Salia Farrokh, PharmD, BCCCP, FNCS
@salia_farrokh
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🧠 ICU PharmD 👩🏻⚕️|| Obsessed with education & research || Wifey to 🫁 ICU 👨🏼⚕️|| Yale alumni || Hopkins Faculty || 🏝Traveller || Competitive Athlete 🏅
Baltimore, MD
Joined March 2011
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Send us removal request.
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🏁⏰It’s FINALLY here
@caseyalbin
✔️Fun 10-15 min episodes
✔️12 total episodes to break down complex neurological emergencies
✔️Practical pearls
New to
#ncc
? Trainee? Just want some practical clinic/pharm pearls for neuro emergencies👇
…
It’s here! 🥳
@salia_farrokh
& I have had so much fun recording these snack-sized episodes featuring content from
@neurocritical
’s ONCALL chapters!
New to
#ncc
? Trainee? Just want some practical clinic/pharm pearls for neuro emergencies! Check it out👇
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✔️Give that beta-lactam first 🕰 ✔️vancomycin can wait 🛑
Administration of a β-Lactam Prior to Vancomycin as the First Dose of Antibiotic Therapy Improves Survival in Patients With Bloodstream Infections | Clinical Infectious Diseases | Oxford Academic
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Ketamine for SE without intubation was discussed at the NCS annual meeting!
So happy to see this in print & the NCS JC will focus on it next Tuesday ALL DAY 🎊🎉🥳🙌🏻🤓✔️👏👇👇
@neurocritical
@SCCM_Neuro
@SCCM_CPP
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It’s perfect time for institutions to share their outcomes!
🩸Among patients with a bleed while taking a FXa inhibitor, there was no difference in clinical outcomes for andexanet-alfa vs PCC!
💲There was a significant difference in cost with andexanet-alfa costing ~4x more!
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📢📣Today is the day 🎉🧠
We are officially transitioning to tenecteplase for acute management of adult AIS in those who meet the fibrinolytic criteria! We will continue to use IV alteplase for Massive PE 🩸🫁
@HopkinsNCCU
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Recertified in critical care 🎉
Yes, I LOVE to take exams whenever they are offered 🙈😅
#criticalcare
#bcccp
#iculife
#pharmlife
#pharmdlife
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When comparing andexanet vs. usual care, Annex-I showed:
⬆️Hemostatic efficacy BUT
↔️mRS
↔️ Mortality
⬆️⬆️⬆️ Thrombotic events
👇👇👇
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What do you mean you only gave 1 mg of lorazepam in someone in status???
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Congratulations to the new Fellows of Neurocritical Care Society!! 👏🧠 live from
#NCS2022
@neurocritical
@CaseyMayPharmD
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🔥🔥 just released
#NCS2022
🔥🔥 seizure ppx in TBI, ICH, Supratentorial Neurosurgery, & SAH? Levetiracetam probably better than phenytoin & shorter duration better than longer ppx but RCTs are needed for sure!!
@neurocritical
@SCCM_Neuro
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This summarizes it all 👇🤔
Looking forward to more discussions on rounds &
@neurocritical
🧠 this summer ☀️🌻😎
#aSAH
#guideline
#ncs
#neurocriticalcare
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The full report is finally out ⭐️🧠
✔️ ASM = no ASM in moderate to severe hospitalized TBI for sz ppx
✔️if ASM is used ➡️ LEV > PHT
👇👇👇👇👇👇👇👇👇👇👇
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📣 ANNEXA-4 full report finally here with reported thrombotic event of 10%!
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A great collaboration with ECMO neurocritical care team & yet we have more questions than answers🤷🏻♀️!
@HopkinsNCCU
@neurocritical
@SCCM_Neuro
@csmfisher
#icu
#ECMO
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See you in 2024
@HopkinsNCCU
🧠🥰Many memories but the highlight of 2023 was to offer a pharmacotherapy elective in our neurocritical care fellowship program for the FIRST time!!
✔️probably the first in the country
✔️interactive
✔️practical
@VishankShah3
@MBowerMD
@csmfisher
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So true ✔️ peripheral administration of vasoactive agents in the CLOVERS trial. If you are thinking about changing your hospital protocol, NOW is a good time 💡✅
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Do you reference a tweet on rounds too?!! 🤓😅 Live from
#SCCM2023
#impactofsocialmediaoncriticalcare
#socialmediaburnout
#isthisthefutureofmedicine
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Thank you
#ASHP
for the invitation to teach the Status Epilepticus recertification course this year in person in Las Vegas! Honored for the opportunity to present with Dr. Kaitlin Hughes 🧠🤓
@SCCM_CPP
@ASHPOfficial
#vegasfor48hours
😅
@neurocritical
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🔥aSAH part 1 is out!
