From Harrison’s Principles of Internal Medicine, 21st edition-
An enduring message since 1950

Medicine is a calling in the service of humanity, for the compassionate pursuit of knowledge and innovation 🙏

Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS Neurocritical Care Society Hera A. Kamdar, MD Nicholas Morris Nicole Davis 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 the EMCrit Crew Casey Albin, MD Richard Choi, DO MountSinaiNCC John Liang Have adapted over time but worth knowing the time it takes to infuse these meds:
250mL 3% at 999 = 15 min
1g/kg mannitol at 999 (20% 250mL bag) ~ 30 min if using one line
23.4% HTS have seen data for minutes to 10 min as an IVP
#NCSTJC

#NCSTJC Q5: What is your biggest challenge in getting hypertonic saline for patients with ICP crises/cerebral edema? ow.ly/lCpZ50RzV3O
Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS

If your response is not in the poll, please share with us in the replies.

Neurocritical Care Society Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS Not necessarily a getting problem but can run into hyperchloremic metabolic acidosis that can be mitigated with sodium acetate / bicarb #NCSTJC

Fantastic programs and career changing opportunities! American Academy of Neurology

There is literally no thought given when it comes to administration of epinephrine pushes in a code. Bolusing HTS should be considered the same. The question is when it’s being run continuously for an arbitrary goal with no exit strategy. #NCSTJC

Thank you to everyone who participated in #NCSTJC today! Feel free to continue to converse with colleagues and take the polls.

Article: ow.ly/lCpZ50RzV3O

Additional thanks to Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS for moderating.

#NCSTJC

#NCSTJC Response Options:
A. Yes; use in preference to other high concentrations of NaCL ex. 23.4%
B. No; we still need a central line at my hospital for any concentration of hypertonic saline
C. No; other reason (please specify in the replies)

#NCSTJC Q4: Do you feel that being able to administer 3% through a PIV will change your practice in managing ICP crises? ow.ly/lCpZ50RzV3O
Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS

#NCSTJC Q3: Do you choose mannitol over hypertonic saline due to access issues? ow.ly/lCpZ50RzV3O
Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS

Never had a problem with peripheral 3% administration #NCSTJC

Join us throughout the day for a discussion on Hat administration for 🧠 injury #NCSTJC

As reminder, the deadline for the American Academy of Neurology #AANleadership programs is tomorrow, May 15th! Applications are open for the Diversity, Practice, and Emerging Leaders Programs. Apply now to further your career. Chelsea Ochoa Amy Nostdahl terry cascino

#NCSTJC

#NCSTJC Aarti Sarwal, FNCS, FAAN, FCCM Professor Casey Albin, MD Casey C. May, PharmD, BCCCP, FNCS Giuseppe Citerio Intensive Care Medicine IMCrit Nick Mark MD Jonny Wilkinson Fluid Academy Manu Malbrain Q1 we have been using 3% via PIV Mount Sinai Neurosurgery MountSinaiNCC thanks to the efforts of our pharmacy colleagues Nicole Davis

Neurocritical Care Society Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS #NCSTJC

Q2 #NCSTJC Fajun Wang, MD Farid Khasiyev Abdullah Hakoun in your study you how did you decide of the rate of blousing 3%?

Our #NCSTJC discussion is beginning! Discussion questions will be posted hourly; please use the hashtag and respond to questions throughout the day. ow.ly/lCpZ50RzV3O Neha Dangayach MD MSCR FAAN FCCP FCCM FNCS