So I just finished listening to the second podcast of The Resuscitationists’ Awesome Guide to Everything (www.ragepodcast.com), and as advertised, it is totally awesome. It’s really cool to have the point of view of several bright acute care clinicians whose field of expertise obviously overlaps but have different perspective in terms of experience and setting.
In episode 2, they do a great review of the MOPETT trial and thrombolysis in PE in general, and really work at distilling clinical information from academic literature, which is ultimately what has to be done. The hashing out of the finer points by using specific clinical scenarios is really, really good.
I have personally applied the MOPETT half dose TPA twice with good success, both in young patients and after explaining the risks and benefits. As in full dose thrombolysis, the clinical improvements in minutes to hours of massive/submassive PEs are quite remarkable.
So much kudos and everyone interested enough to read this should most definitely be checking them out, I know I’ll be!
This is my approach to fluid resuscitation – sorry for the lack of precision which, to me, is actually key. It would be against the N=1 principle to give out a recipe…but here’s a way to think about it:
Sorry the last bit cut off – my iphone can only email an 8 minute audio clip! Which I wasn’t aware of until today. Anyway all that was lost at the end was “thanks for listening and I’d really like to hear comments and others’ practices!”
And here’s a disclaimer: I don’t think this is the be-all and end-all. My resuscitation is a work in progress, both in terms of new fluids coming up, and in terms of identifying subgroups or individuals who would benefit from a different approach, so I’m definitely eager to hear from anyone who does things differently – but physiologically!
Please see Dr. John Myburgh’s excellent review on fluid resus in NEJM sep 26th issue!
So here’s a short intro to what I’ll be calling the N=1 Podcasts. Why N=1? Because each patient we treat is just that, a single patient. Not a cumulated average result of a hundred or a thousand different people, and should be treated as such, meaning, know the good evidence that’s out there, be able to properly assess your patient and tailor your therapy appropriately.
Hope you like the concept, first real one should be up shortly!