We discussed NEW Guidelines too‼️
We had so much fun talking about these clinical pearls & hope that you enjoy it too!
@caseyalbin
@neurocritical
@SCCM_Neuro
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Hopkins neurocritical care well represented @ SCCM2023
@SCCM_Neuro
@neurocritical
@HopkinsNCCU
@VishankShah3
@LuciaRiveraLara
#SCCM2023
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So beyond excited to see this in print! Happy that I get to work on projects I’m so incredibly passionate about every day! 🤓❤️This pharmacy board review book is designed to provide comprehensive must-know information in a fun, clear, and concise way! Thank you APHA & BannerLLC
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Ketamine appears to be helpful in SE if
✔️used early
✔️appropriate doses are used
#NCS2023
#SE
#debate
#ketamine
@gabe_fontaine
@neurocritical
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If you didn’t believe in albumin & Lasix maybe it’s time to give it a shot???? 💉⏳⏱🩸
Can we do a journal club on this 💡
@HopkinsNCCU
@csmfisher
@FeghaliJames
@jrcarhuapoma
@VishankShah3
@MBowerMD
🙋♂️Albumen + diuretics (push-pull) REDUCES ⬇️ Ventilator days & ⬆️ P/F ratio in ICU
New Meta-analysis just published:
#FOAMcc
#MedEd
#MedTwitter
#albumen
#ICU
H/T
@gsmartinmd
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Dr.
@LaurenKoffman
discussing importance of simulation based learning for management of neurological emergencies in neurology residency programs!
@SCCM_Neuro
#SCCM2023
@HopkinsNCCU
@TempleNeurology
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One just starting a neurosurgery residency & one finishing a neurocritical care fellowship! They both wished me peace on rounds!! 😂Thank you
@nibalrizk
for the thoughtful gift! We will miss you!!
@nibalrizk
@FeghaliJames
#hopkinsneurocriticalcare
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@neurocritical
here we come! Plenty of time to plan residents’ projects on the ✈️ 😅🤓😎
#NCS2022
#neurocriticalcare
#sanantoniotx
#icupharmd
#neuroicupharmd
@SCCM_Neuro
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We did it 🎉🧠
@karenccrx
Yale alumni presenting “seizing the opportunity: seizure prophylaxis in neurocritical care”
@ASHPOfficial
#ASHP2023
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Can I put this sign up if someone said “let’s hold ASA dose tonight” on rounds 😂😅
#pharmacology
#pk
#ICHreversalguidelines
@neurocritical
@SCCM_Neuro
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A reminder to avoid CYP inducers & CYP inhibitors in aSAH due to DDIs!
@ASHPOfficial
#ASHP2023
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🧠A dedicated protocol for ETOH WD in neurocritical care is key! We are still searching for the “best algorithm” 🤓✔️Do not underestimate utility of adjunct medications!
@tigernole13
@senelson13
👇
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We are back
@caseyalbin
🚒☄️
This time we talked about one of the most common yet unspoken emergencies in neurocritical care ➡️neuromuscular emergencies!!
✔️diagnostic clinical pearls
✔️pharm pearls
✔️we even talked about PLEX vs. IVIG 🤷🏻♀️
A new podcast episode from the INSIGHTS subseries is now available for listening 🎧 In this episode,
@caseyalbin
and
@salia_farrokh
dive into neuromuscular emergencies. Listen now on the NCS website or wherever you get your podcasts:
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Boarding for SF to see all my people at SCCM “in person” after soooo long!!
#SCCM2023
@LaurenKoffman
@caseyalbin
@karenccrx
@MeganRx1
@tigernole13
@VishankShah3
@LuciaRiveraLara
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ICP management is the core of neurocritical care training 🎯
It can be challenging & stressful in emergencies so
👇
✔️we simplified it here for you
✔️we shared real life experiences
@caseyalbin
@HopkinsNCCU
@SCCM_Neuro
@neurocritical
Management of elevated
#ICP
is foundational to many neurologic emergencies, but it can be confusing. In this episode we break down the fundamentals and go through all you need to know!
@salia_farrokh
@neurocritical
@namorrismd
@biogen
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🔥📢Have we been delaying DOAC initiation post stroke?? 👇👇👇👇Early versus Later Anticoagulation for Stroke with Atrial Fibrillation | NEJM
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🔔We are back!!
@caseyalbin
🎊🥳In honor of National Pharmacy Week we are discussing analgesia & sedation 💊⚕️in neurocritical care in this episode!
