Anand Swaminathan
@emswami.bsky.social
EM doc | Resuscitationist | Medical Educator | EMRAP Managing Editor
He/Him/His
Instagram: @EMSwami
Anand Swaminathan is an Indian-American researcher and academic. He is the Robert C. Goizueta Chair of Organization and Management and Associate Dean of the Ph.D. program at the Emory University Goizueta School of Business. Previously, he held academic appointments at the University of Michigan School of Business and the University of California, Davis. .. more
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Dogmalysis - Pretreatment for IV Contrast #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Dogmalysis: pretreatment for IV contrast is ineffective in reducing the risk of serious adverse reactions and harms patients by delaying definitive diagnosis.
youtube.com/shorts/tMVca...
#EMIMCC
youtube.com/shorts/tMVca...
#EMIMCC
D-dimer in PE: Age-adjustment, YEARS etc #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
D-dimer in PE: High false pos rate at standard thresholds
-Age-adjust(PMID: 24439717) + YEARS(PMID 28549662) incr threshold w/o incr miss rate
-Lancet Study(PMID: 41135553) simplifies: If PE isn’t most likely dx, double threshold
-0% miss rate w/ 19% decr CT
youtube.com/shorts/rfXcN...
#EMIMCC
-Age-adjust(PMID: 24439717) + YEARS(PMID 28549662) incr threshold w/o incr miss rate
-Lancet Study(PMID: 41135553) simplifies: If PE isn’t most likely dx, double threshold
-0% miss rate w/ 19% decr CT
youtube.com/shorts/rfXcN...
#EMIMCC
Deliberate Practice: Cric #criticalcare #emergencymedicine #airway
YouTube video by EMSwami
youtube.com
Scalpel-Finger-Bougie Cric
-Large, midline vertical incision
-Palpate cricothyroid membrane w/ finger of nondominant hand
-Scalpel through membrane, drag laterally, flip and drag laterally
-Scalpel out, finger in
-Bougie in guided by finger
-6-0 ETT over bougie
youtube.com/shorts/jB3vq...
#EMIMCC
-Large, midline vertical incision
-Palpate cricothyroid membrane w/ finger of nondominant hand
-Scalpel through membrane, drag laterally, flip and drag laterally
-Scalpel out, finger in
-Bougie in guided by finger
-6-0 ETT over bougie
youtube.com/shorts/jB3vq...
#EMIMCC
Hypotension + Bradycardia #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
Hypotension + Bradycardia: Updated Differential
-HyperK
-Beta blocker/CCB tox (can occur outside overdose)
-Clonidine or digoxin tox
-Blood in belly (vagal stim)
-Neurogenic shock
-Severe hypothyroid
-HyperMg
-Inferior MI
-Advanced AV blocks
-BRASH Syndrome
youtube.com/shorts/S3ibt...
#EMIMCC
-HyperK
-Beta blocker/CCB tox (can occur outside overdose)
-Clonidine or digoxin tox
-Blood in belly (vagal stim)
-Neurogenic shock
-Severe hypothyroid
-HyperMg
-Inferior MI
-Advanced AV blocks
-BRASH Syndrome
youtube.com/shorts/S3ibt...
#EMIMCC
The Physiologically Difficult Airway - PubMed
Airway management in critically ill patients involves the identification and management of the potentially difficult airway in order to avoid untoward complications. This focus on difficult airway management has traditionally referred to identifying anatomic characteristics of the patient that make …
pubmed.ncbi.nlm.nih.gov
Couple of issues:
-paralysis: even 30 sec of apnea can drop pH precipitously
-paralysis duration after intubation won't allow overbreathing
-If pt truly tiring, pulling extra breaths from vent gonna be huge challenge
My exp: these pts do poorly w/ intubation. Check out this article: PMID: 26759664
-paralysis: even 30 sec of apnea can drop pH precipitously
-paralysis duration after intubation won't allow overbreathing
-If pt truly tiring, pulling extra breaths from vent gonna be huge challenge
My exp: these pts do poorly w/ intubation. Check out this article: PMID: 26759664
The RSI Trial: Etomidate vs Ketamine #criticalcare #emergencymedicine #intubation
YouTube video by EMSwami
youtube.com
RSI Trial(PMID:41369227): Etomidate vs Ketamine
-No diff 28d mortality
-Incr HD collapse w/ ketamine (driven by incr/new pressors)
-Not clear why (More aggressive resus in etomidate group?)
