Are IV antibiotics easier than Oral antibiotics on the gut microbiome?

I was watching a video on KZbin when I saw your channel. I noticed one thing: Your content is excellent but your video views are decreasing. Then, I researched your channel and found that your video's SEO score is terrible. If you can do SEO-friendly things for your channel, your KZbin channel and videos will develop rapidly. If you want, I can help you grow your KZbin channel.

Great video! I agree with your take on the data, for ED docs specifically this doesn't change much. I'd reiterate what you said about the perils of interpreting observational, association-based data. I often ask myself the inverse interpretation of the data, to see if it seems just as plausible. In this case, saying "slow correction of hypona is associated with worse outcomes" could just as easily be interpreted as "hypona is more slow to correct/ more recalcitrant in sicker patients" which on the face of it sounds equally plausible if not likely. As you alluded to, the patients who were slower to correct appeared to have higher rates of CHF/cirrhosis/cancer (almost certainly their underlying drivers of hypoNa), so it makes sense that this might be a sicker group that had worse outcomes and responded less well to therapies aimed at correction of sodium. HypoNa is very heterogenous clinical entity with lots of different underlying causes and chronicities, some of which are more easily reversible than others, so I do wonder how clinically practical it is to lump all hyponatremia together, when we are dealing with an individual patient at the bedside. For instance, I would be more curious to look at data for rates of correction in acute substance induced hypoNa as this is pathophysiologically very different than more chronic causes like CHF/cirrhosis/cancer. It seems from the subgroup analysis in this study that there was no association in the alcohol use disorder subgroup between fast and slow correction and ODS though that data is far from definitive. My tongue in cheek ED mindset for hypoNa is, if they're seizing or altered because of it, give hypertonic. If not, just try to figure out and treat what is wrong with them, and just make sure the sodium and ins/outs are being monitored. So that includes good volume status assessment and appropriate management of their volume status and underlying disease process (eg in hypervolemic CHF or cirrhosis patient, restricting IV fluids and giving generous doses of furosemide, as you would for any sick hypervolemic CHF patient regardless of serum sodium, will often do wonders for their sodium, because you are treating the underlying cause of their hypoNa).

Thanks for the episode ! Being both an ER doc and an outdoor and woodworking enthusiast I can attest for the usefulness of cyanoacrylate glue for wound closure! I never found it to heat up significantly but the the commercial glues seem to be less flexible and tend to crack rapidly and then peel off before the wound is closed 🤷

I was diagnosed with covid on 12/16 and was prescribed this medication

We don't have easy access to IV CCBs in Australia. Any utility with oral agents?

Great content, as always. I'm an emergency resident from Brazil. Usually see the status in patients who stop convulsive activity but don't recover consciousness after that. I find it hard to convince the team and my superiors to be aggressive in the management of those situations.

Outstanding once again Justin. Ive been doing a lot if this thanks to PulmCrit but this is a comprehensive evidence rich masterclass. Thank you sir.

You should look at the logistics of getting a ceribell POC EEG monitor. Especially for detection of sz with paralytic on board.

Hey doc, I’m a Paramedic from the US. I work in an environment where long transports to the hospital are very common and where we are frequently the highest level of care available for an hour or more. This is complicated by the fact that we do not have Prop, Phenobarb, or Kepra stocked on the ambulance. The closest standalone or community ER we could get those drugs from, could be 30mins away, and they certainly don’t have an ICU. So they become but a pit stop on our way to the nearest university or tertiary hospital in the area…. which is another 30min drive. Recently we had a call where a pediatric pt seized for about 30mins straight, and all we could do is… keep pushing midazolam. We gave her about 20mg in total, didn’t do a thing. So my big question is.. What about early Ketamine? We carry Midazolam and Ketamine in abundance on our rigs. Could following a Benzo, Benzo, Ketamine algorithm be a valid option for us? Thanks for your fantastic content, your tracheotomy videos helped me save a very very sick pt on Thanksgiving day. Keep up the good work!