Tune in & ✍️clinical pearls👇👇👇👇
@HopkinsNCCU
@SCCM_Neuro
@neurocritical
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Survived a busy weekend at work 👩🏻💻& made it just in time to the airport for my flight to the neurocritical care society annual meeting in AZ 🌵🏜️See you soon
@neurocritical
🧠
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🚨 🧠Excited to share that the ICP application for 2023 is now open & accepting applications! See link below or contact me for more information ✔️
@neurocritical
@SCCM_Neuro
@SCCM_Anesth
Invited Clinical Pharmacist (ICP) Program
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🔥An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline | American Journal of Respiratory and Critical Care Medicine | Articles in Press🔥
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Sometimes you just have to pause & talk about PK/PD on rounds in the ICU 😅, right!?
@juneuromd
@HopkinsNCCU
@VishankShah3
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Next time you order, verify, dispense “tramadol” think twice 🕵🏻😂👇
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Thank you NCS for supporting the invited clinical pharmacist program (ICP)!! Visiting a new neuro ICU, rounding with the team, helping initiate new protocols, & more importantly supporting a junior neurocritical care PharmD was beyond rewarding!
@neurocritical
@SCCM_CPP
@SCCM_CPP
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SCCM Day 3 continued 🔥
What an honor to coordinate the SCCM CPP Year in Review
#SCCM2024
#PharmD
#pharmacy
Excellent 👏job
@AJWPharm
@jfarrarPharmD
@Tribidibidy
@SCCM_CPP
Pharmacy Year in Review session coordinated by
@salia_farrokh
and moderated by
@karenccrx
to wind up
#SCCM2024
!
- Neurocritical Care updates by
@AJWPharm
- Nephrology updates by
@jfarrarPharmD
- Trauma updates by
@Tribidibidy
👏🏽👏🏽👏🏽👏🏽👏🏽
#PharmICU
#GoProgram
#TwitteRx
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Did I mention that I am team TNK & that we are also transitioning soon!!!! 💡💫🌟✨🤩😀🧠❤️
#teamTNK
#stroke
#ncs
#PharmICU
#criticalcare
@SCCM_CPP
@SCCM_Neuro
@salia_farrokh
discussing tPA v. TNK and declaring her champion! 🥊
This and much more in
"SCCM PharmD Speakers Part II"
Download here:
#PharmICU
#TwitteRX
#critPRN
#NeuroTwitter
#MedEd
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40 looks good on you Hopkins NCCU! So grateful I get to work with some of the most brilliant clinicians in the 🌎
@HopkinsNCCU
@VishankShah3
@csmfisher
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We commonly use oral clonidine as our strategy to wean DEX {& it works beautifully!!}. I’m worried if I recommend “guanfacine” next time they think I’m asking for a cough syrup 😂🤔
#lookalike
#soundalike
#whynotclonidine
#nottobeconfusedwithguaifenesin
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All you need is good coffee & a good neurocritical care lecture on a Thursday morning! ☕️🧠Thank you
@romergeocadin
@HopkinsNCCU
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One of the best parts of being a clinical pharmacist in a big academic center is to watch your residents & fellows graduate and do some amazing work in the world!! 🌏❤️🌟🧠
@csmfisher
@aarongusdon
@yunismayasi
@HopkinsNCCU
@SCCM_Neuro
@StrokeAHA_ASA
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🔔It was an absolute pleasure to discuss everything “stroke” & “tenecteplase” related with
@PharmacyToDose
! From 1995 ➡️ 2023 we covered it all‼️
#stroke
#thrombolysis
#criticalcare
#medicationsafety
🚨NEW POD ALERT🚨
Tenecteplase in Acute Ischemic Stroke with Salia Farrokh
@salia_farrokh
PK comparison 📊
Guideline discussion 📝
Literature review 📑
Advice if switching thrombolytics 🙏
Tenecteplase v. TNK 🛑
Argument against? 😱
AND MORE!
Download/subscribe:
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We keep studying haloperidol in icu delirium while forgetting about the most significant factor (i.e family in the room)! Such a good reminder that non-pharm interventions do matter!