-Forces us to reconsider our induction agent choice
youtube.com/shorts/CFWOR...
#EMIMCC
-No diff 28d mortality
-Incr HD collapse w/ ketamine (driven by incr/new pressors)
-Not clear why (More aggressive resus in etomidate group?)
-Forces us to reconsider our induction agent choice
youtube.com/shorts/CFWOR...
#EMIMCC
Reposted by Anand Swaminathan
Hi, medical toxicologist/ER doctor here 👋
here’s what you need to know about medetomidine in the illicit opioid supply
here’s what you need to know about medetomidine in the illicit opioid supply
Does Vent Strategy Matter in the ED #criticalcare #emergencymedicine #airway #intubation
YouTube video by EMSwami
youtube.com
Do ED vent settings matter?
LOV-ED (PMID: 28259481): decr in ARDS + vent assoc conditions w/ lung protective ventilation protocol in ED (14.7% to 7.3% NNT = 14)
Bottom Line: ED vent choices matter. TV 6-8 cc/kg IBW
+ titrate FiO2 + PEEP together
youtube.com/shorts/MgGjJ...
#EMIMCC
LOV-ED (PMID: 28259481): decr in ARDS + vent assoc conditions w/ lung protective ventilation protocol in ED (14.7% to 7.3% NNT = 14)
Bottom Line: ED vent choices matter. TV 6-8 cc/kg IBW
+ titrate FiO2 + PEEP together
youtube.com/shorts/MgGjJ...
#EMIMCC
Full Fast + Squeezed #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Pericardial Tamponade: fix is drainage but resus prior focuses on full, fast + squeezed
#1: Full: Volume expansion
#2: Fast: Tachycardia helpful as increases cardiac output
#3: Squeezed: Use vasoactives to ensure adequate SVR + contractility (epi if bradycardic)
youtube.com/shorts/2Yth1...
#EMIMCC
#1: Full: Volume expansion
#2: Fast: Tachycardia helpful as increases cardiac output
#3: Squeezed: Use vasoactives to ensure adequate SVR + contractility (epi if bradycardic)
youtube.com/shorts/2Yth1...
#EMIMCC
STEMI with RAD #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Right Axis Deviation (Dominant R II, III, aVF + Dominant S lead I) extremely uncommon in STEMI
PE should be strongly considered even if STEMI pattern
Avoid premature closure + consider alternative diagnoses
youtube.com/shorts/C0n6C...
#EMIMCC
PE should be strongly considered even if STEMI pattern
Avoid premature closure + consider alternative diagnoses
youtube.com/shorts/C0n6C...
#EMIMCC
Mechanical Ventilation in Resp Acidosis #criticalcare #emergencymedicine #intubation
YouTube video by EMSwami
youtube.com
Intubated a patient w/ severe metabolic acidosis?
Goal: mimic pre-intubation respiratory parameters
-Prior to intubation, pt tachypneic + hyperperpneic to blow down CO2
-Set RR high (may be 30+). Can get RR + TV off of NIV that you use for preox
youtube.com/shorts/HF095...
#EMIMCC
Goal: mimic pre-intubation respiratory parameters
-Prior to intubation, pt tachypneic + hyperperpneic to blow down CO2
-Set RR high (may be 30+). Can get RR + TV off of NIV that you use for preox
youtube.com/shorts/HF095...
#EMIMCC
Dimer in context of the aortic dissection detection risk score (ADD-RS) has good evidence and endorsed by ACEP. It’s a reasonable approach but I worry that indiscriminate use will incr CT use
Aortic Dissection Diagnosis #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Aortic Dissection
Classic signs/sx insenstitive: ~ 50% w/o HTN, ~15% w/ pulse deficit, 20% w/ normal CXR
Keys to make dx:
High risk features: family hx sudden death, connective tissue disorders
History: sudden/max/severe onset of pain
Sx above + below diaphragm
youtube.com/shorts/0xiar...
#EMIMCC
Classic signs/sx insenstitive: ~ 50% w/o HTN, ~15% w/ pulse deficit, 20% w/ normal CXR
Keys to make dx:
High risk features: family hx sudden death, connective tissue disorders
History: sudden/max/severe onset of pain
Sx above + below diaphragm
youtube.com/shorts/0xiar...