Great video as usual

could you possibly link the talk that you’re referring to in the video, thank you !

Love it fellas, thank you

I oftentimes see medical youtube channels with subscribers in the 1k - 10k range and compare it to non-medical channels with hundreds of thousands of subscribers. And then make the unfair assumption that lower subscriber count means lower quality videos. But I've realised it's such an unfair comparison because the medical audience is so small. Your like a superstar lol. This is amazing and pioneering, it is such a great way of teaching and discussing. I can't wait till channels like yours become more common to see here on KZbin.

this is an amazing channel, your videos are always consice and practical, saves so much time and effort trying to wade through dense boring literature. and i definitely find video content far more engaging and effective for retention compared to podcasts. Looking forward for your next episodes

Thank you! Very interesting. One element I'd also consider is that you miss out on the diagnostic element of the adenosine because there is always that question whether it's not really an atrial flutter.

Thank you!

It hasn't been shown to help in any clinical situation? As in it doesn't help at the beginning of COVID either?

trachs are pretty scary

💪strong work bud 💪

I spent 2 weeks in the hospital and was labeled a fall risk because of the section I was in, not because of anything medically wrong

Great format!

Thanks a lot!

Baby face Morgenstern dropping pediatric evidence bombs! Love it!

Hello I,m an Spanish emergency doctor. Thank you for your great work, i´m so impress. I´d like to know how do you do this videos. I refer to the process, edition, programs that you use, win/mac. Thank you again.

So what’s your recommendation for use? PCC?

I struggle to trust people who say the world is simpler than it seems. Every time I look closer at something, I find more complexity.

Great teaching. Thank you.

I understand the “horrible” feeling argument but for me, a prior explanation has worked very well. Having to use procedural sedation for 5 seconds “horrible” feeling is a bit much. However, risk of hypotension and the possibility of cardiomyopathy is too much risk to take.

Awesome resource Justin. Very well articulated!

You mentioned that you don’t have any Australian viewers… Aussie here 🇦🇺🙋‍♂️ Thanks for this video and your comments on putting nasal prongs underneath mask

Awesome video, I've been really enjoying this channel! Would love to see a video on Heparin in NSTEMI/unstable angina- I had never previously heard of the harms of it outweighing the benefits. I just read all your previous articles on it and find it all very fascinating. I think it is quite difficult for most physicians to go against long standing guidelines that are common practice (such as the AHA/ACC recommending anticoagulation with heparin; Class I recommendation). To clarify, does what you're discussing and your approach apply to all anticoagulation in NSTEMI/unstable angina or just the use of heparin? What about enoxaparin or fondaparinux? You stated in your previous article on the topic that you don’t prescribe heparin in NSTEMI or unstable angina patient. From the evidence you provide, I can see why that would be reasonable if you are treating with a non-invasive approach. I'd love to hear you expand a bit more on the fact that most of the studies were done in the pre-catheterization era. I'd wonder if there would still be benefit when treating with an invasive strategy, with heparin being a temporary bridge to definitive revascularization. Are you still not using heparin in these cases? Also, in your center when you don't give heparin in your NSTEMI/unstable angina patients do you find the cardiologists just end up giving it when they assess/admit the patient?

great video. i just never know where to start. do i just start with any new issue of a top journal? is there a way to see trending papers?

AI already being used for the censorship of literature searches. This is the true reason for it.

I am a rural doctor. This is gold.

Thanks a lot for this information. It confirms the relatively new saying, "Don't just do something. Stay there!"

I've lost nails twice, once as a kid. They both fell off on their own and grew back fine.