#icudelirium
#earlymobility
#sleep
#family
#noisereduction
Impact of family presence on ICU delirium🧠
👉 Elective surgical pts w/GCS 15, family presence⤵️delirium prevalence (aOR 0.6, p= 0.02)
👉No impact on delirium prevalence in med/emerg surg pts
👉 Family presence & phone calls⤵️delirium duration in all pts
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📣The CPP plans a Year in Review (YIR) session for SCCM Congress each year! We are soliciting speakers for “2025” for the following topics:
✔️ID
✔️CV
✔️Nutrition
If you are interested to self-nominate or nominate another CPP member, contact me directly 😀👇
@SCCM_CPP
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Sweet or salty?? 🧂🍭
Despite ⬆️ popularity in its use, this meta-analysis showed that when comparing HTS to other hyperosmolar agents (mannitol), similar outcomes were seen in
✔️long-term neurological function
✔️all-cause mortality
✔️ICP control
✔️length of hospital of stay
Shah et al: Hypertonic Saline Versus Other Intracranial-Pressure-Lowering Agents for Patients with Acute Traumatic Brain Injury: A Systematic Review and Meta-analysis
Link:
@neurocritical
#NeuroCritCare
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Join us tomorrow to listen to our superb critical care pharmacy residents discussing trials below🤓🤩
@neurocritical
@SCCM_Neuro
@SCCM_CPP
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Live from the Maryland Stroke Conference!
DOACs for CVT! Yes or no? When & what dose AND more 🧠
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🤯I was just told it’s not central diabetes insipidus anymore, it’s actually “arginine vasopressin deficiency”….wait, what?
Has this been happening for some time?
Who’s changing medical terms right & left? 🤔
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🚨‼️Did you miss the debate this am?? Don’t worry 😀
Here’s a brief (but fun) conversation with the presenters!! 🤓💊
Tune in 👇
#NCS2023
@neurocritical
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Although all BZDs are considered 1st line tx in status epilepticus, Lorazepam hangs out in 🧠 tissue the longest.
#ASHP22
@salia_farrokh
@ASHP_EMPharm
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Too late to survive the SB line..need all the energy & hydration for a quick (48 hr) trip to Anaheim for Midyear to talk about one of my favorite topics in neurocritical care with
@karenccrx
♥️ stay tuned 🤓
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🔥Such a useful and timely study!!authors found 👇👇
“no more ♥️ were transplanted from donors treated with thyroid hormone. It also did not enhance EF or rate of weaning off vasopressors. It did result in more hypertension and tachycardia” ‼️
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The whole point of this article was IV push administration of 23.4% & not peripheral administration 🧂🧠💉
✅ IO administration is always an option but of course peripheral route may be considered in emergencies
@neurocritical
@SCCM_Neuro
#NCSPharmJC
#RXTweet
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Are you struggling to choose?
Here’s what you cannot miss 😎
Live from
#NCS2022
@neurocritical
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Until next time!
@neurocritical
thank you for all the educational sessions, networking opportunities, 💡research ideas, & seeing good old friends 🧠🤩
Last post from
#NCS2022
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We are back
@caseyalbin
with one of my FAVORITE topics “meningitis & encephalitis” 🤓🧠🦠
If you have ever rounded with me you know abx stewardship & appropriate use is always a priority on my list ☺️♥️ Hope you enjoy this episode & as always feel free to provide feedback ✔️
In the latest episode of the NCS Podcast Series, Drs.
@caseyalbin
&
@salia_farrokh
dover meningitis encephalitis. Listen now on the NCS website or wherever you get your podcasts and don't forget to subscribe for weekly episodes.
@CeribellEEG
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Thank you to my Yale family for always being so supportive!!
@HeavnerPharmD
|
@SCCM2023
Supporting
@salia_farrokh
at the
@SCCM_CPP
Year-in-Review at
#SCCM2023
#proudRPDmoments
Almost all of my
@YNHH
PGY2 Critical Care residents (missing
@AJonesPharmD
) in one place 🥰
#PharmICU
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SCCM Day 1 was amazing 😊🤓
Brain death guideline updates ✔️
Vasopressors in the ICU ✔️
Tons of networking 😍✔️
@karenccrx
@GretchenBrophy
@LaurenKoffman
@MeganRx1
@GilbertPharmD
@gabe_fontaine
@MeganARech
#sccm2024
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“We made an ophthalmologist come in on the weekend” 😅😂😅😂
Excited for the plenary today
@AmyDzierba
@DGlaucomflecken
@LGlaucomflecken
- we made an ophthalmologist come in on the weekend!
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Out of all my accomplishments, finding you & building a life with you is what I’m the most proud of ❤️
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The feeling is certainly mutual
@caseyalbin
😍👸🏻🥰 I love all the time we have spent together to create something amazing & that we keep going!! We can’t wait to share what’s to come later this spring, early summer 🧠 so stay tuned 📢📣🎉
A throw back from
#sccm2023
! I am so glad that i met
@salia_farrokh
through ncs/sccm🥰!! We’ve been working on something super fun with
@neurocritical
that we can’t wait to share later this spring/early summer!!!