#EMIMCC
Antibiotics After Thoracostomy #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
Antibiotics reduce the rate of empyema in patients getting emergency thoracostomy tube placement for traumatic hemothorax/pneumothorax (PMID: 36312819)
Rx: Cefazolin 1 gm IV
youtube.com/shorts/pyNMt...
#EMIMCC
Rx: Cefazolin 1 gm IV
youtube.com/shorts/pyNMt...
#EMIMCC
Critical DKA + Intubation #criticalcare #emergencymedicine #intubation #airway
YouTube video by EMSwami
youtube.com
Be cautions intubating patients w/ severe metabolic acidosis
-Hyperperpnea drives CO2 down supporting pH
-Removing resp drive will drop pH ➡️ HD collapse
-Mech vent challenging as must mimic preintubation parameters
-Use NIV to support work of breathing instead
youtube.com/shorts/zn7hi...
#EMIMCC
-Hyperperpnea drives CO2 down supporting pH
-Removing resp drive will drop pH ➡️ HD collapse
-Mech vent challenging as must mimic preintubation parameters
-Use NIV to support work of breathing instead
youtube.com/shorts/zn7hi...
#EMIMCC
Altered Mental Status in Dialysis Patients #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
AMS in Dialysis Patients
-Long differential w/ some special considerations
-Unique: Uremic encephalopathy, dialysis disequilibrium syndrome, med accumulation
-More common: Electrolyte abnormalities, hypoglycemia, infections/sepsis, spontaneous ICH (poor plt fxn)
youtube.com/shorts/ZInVd...
#EMIMCC
-Long differential w/ some special considerations
-Unique: Uremic encephalopathy, dialysis disequilibrium syndrome, med accumulation
-More common: Electrolyte abnormalities, hypoglycemia, infections/sepsis, spontaneous ICH (poor plt fxn)
youtube.com/shorts/ZInVd...
#EMIMCC
Patient with cirrhosis and INR of 3 needs a procedure
Please step away from the FFP
EVERY guideline & article agrees that FFP shouldn't be given for pre-procedure coag optimization (even high-risk procedures)
Plt & fibrinogen are more controversial
Discussion emcrit.org/ibcc/cirrhos... #EMIMCC
Please step away from the FFP
EVERY guideline & article agrees that FFP shouldn't be given for pre-procedure coag optimization (even high-risk procedures)
Plt & fibrinogen are more controversial
Discussion emcrit.org/ibcc/cirrhos... #EMIMCC
Preach
So tired of having this conversation
So tired of having this conversation
Reposted by Anand Swaminathan
Patient with cirrhosis and INR of 3 needs a procedure
Please step away from the FFP
EVERY guideline & article agrees that FFP shouldn't be given for pre-procedure coag optimization (even high-risk procedures)
Plt & fibrinogen are more controversial
Discussion emcrit.org/ibcc/cirrhos... #EMIMCC
Please step away from the FFP
EVERY guideline & article agrees that FFP shouldn't be given for pre-procedure coag optimization (even high-risk procedures)
Plt & fibrinogen are more controversial
Discussion emcrit.org/ibcc/cirrhos... #EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Nov 26
Tips in Pregnancy Resus #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Tips in Pregnant Patient Resuscitation
-Focus resuscitative efforts on the mother. The better we resus mom, the better the outcome for both
-Access: 2 IV above the diaphragm
-Displace the uterus (Push to L lateral). Tilting can make resus more challenging
youtube.com/shorts/uU0Ya...
#EMIMCC
-Focus resuscitative efforts on the mother. The better we resus mom, the better the outcome for both
-Access: 2 IV above the diaphragm
-Displace the uterus (Push to L lateral). Tilting can make resus more challenging
youtube.com/shorts/uU0Ya...
#EMIMCC
Erin Reed
@erininthemorning.com
· Nov 24
Study In The Journal Of Pediatrics Finds Trans Youth Care Lowers Suicidality, Few Detransition
The groundbreaking study found that suicidality dropped for transgender youth receiving hormone therapy by nearly 70%, with only 7 patients of 432 discontinuing treatment.
www.erininthemorning.com
1. A landmark study was just published in The Journal of Pediatrics.
It found a 68% reduction in suicidality for trans youth getting HRT.
