@adamdavidthomas

Emerg Doc / Intensivist. FOAMite. Podcast host for @iBookCC. Passionate about medical education & innovation

 Victoria, British Columbia
emcrit.org/ibcc/toc/
Joined January 2014
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And with that, @iBookCC just posted our 100th episode. Thanks for everyone's continued support! @PulmCrit
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2 RCTs testing IV vs IO vascular access in OHCA patients just published in the @NEJM and concomitantly presented at #RESUS24 @ERC_resus ➡️ No difference in 30d survival in both trials ➡️ Higher rate of ROSC with IV access in the #PARAMEDIC3 trial 🇬🇧 nejm.org/doi/full/10.1056/NE… 🇩🇰 nejm.org/doi/full/10.1056/NE… Congratulations to the authors for randomizing 6082 + 1506 patients to answer this important question!
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🚨 🏥 Please Retweet! Early enteral #nutrition (EN) w/in 3 d of ICU admit/intubation improves outcomes! ⬇️ Hospital MORTALITY ⬆️ D/C to Home ⬇️ ICU & Hosp LOS ⬇️ Vent Days ⬇️ Costs 🙋‍♂️Data from >27800 pts in real world practice 🔗 sciencedirect.com/science/ar… #ICUNutrition #FOAMcc @drshahrul80 @ICUnutrition
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Hot Take on PROPHY-VAP trial: 🔥Prophylactic 2g ceftriaxone among patients intubated for airway protection reduced pneumonia & ICU/hospital length of stay 🔥Prophylaxis *reduced* total antibiotic exposure 🔥Consistent w/ SuDDICU & ANTHARTIC trials Blog emcrit.org/pulmcrit/prophy-v… – at Burlington, VT
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Single-dose cefreiaxone to prevent VAP in ventilated acute brain injury patients Multicenter RCT with 345 pts🇫🇷 Compared to placebo, CTRX reduced VAP (14% vs 32%; HR 0·60 [0·38–0·95], p=0·03) thelancet.com/journals/lanre… @SCCM @KhannaAshishCCM @SCCMPresident #SCCM2024
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Adam Thomas retweeted
Elliot Tapper@ebtapper20 Aug 2018
The liver is awesome. Yet its vocabulary is ... limited. We can all tell when it is upset - high ALT, AST. But that could mean anything! So what's your specific patient's specific reason for high ALT?
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Adam Thomas retweeted
Elliot Tapper@ebtapper1 Jan 2024
True story There have been 15 trials of tooth brushing in the ICU and those trials have demonstrated fewer pneumonias and icu deaths In @JAMAInternalMed jamanetwork.com/journals/jam…
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Great #AHA23 so far: @AHA_Research 🥸8 Trials: 8 take aways below Read the read👇👇 1/ATRESIA: Patients with subclinical atrial fibrillation can benefit from apixaban to reduce the risk of stroke and systemic thromboembolism.
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New IDSA/SCCM guidelines on evaluation of new fever in ICU! 🤒 bladder/esophageal > rectal > oral > axillary/ear 🤒CRP and/or procal rec for patients with low/intermediate risk of infection😳 🤒consider test for COVID, resp viruses Fresh blogitorial: emcrit.org/pulmcrit/idsa-fev…
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STRATUS Trial published @JAMA_current 🩸Cluster trial 25 ICUs >27,000 patients 🩸Switch to “small-volume” tubes that⬇️blood drawn for lab tests may⬇️RBC transfusion↔️effect on testing 🩸Available, cost-neutral, compatible with analyzers – will you switch? jamanetwork.com/journals/jam…
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fresh blog: why the new brain death guidelines are unacceptable 🧠guidelines rec urine tox screen & time-based clearance of intoxicants, *ignoring* toxicology guidelines & toxicologists 🧠arbitrary ranges are required for labs (iCal must be 1 -1.3 mM😳) emcrit.org/pulmcrit/bdguidel…
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Adam Thomas retweeted
Karim Brohi@karimbrohi13 Oct 2023
OK here's a run down of why @CRYOSTAT_2 trial results will mark a turning point in the treatment of trauma-induced coagulopathy (TIC) Paper in @JAMA_current: jamanetwork.com/journals/jam… and some additional resources on our @CommsC4TS web pages: c4ts.qmul.ac.uk/research-pro… Firstly...
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Thanks to @accpchest for the opportunity to present high risk #PE data from #FLAME 🔥 at #CHEST2023! (Finally have a good reason to use that emoji!) FT pts w significant decreased primary outcome and in-hospital mortality (1/3) @RosovskyRachel @roblookstein
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Adam Thomas retweeted
Anton Helman@EMCases19 Sep 2023
Very excited to have the voice and brains behind IBCC podcast and Crackcast, @adamdavidthomas co-instruct this year's Podcast CAMP Nov 30th, Dec 7th, Dec 14th. Plus keynote speaker @srrezaie of REBELCast Details @ podcastcamp.org/
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in case you use an RSS feed: the new IBCC chapters will be going up on a *separate* IBCC RSS feed. to subscribe, click the link shown below & copy the text that shows up into your RSS reader. and if you've achieved this peak level of nerdiness, I honestly salute you 🫡
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The Lancet
@TheLancet28 Jun 2023
#Opioid pain relievers do not reduce acute lower back and neck pain, new study suggests: hubs.li/Q01W2WC90
Longitudinal plot of mean pain severity score. Datapoints show mean scores at each timepoint, and the shaded areas show 95% CIs. Estimates are raw values (not modelled).

