@Bingmer Katie congrats!!!!!!! I had no doubt you would match.......you will no doubt be an awesome surgical oncologist......

@mike_smith_ @JaswinSawhney @johnjcomo It was easy to compare bicarbonate or mannitol vs routine medical care (PICOs 1 and 2) however defining aggressive fluid Resuscitation was a bit challenging for PICO 3 due to such high variability of protocols in different institutions and in literature.

@mike_smith_ @JaswinSawhney I don't want to speak for Jaswin but being on the PMG I can say that when we first started one of the reasons I felt this PMG was important was because of the lack of protocols and huge variability of treatment of rhabdo at different institutions.

@mike_smith_ @JaswinSawhney @EASTjournalclub Good morning!!!! Excited to co-moderate this journal club with @mike_smith_ ......thank you EAST for the opportunity!

@vanessapho @claraknlaimbbs @MHGenSurgery @SurgInfxSoc @ClaridgeJeffrey @laurarbrownmd @laurakreiner @esthertsengmd @ladha_prerna @DarkCloudTrauma @cintastine24 Fantastic job presenting and representing MetroHealth!!!!!!!!

@mikeditillo @KevinCChiang ....and don't forget your med students that were so awesome when you were a 3rd year resident!!!!!! 😬😜

@aalthans @zsendersmd Congrats Zach!!!!!!

@MHGenSurgery @ClaridgeJeffrey @vanessapho @ladha_prerna @cintastine24 Congrats to our new incoming surgical residents!!!!!! Welcome to Metro......we are super excited you will be joining our family!!!!!!!!! 🥳🥳🥳

@EASTjournalclub @BHWilliamsMD @SleetMd @EAST_TRAUMA Thank you EAST, @BHWilliamsMD @SleetMd for a great journal club!!!!! #eastjc

@SleetMd @BHWilliamsMD @EASTjournalclub @EAST_TRAUMA I believe the articles used in the PMG used chest tubes initially to drain hemothorax. #eastjc @BHWilliamsMD @SleetMd

@SleetMd @BHWilliamsMD @EASTjournalclub @EAST_TRAUMA I do think it is reasonable to do VATS in 2-3 days if there is retained hemothorax. Another meta-analysis published in April 2020 (Ziapour et al.) also suggest early VATS (day 1-3) which significantly shortened hospital LOS. #eastjc @BHWilliamsMD @SleetMd

@BHWilliamsMD @SleetMd @EAST_TRAUMA @EASTjournalclub Absolutely......in our typical patients early VATS as first line therapy for retained hemothorax still more beneficial especially when taking into account hospital LOS (resource utilization). Another reason for the conditional recommendation. #eastjc @BHWilliamsMD @SleetMd

@SleetMd @BHWilliamsMD @EAST_TRAUMA @EASTjournalclub I recently used tPA in patients who had EF 15% and was on 4 L home O2 for COPD. This was the very patient the working group suggested tPA over VATS in the PMG. #eastjc @BHWilliamsMD @SleetMd

@SleetMd @BHWilliamsMD @EAST_TRAUMA @EASTjournalclub The other outcome which was hospital LOS favored VATS. I think if their had been better quality evidence and other outcomes such as empyema that could have been compared this may have altered the recommendation #eastjc @BHWilliamsMD @SleetMd

@SleetMd @BHWilliamsMD @EASTjournalclub @EAST_TRAUMA The papers that were reviewed did not look at pain control or complications. However, those 2 outcomes I think would be essential to look at especially since I think it would help strenghten the recommendation assuming it favors pigtails. #eastjc @BHWilliamsMD @SleetMd

@SleetMd @BHWilliamsMD @EASTjournalclub @EAST_TRAUMA I do think that technique (utilizing US) to place the pigtail catheters (which 3 of 4 articles used) does play a role in perhaps placing the catheters in the more dependent portion or largest concentration of hemothorax possibly decreasing need for additional procedure #eastjc