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James @lordofthelungs.bsky.social · Jan 4

I pretend I'm not surprised when it works out like that.

James @lordofthelungs.bsky.social · Dec 22

I hear you. I hobble around until I get my orthotic indoor sandals on so my flat feet and plantar fasciitis don't keep me from packing lunches every morning.

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James @lordofthelungs.bsky.social · Dec 22

Super interesting paper and study. Did we need the placebo group? Would pre-post have been enough? Just wondering since I would feel bad about keeping my IPF patient off of nintedanib for three months.

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James @lordofthelungs.bsky.social · Dec 19

I love changing to odd numbers and seeing how long until the RT can't resist the urge to change back to evens

James @lordofthelungs.bsky.social · Dec 19

Great story!

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James @lordofthelungs.bsky.social · Dec 16

ashpublications.org/bloodadvance...

this is the study about eliquis and APS

Apixaban compared with warfarin to prevent thrombosis in thrombotic antiphospholipid syndrome: a randomized trial

Key Points. The primary outcome, stroke, occurred in 6 of 23 patients randomized to apixaban compared with 0 of 25 patients randomized to warfarin.This stu

ashpublications.org

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James @lordofthelungs.bsky.social · Dec 16

I would think that PRVC is more problematic if used in a non-invasive setting. The awake patient with leaking around the mask could throw off the algorithm and result in too much variation in volume wouldn't it?

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James @lordofthelungs.bsky.social · Dec 16

This comes up in pulm clinic as part of the work up in dyspnea consults as well, and I still don't know if non anemic iron deficiency can be a cause for dyspnea. I think it probably can, but I'm reminded that I don't understand the human body on a daily basis. It seems impossible to study

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James @lordofthelungs.bsky.social · Dec 16

I've never seen a noninvasive vent that can do PRVC. Do you know what device you have at your place?

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Reposted by James

Kai Kupferschmidt @kakape.bsky.social · Dec 14

Sadly, it’s a good time to once again share this amazing infographic that we ran at @science.org more than 7 years ago
🧪 #IDsky
www.science.org/content/arti...

Here's the visual proof of why vaccines do more good than harm

See year by year how vaccines beat back nine dangerous infectious diseases

www.science.org

230 3.7K 10K

James @lordofthelungs.bsky.social · Dec 16

I feel like you and I would bore everyone on rounds. For just hypoxia, there's no role for inhaled vasodilators for me. either overcome with the vent or they go on ecmo.

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James @lordofthelungs.bsky.social · Dec 16

I'd also add that I'm not sold on a benefit from matching intrinsic peep. Doesn't seem to help. You also risk increasing end expiratory volume, which will worsen hyperinflation.

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James @lordofthelungs.bsky.social · Dec 16

I'm a pulmonologist, and you did an amazing job here. To look like a boss when bipap is failing, just say change to AVAPS and walk away.

here.to

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James @lordofthelungs.bsky.social · Dec 11

That's my kind of hobby

James @lordofthelungs.bsky.social · Dec 11

That's awesome. I was thinking of doing that with this little dwarf pomegranate I have, but it looks like an intense hobby

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James @lordofthelungs.bsky.social · Dec 11

CT progression of a patient with GPA. Discussed in ILD conference that centrilobular nodules aren't just bronchiolitis. Can sometimes be early vasculitis. This patient needed ecmo,steroids, cytoxan,PLEX, ivig 2g/kg. #pccmsky #emimccm #ctchest #ecmo #ILD

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James @lordofthelungs.bsky.social · Dec 4

Would be interesting to see a similar study on patients who have had pericardiotomy

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James @lordofthelungs.bsky.social · Dec 3

South Korean won falls sharply after president declares martial law

Democracy is more fragile than we like to think

James @lordofthelungs.bsky.social · Dec 1

That's what I was taught as a reason to push for rhythm control in PAH patients in Afib. Also explains why these patients can crash so quickly when they flip into a fib and the dangers of inotropes. This is more pulmonary hypertension than critical care, but I think the concept remains.

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James @lordofthelungs.bsky.social · Dec 1

I have a lot of veterans in pulm clinic. They don't get nearly enough benefits. This article is garbage

James @lordofthelungs.bsky.social · Dec 1

So agreed. Multicenter randomized control trial looks like it's in the works with our institutions. I'll get the protocol drafted and send it to you both.
First obstacle will just be to get people to care about the poor right ventricle

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James @lordofthelungs.bsky.social · Dec 1

Totally reasonable and I recognize that some folks will look at you cross eyed when ordering treprostinil. I think the key is having an objective way to measure if there was an improvement. If not, do something different.

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James @lordofthelungs.bsky.social · Dec 1

A stunned RV with normal pulmonary vascular compliance maybe. But not enough after load reduction to help when after load is the main problem.
I often cite this paper to highlight the dangers of Afib in RV failure. They're much more reliant on atrial kick. pubmed.ncbi.nlm.nih.gov/27683609/

Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension - PubMed

Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each c...

pubmed.ncbi.nlm.nih.gov

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James @lordofthelungs.bsky.social · Dec 1

I know a lot of people like milrinone in RV failure, but it doesn't work when the PVR is high. And the risk of arrhythmia is particularly dangerous with a weak RV

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James @lordofthelungs.bsky.social · Dec 1

I've given up on inhaled because I've never seen objective evidence of improvement like this when ARDS is this bad. I think there isn't enough ventilation

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