Hint: 🔉
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Dear 2022 you gave us so much to be grateful for {personally & professionally} 🙏🏻! Can’t wait to see what 2023 brings 😇
@dr_merwin
#powercouple
#partnerincrime
#happy
#blessed
#lucky
#iculife
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Live from SCCM ➡️ liberal vs restrictive fluid management in sepsis resulted in similar outcomes per CLOVERS trial 🚨💡
#SCCM2023
#sepsis
#fluids
#vasopressors
#peripheralvasoactives
#criticalcare
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During Pharmacy PT Rounds this week Dr
@Hailey_rx36
presented on evaluation of prolonged infusion B-lactam abx in critically I’ll patients including the MERCY trial 👏👏
“Prolonged infusion remains preferred”
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When one of your favorite attendings is on & has a 🍌 for breakfast (just like you do) & says let’s do a “banana cheers” 😂
@VishankShah3
We are a fun team this week! Let’s go! 🧠💊💉
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Happy International Women’s Day ❤️Grateful for a lot of strong women in my life
@LaurenKoffman
@LuciaRiveraLara
@caseyalbin
@CaitPalmisanoNP
@karenccrx
@MeganRx1
Ps. thank you
@Starbucks
😎
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Congratulations to our PGY2 critical care pharmacy resident! We are soooo proud of you Haley 👸🏻👏
We are also very excited to keep you here at Hopkins!
@johnshopkinshospital
@SCCM_CPP
@SccmBaltimore
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Another big teaching day in the unit, ABX pk/pd 🦠& autoregulation 🧠
@VishankShah3
@HopkinsNCCU
@
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⭐️💫We are soooooooo excited for next week 📣📢
Drumrolllllll🥁🥁🥁
@salia_farrokh
and I have been hard at work on a fun project with
@neurocritical
for awhile ... and it launches next week!!!!
We hope you will love it and stay tuned for the release!!
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Happy BD to my ride or die! My favorite fellow (now attending), my bestie, my maid of honor & sister ❤️👸🏻🎉🥰 so glad Hopkins connected us!! Thank you
@neurocritical
@HopkinsNCCU
for bringing such great ppl into my life ❤️
@LaurenKoffman
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🇫🇷French neuro ICUs ➡️30 mg/kg VPA bolus followed by 1 mg/kg/hr VPA infusion in this trial!!
Do centers in 🇺🇸 use VPA gtt?
#CPPPLU
Highlights: Adjunctive VPA added to 1st & 2nd line ASMs did not ⬇️ proportion of patients discharged from 🏥 in critically ill patients with GCSE.
#PharmICU
#NeuroTwitter
@HerveOutin
@AMazeraud
@benrohaut
@romsonnevil
@ArgaudLaurent
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Coming to my hotel room for a quick break & find this cute care package delivered to my room by my favorite person
@Inner_Peace
! Thank you for always being there for me 💕 live from
#NCS2022
#favoriteperson
#besthusbandaward
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Interested to know more about NOR-TEST 2 & other exciting thrombolysis trials?? Check out our recent podcast 🧠💉
ICYMI:
#TrialOfTheDay
for May 4th is the NOR-TEST 2, Part A trial
Looking for more?
@salia_farrokh
and I do a deep dive into Tenecteplase in Acute Ischemic Stroke.
Apple:
Spotify:
Article Link:
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Happy Birthday to our wonderful & hardworking critical care pharmacy resident
@Hailey_rx36
!! I’m glad we got to celebrate with cupcakes & status epilepticus topic discussion today🧠🎊🧁
@HopkinsNCCU
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Primary stroke prevention in this house🧠😅🍇🍎
#Mediterraneandiet
#dashdiet
#vitaminc
#potassium
#wholefoods
#fuelforlife
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Congratulations to our newest
@neurocritical
FNCS pharmacists! Almost half of this year's recipients are pharmacists - so incredibly proud!
#NCS2023
#NCSPharmacy
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🔔Working on a project related to communication in the ICU 🙋🏻♀️
Some reports show👇
✔️7% of the things you say are the words
✔️ 38% are the tone of voice
✔️55% are the body language
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🩸 when UFH becomes an unreliable AC treatment strategy🩸
👇👇👇nice summary
🩸 Resistance to unfractionated heparin in
#ICU
, evaluation & management options
💉 monitoring UFH
💉 mechanisms of resistance
💉 how to manage UFH resistance
PS check supplement table on IV anticoagulants in ICU
#FOAMcc
@JerroldLevy
@Dr_Cit
@foamecmo
🖇️
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This can only happen in the neurocritical care unit 😂❤️🧠
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