ALT Longitudinal plot of mean pain severity score. Datapoints show mean scores at each timepoint, and the shaded areas show 95% CIs. Estimates are raw values (not modelled).

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Have I got this right? #CCR23 #PedsICU @CritCareReviews #PATCH @OxyPicu #AIDICU #MERCY #CLOVERS #CRYOSTAT2trial #PROCOAG #DEVICE @remap_cap #TAMEtrial @UKREBOATrial #Trauma #CriticalCareTrials #EmergencyMedicine
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Adam Thomas retweeted
NEJM
@NEJM14 Jun 2023
Late breaking at #CCR23: In the PATCH-Trauma trial involving adults with major trauma, treatment with tranexamic acid did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. nej.md/43zNuMj
Levels on the Glasgow Outcome Scale–Extended (GOS-E) at 6 Months. The GOS-E ranges from 1 to 8, with higher levels indicating better outcomes. The percentages represent the percentage of patients with each level. No patients in the tranexamic acid group had a GOS-E level of 2. The dotted line indicates the demarcation between death or survival with an unfavorable functional outcome (GOS-E levels of 1 to 4) and survival with a favorable functional outcome (GOS-E levels of 5 to 8). Results are shown without imputation; the results of an analysis that used imputation are provided in Figure S3 in the Supplementary Appendix. Percentages may not total 100 because of rounding.

ALT Levels on the Glasgow Outcome Scale–Extended (GOS-E) at 6 Months. The GOS-E ranges from 1 to 8, with higher levels indicating better outcomes. The percentages represent the percentage of patients with each level. No patients in the tranexamic acid group had a GOS-E level of 2. The dotted line indicates the demarcation between death or survival with an unfavorable functional outcome (GOS-E levels of 1 to 4) and survival with a favorable functional outcome (GOS-E levels of 5 to 8). Results are shown without imputation; the results of an analysis that used imputation are provided in Figure S3 in the Supplementary Appendix. Percentages may not total 100 because of rounding.

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Adam Thomas retweeted
Paul Young@DogICUma14 Jun 2023
The @PATCHTrial, led by @RussellGruen, a study of pre-hospital TXA for severe trauma in adults at high risk of acute traumatic coagulopathy treated in advanced trauma systems, has been published today in @NEJM. #CCR23 Here’s a summary of what we did... nejm.org/doi/full/10.1056/NE…

Prehospital Tranexamic Acid for Severe Trauma | NEJM

Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulop...

nejm.org
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90 pts enrolled (terminated after 2nd interim analysis) Median Injury Severity Score: 41 90-day mortality: 54% vs 42% 86.9% of mortality increase when REBOA was added to standard of care #CCR23 #UKREBOAtrial
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Peak excitement... @CritCareReviews
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