Early Prehospital Fibrinolysis an Equal to Primary PCI?

“Our analysis suggests that prehospital FL is associated with similar early and late mortality rates compared with PPCI in patients with STEMI managed early after symptom onset in the prehospital setting. Prehospital FL was associated with a decreased risk of cardiogenic shock but an increased risk of stroke. Prehospital FL appears to be a valuable alternative to PPCI. Pharmacoinvasive strategies including prehospital FL and transfer to hub PCI centers may allow reduction of the cost allocated to developing proximity centers with 24/7 PCI facilities while providing similarly efficient reperfusion therapy.”

Encouraging results for the majority of centers without early PCI options to treat ACS patients. Different complications but same life or death outcomes. 

Hello, World!

Random Thoughts (15/3/18)

1) Toys R Us is closing down in the states. 800 stores. 33000 jobs. Lost childhood memories.

2) 20 years blogging (or anything that consistent) is no mean feat. With such a timeline, you really get to see your growth. And yes, I do cringe at my past (notes and everything else). Just like Jason Kottke:

“I’ve been reading back through the early archives (which I wouldn’t recommend), and it feels like excavating down through layers of sediment, tracing the growth & evolution of the web, a media format, and most of all, a person. On March 14, 1998, I was 24 years old and dumb as a brick. Oh sure, I’d had lots of book learning and was quick with ideas, but I knew shockingly little about actual real life. I was a cynical and cocky know-it-all. Some of my older posts are genuinely cringeworthy to read now: poorly written, cluelessly privileged, and even mean spirited. I’m ashamed to have written some of them.”

3) I've started taking magnesium supplementation. It's more than a supplement; it's a drug (and hey, even IV fluids should be thought of as drugs and not something completely benign). It helps with insomnia (a byproduct of my pharmacologically revved up lifestyle) and sleep quality. It helps with blood pressure and sugars (more studies are needed). It even boosts testosterone levels (and yes, I'm not on roids). It's one of the best utilitarian drugs in anesthesia and ICU (used to manage pain, blood pressure, anesthetic requirements (especially with TIVA vs inhalational anesthesia), rhythm abnormalities, general ICU outcomes, effects on other electrolytes (especially managing hypokalemia), everything). Let's see if it improves my overall well-being. And I've done the calcuation: 1 tablet of this is equivalent to 15 mmol of magnesium. And I take it for immediate effect rather than a slow release: I slowly chew on it with water in my mouth (don't try it yourself unless if you are a masochist) right before bed.

Brachial Plexus (Simplified Functional Anatomy)

2nd take on an old topic (which I never shared). It came out in the written FCAI exams the other day, and I don't think I did very well. Like I said, you can study all of the things in the world, but what counts is what you recalled. And I definitely did not recall enough. And so I'm not happy about it.

Way back in 2013/2014, I guess with the Parker Frontier and Parker Blue-Black

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