It also found only 7 of more than 400 stopped taking HRT... and of those that did, 4 still identified as gender-diverse.
Transgender care saves lives.
It found a 68% reduction in suicidality for trans youth getting HRT.
It also found only 7 of more than 400 stopped taking HRT... and of those that did, 4 still identified as gender-diverse.
Transgender care saves lives.
Anand Swaminathan
@emswami.bsky.social
· Nov 24
DOPES in Crashing Vent #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
DOPES Mnemonic: structured approach to deal with hypoxia in the ventilated patient
Displacement, Obstruction, Patient factors (ie PE, PTX), Equipment Issues, Stacked Breaths.
Address all of these factors in parallel
youtube.com/shorts/rwumW...
#EMIMCC
Displacement, Obstruction, Patient factors (ie PE, PTX), Equipment Issues, Stacked Breaths.
Address all of these factors in parallel
youtube.com/shorts/rwumW...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Nov 23
Flu + COVID PSA
YouTube video by EMSwami
youtube.com
Get your flu + COVID shots now!
-Markedly lowers risk of getting COVID/Flu (doesn't eliminate completely)
-Reduces severity of illness
-Reduces likelihood of hospitalization in older, immunocompromised people
-Reduces the risk of transmission to others
youtube.com/shorts/nxPu5...
-Markedly lowers risk of getting COVID/Flu (doesn't eliminate completely)
-Reduces severity of illness
-Reduces likelihood of hospitalization in older, immunocompromised people
-Reduces the risk of transmission to others
youtube.com/shorts/nxPu5...
Anand Swaminathan
@emswami.bsky.social
· Nov 21
I don't hear it but, I will gladly take the compliment!
Anand Swaminathan
@emswami.bsky.social
· Nov 21
Discussed in the video
I wouldn’t do pushes but isotonic bicarbonate infusion would be great
I wouldn’t do pushes but isotonic bicarbonate infusion would be great
Anand Swaminathan
@emswami.bsky.social
· Nov 21
Fluids in Hyperkalemia #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
Fluids in HyperK
-Restore volume, incr kidney perfusion leading to incr urine output + K elimination
-0.9% saline: pH 5.5, big Cl load. Worsen acidosis leading incr serum K
-LR superior: small amount of K in it won’t raise serum K. Won’t contribute to acidosis
youtube.com/shorts/3G4yc...
#EMIMCC
-Restore volume, incr kidney perfusion leading to incr urine output + K elimination
-0.9% saline: pH 5.5, big Cl load. Worsen acidosis leading incr serum K
-LR superior: small amount of K in it won’t raise serum K. Won’t contribute to acidosis
youtube.com/shorts/3G4yc...
#EMIMCC
Reposted by Anand Swaminathan
Isaac Bogoch
@isaacbogoch.bsky.social
· Nov 20
More data outlining how COVID vaccines reduce the risk of hospitalizations & death, especially among those aged 65 and older.
This aligns nicely with recommendations from Canada's National Advisory Committee on Immunization. 🇨🇦
Link: tinyurl.com/yuwmmtt4 by Hansen et al.
This aligns nicely with recommendations from Canada's National Advisory Committee on Immunization. 🇨🇦
Link: tinyurl.com/yuwmmtt4 by Hansen et al.
Anand Swaminathan
@emswami.bsky.social
· Nov 19
Thanks! Not worked anywhere where it was available but maybe just not considered an ED drug
Anand Swaminathan
@emswami.bsky.social
· Nov 19
Not available in US so I don't have experience with it
We have octreotide which is very underwhelming
www.thennt.com/cms/nnt/octr...
We have octreotide which is very underwhelming
www.thennt.com/cms/nnt/octr...
Anand Swaminathan
@emswami.bsky.social
· Nov 19
Octreotide for Gastrointestinal Hemorrhage from Esophageal Varices – TheNNT
www.thennt.com
The benefit on octreotide is pretty low (though I still get asked to do it and do it on my own)
www.thennt.com/cms/nnt/octr...
www.thennt.com/cms/nnt/octr...
Anand Swaminathan
@emswami.bsky.social
· Nov 19
Promotility Agents in UGIB #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
Priorities in UGIB management: blood, ceftriaxone (if varices suspected), GI to bedside + consider intubation
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC