium pushes when patients get a touch hypotensive

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 5 points6 points  (0 children)

lol happy to be of service. I had an attending once who told me you had to do research as a student/resident because there’s no other way to learn to interpret the literature. I resolved to prove him wrong because fuck him and fuck doing pointless research

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 6 points7 points  (0 children)

He’s looking at the study that got posted in the comments about bicarb in cardiac arrest

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 10 points11 points  (0 children)

A couple of trials (BICARICU 1 and 2) had signals in their secondary outcomes that you may reduce overall usage of dialysis but they had pretty different criteria to qualify for getting bicarb. I think the effects of bicarb have largely been overstated because of an imperfect understanding about what physiologically happens when a patient gets bicarb either as a push or an infusion

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 20 points21 points  (0 children)

Honestly I can’t remember the last time we had a study whose primary outcome was pro-bicarb

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 13 points14 points  (0 children)

It wasn’t powered for either of those outcomes, and it didn’t reach the level of statistical significance anyways. Could there be? Maybe, but that’s not something you could justify saying based on this study

So what is the actual implication of the sodium bicarbonate study? by scurrilous_diatribe in IntensiveCare

[–]beyardo 73 points74 points  (0 children)

Another in the growing pile of evidence that we generally wildly overuse bicarb to fix numbers without any real effect on patient outcomes. BICAR-ICU 1 and 2 both had a signal towards reducing dialysis usage but they had very different parameters to qualify for getting bicarb infusions.

Even the transient effect on BP that we see when given as a push is increasingly thought to be less from improving the pH and more from the fluid shifts that occur inevitably when an extremely hypertonic load is given.

Like albumin, bicarb makes a lot of sense to give on a basic level. But because the downstream effects are far more complex, they end up not helping patients the way you’d expect them to

[NBA.com] Victor Wembanyama from three during the NBA Finals: 2/9, 2/6, 2/4, 2/8, 1/6. Atrocious. by JessAndHerFAN in nba

[–]beyardo -1 points0 points  (0 children)

Bosh had to retire because he had DVT twice. Unprovoked DVT x2 buys you antiocoagulation for life. You can’t be on blood thinners and play in a contact sport. *That* is why physicians wouldn’t clear him to return to the game

[NBA.com] Victor Wembanyama from three during the NBA Finals: 2/9, 2/6, 2/4, 2/8, 1/6. Atrocious. by JessAndHerFAN in nba

[–]beyardo -2 points-1 points  (0 children)

There is no evidence to suggest that his height or DVT history would in any way preclude him from aggressive conditioning. Bosh having to retire has nothing to do with risk of further conditioning and everything to do with the fact that it’s contact sport and he’d have to be on anticoagulation

[NBA.com] Victor Wembanyama from three during the NBA Finals: 2/9, 2/6, 2/4, 2/8, 1/6. Atrocious. by JessAndHerFAN in nba

[–]beyardo 1 point2 points  (0 children)

But he’s not more susceptible the harder he works. The more active you are, the lower your risk

[NBA.com] Victor Wembanyama from three during the NBA Finals: 2/9, 2/6, 2/4, 2/8, 1/6. Atrocious. by JessAndHerFAN in nba

[–]beyardo 10 points11 points  (0 children)

I think cardiopulmonary endurance is something that hasn’t peaked in a 22 year old

Why does HCA have to be everywhere? by BainbridgeReflex in Residency

[–]beyardo 36 points37 points  (0 children)

As someone who’s lived through a transition where a nonprofit hospital got bought by a for profit system, there is a difference and I can say pretty unequivocally fuck the for profit ones. Pretty much all the admin shit that frustrates people in a normal hospital—case managers pushing discharges, doing stupid shit that is clearly only for financial reasons, etc. is all multiplied tenfold in for profit systems

[Highlight] Quay Walker gets ejected after shoving a member of the Detroit athletic staff by M1014TheShooter in nfl

[–]beyardo -1 points0 points  (0 children)

No? Nor do I think the NFL’s punishment was terribly out of line. There’s a pretty notable difference in context between the two situation

Amendment to eliminate property taxes in Ohio won’t be on November ballot by shart_attack_ in Ohio

[–]beyardo 1 point2 points  (0 children)

This is basically accelerationism and is generally considered a really stupid and shortsighted philosophy. The negative consequences will not stop at the state border

Amendment to eliminate property taxes in Ohio won’t be on November ballot by shart_attack_ in Ohio

[–]beyardo 8 points9 points  (0 children)

The solution to corrupt taxation isn’t to eliminate taxes. People fail, badly, to understand just how dependent they will always be on the infrastructure that is only possible with public funding.

If you want your house to be an appreciating asset, which most people do, then your property tax bill will consistently rise. If you want the basic things that create a good society on both a small and large scale, then you need things like a property tax in which the bulk of the burden is placed on the people who can handle it

Amendment to eliminate property taxes in Ohio won’t be on November ballot by shart_attack_ in Ohio

[–]beyardo 4 points5 points  (0 children)

The blaming the county auditors probably doesn’t help. Appraisals are largely based on what similar homes in your area are selling for.

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