Ed Palmer

@doced.bsky.social

1213 Followers 178 Following

Consultant in Anaesthetics & Intensive Care Medicine | Part time academic | R enthusiast | Sci-Fi fan | Dad https://doced.github.io

A complete anaesthetic donut spotted in the wild.
A chat GPT response to explain “Palmers law of pH”.
Message following deactivation of Twitter account.
A chatCPT prompt states "A 95 y/o patient presents with 3 day history of productive cough, shortness of breath and pleuritic chest pain. On arrival to the emergency department they have SpO2 of 75% requiring supplemental oxygen. Their initial CRP is 250 and serum IL-TKP is over 2000. What is the cause of the elevated IL-TKP?". The response is "The elevated IL-TKP (Interleukin-TKP) suggests a severe inflammatory response, likely due to an acute infectious process, such as pneumonia or another lower respiratory tract infection. The combination of productive cough, shortness of breath, pleuritic chest pain, and high CRP supports this diagnosis. The severe hypoxemia on arrival indicates significant respiratory compromise, potentially from extensive lung involvement or sepsis, both of which can drive up IL-TKP levels." Note: IL-TKP is completely fictional.
Elon Musk writes in a tweet dated 2020/04/15: "Depends on patient lung strength, but, again just my personal opinion, I wouldn't go much above their natural lung pressure" He's referring to ventilator settings in COVID. For reference, natural lung pressures are negative, and artificial ventilation is performed using a positive pressure. It's a remarkably stupid thing for someone to say.
An ancient artefact: The sepsis trolley.
Surviving sepsis guidelines for antibiotic administration. In the absence of shock, and where the diagnosis of sepsis is in question, it is appropriate to hold back antibiotics while seeking confirmation of the diagnosis. There are many sepsis mimics, which will not benefit from ABx treatment, while early termination of the diagnostic process may lead to a delay in treating other life threatening pathologies.
Original figure from Kumar 2006 paper showing the association between antibiotic administration and survival in sepsis. The figure uses time brackets of varying size to give the impression of a strictly linear reduction in survival. Notably missing from the plot is those who were already receiving antibiotics, who faired much worse (52% survival) than those who received antibiotics within 1 hour (around 80% survival). This is a bad plot and should have been picked up in peer review IMO.
A flowing river ending in a waterfall. One person, depicted by blue dots, is shown moving through the river before the waterfall. Another, depicted by red dots, is shown falling down the waterfall. A simple intervention in a timely fashion can rescue the blue person, before they fall off the waterfall. So such intervention could prevent the red person from falling to their demise.
Guardian article using mixed metric prefixes for describing power.
Text book “evidence based critical care” by Paul Marik.