Hey, just wanted to find out about your thoughts on using AI tools such as OpenEvidence. I searched "Is oral antibiotics better than IV antibiotics" and this is what the AI generated The question of whether oral antibiotics are better than intravenous (IV) antibiotics depends on the specific clinical context and the type of infection being treated. For bone and joint infections, the OVIVA trial demonstrated that oral antibiotics are non-inferior to IV antibiotics in terms of treatment failure within one year.[1-2] This finding is supported by the National Institute for Health Research (NIHR), which funded the OVIVA trial. The trial also highlighted that oral therapy is associated with fewer catheter-related complications and reduced healthcare costs. In the treatment of infective endocarditis, recent studies and reviews, including those published in JAMA Internal Medicine and The New England Journal of Medicine, have shown that oral step-down therapy is at least as effective as prolonged IV therapy in selected patients.[3-4] This approach can reduce hospital stays and the risk of catheter-related adverse events. For community-acquired pneumonia (CAP), a post-hoc analysis of a randomized clinical trial indicated no significant difference in efficacy between initial IV and exclusive oral treatment among hospitalized patients.[5] This suggests that oral antibiotics can be a viable option for CAP in certain cases. In pediatric patients with complicated appendicitis, oral antibiotics post-discharge were associated with lower rates of treatment failure and hospital revisits compared to IV antibiotics.[6] Overall, oral antibiotics can be as effective as IV antibiotics for certain infections, provided that the patient is clinically stable and the oral antibiotic has good bioavailability. This approach can also reduce the risk of catheter-related complications and healthcare costs.[1-3][5-7]

Medicine is full of treatments that may have made physiological sense, were introduced without evidence based on popularity, and then are proven to have no effect. A big thing with this trial is the fact that there were so many recruiting institutions to the point where each recruited one patient per year. Lots of patients left out, for example all of the trivial ground level falls, which are the majority of my practice as well.

It didn’t work

For bleeding- how can you tell pt has cuffed or uncuffed tube from the beginning? When intubating from above, im assuming i would have to deflate the trach cuff in order to push the tube through past it correct?

The limitations of KZbin shorts bother me, but if you want more, check out the full video

I personally have long covid and have been suffering for 3 years. They should be thinking out of the box for realistic solutions. I heard about German company Berlin cures that remove auto antibodies, help aphresis, HBOT. The need to collaborate to all these organizations and working together is the way to help speed up this process. I am sympathetic for Physics Girl (youtuber with long haul) since I can really relate her suffering.

My sentiment exactly. Using paxlovid on long covid does not make any sense.

Nice. Might use this in the field sometime if I get the chance and have a long transport time with a critical pt.

to intubate or not to intubate ? if GCS8 ?

pharm companies convinced us that it has some effect on acute covid viruses are complicated iam still not convinced

I am a young hungarian em doctor with so many talented and motivated young collegues. We completely lack good quality em education. Hungary adopted the idea of these departments, but do it in our hungarian ways, so everything but a real castle of high quality emergency medicine. Most of the chief doctors are ex anesthesiologist, who are good at their jobs, but that is something else and to be honest they are not really open to new directions. We have no opportunity to learn from real em doctors, especially evidence based, experience based infos. We try, really try, so these videos mean everything to us! They make us better at our job! Thanks a lot and keep going, it is more important, than you imagine. I would give everything, to spend even a month at your department learning from such great doctors!

Actually the 14% death rate may be the canary to show how dangerous Xa inhibitors are, if you say miss a dose (upregulated Xa production to compensate)

Thousands of dollars per dose? Ha, it's about $20K per dose in the States! Despite these data, my hospital has added Andexanet to the formulary and neurosurgery has begun to request it for every ICH patient on DOACs. Despite the fact that 4-Factor is readily available. I don't think we'll ever have a better drug than 4-Factor for ICH. The problem is that by the time of hospital arrival, most of the damage from the hematoma has already been done. Reducing the enlargement by a few percent doesn't fix the problem or buy you much clinical improvement. Therefore the least toxic reversal agent is probably going to be best. Unless we can invent one that can reverse causation and travel backwards in time. I also remember trying to enroll a patient in this trial. The investigator wanted me to estimate the volume of the hematoma on CT, after the attending radiologist refused to do so! I assume that someone later on would have performed a standardized measurement of pre- and post-CT scans, but that makes me suspicious of the enrollment process. Another excellent video, thank you for creating such an easy to follow video! This is a great service to all the overworked EPs trying to stay current on the literature.