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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Mechanical Vent in Asthma #criticalcare #emergencymedicine
YouTube video by EMSwami
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Permissive Hypercapnia
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
FAST in Hypotensive Trauma #emergencymedicine #criticalcare #trauma #fast
YouTube video by EMSwami
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FAST in Hypotensive Trauma
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
Safe Apneic Time #emergencymedicine #criticalcare #intubation #airway
YouTube video by EMSwami
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Incr safe apneic time important in improving 1st pass success
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
Intubating in Large Vessel Occlusion Stroke #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
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Endovasc Stroke Tx + Airway
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
VTach ECG Features #emergencymedicine #criticalcare #cardiology #resuscitation
YouTube video by EMSwami
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VT ECG
-ERAD(down I + aVF)
-V6 dominant S wave (all electricity from L heart away from ECG lead)
-RS > 100 msec in precordial leads
-QRS > 160 msec and Either no RSR’ in V1 L rabbit ear > right
In real life, if rhythm fast, wide + regular, assume VT + treat as VT
youtube.com/shorts/glxzf...
#EMIMCC
-ERAD(down I + aVF)
-V6 dominant S wave (all electricity from L heart away from ECG lead)
-RS > 100 msec in precordial leads
-QRS > 160 msec and Either no RSR’ in V1 L rabbit ear > right
In real life, if rhythm fast, wide + regular, assume VT + treat as VT
youtube.com/shorts/glxzf...
#EMIMCC
I've got to review again as well but a couple things pop up aside from the high vs low resource:
-Admitted CAP patients sicker than what I see in US setting
-HIV + TB rates
-Entry criteria likely included lots of viral stuff
Interesting discussion. I would probably defer at this point for most CAP
-Admitted CAP patients sicker than what I see in US setting
-HIV + TB rates
-Entry criteria likely included lots of viral stuff
Interesting discussion. I would probably defer at this point for most CAP
Is there enough different between resource scarce + resource rich populations to not adopt this for all admitted pts w/ CAP?
TB rates clearly higher in Kenya but not crazy. Same w/ HIV though unclear how well controlled HIV was in the specific pt
TB rates clearly higher in Kenya but not crazy. Same w/ HIV though unclear how well controlled HIV was in the specific pt
An important thing to consider: did patients w/o a-lines get more frequent bedside reassessment (just naturally)
It's easy to look at the a-line numbers and if they're w/in norm range, no need to reassess
w/o advanced monitoring, likely get more doc/RN at bedside assessing pt
It's easy to look at the a-line numbers and if they're w/in norm range, no need to reassess
w/o advanced monitoring, likely get more doc/RN at bedside assessing pt
Reposted by Anand Swaminathan
MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Reposted by Anand Swaminathan
New RCT: Avoiding A-line in shock didn't affect mortality (trend towards *reduction*) & decreased line complications
They avoided A-lines despite patients requiring pretty substantial doses of vasopressors
Very #zentensivist
Don't need to rush to an A-line
www.nejm.org/doi/full/10.... #EMIMCC
They avoided A-lines despite patients requiring pretty substantial doses of vasopressors
Very #zentensivist
Don't need to rush to an A-line
www.nejm.org/doi/full/10.... #EMIMCC
Chest Tube Irrigation #emergencymedicine #criticalcare #trauma
YouTube video by EMSwami
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Chest Tube Irrigation After Hemothorax Drainage
-Accumulating evidence shows reduction in complications (reaccumulation, effusions, empyema) PMID: 38764139
-Easy to do: place tube, drain blood, instill 500 cc of NS and suction out
-Can repeat 1-2 times
youtube.com/shorts/QhpAN...
#EMIMCC
-Accumulating evidence shows reduction in complications (reaccumulation, effusions, empyema) PMID: 38764139
-Easy to do: place tube, drain blood, instill 500 cc of NS and suction out
-Can repeat 1-2 times
youtube.com/shorts/QhpAN...
#EMIMCC
Absolutely. I like ketamine as an alternate here
I’m not impressed by the lidocaine lit but topicslization may reduce the reflex response to laryngoscopy
Intubating Increased ICP #emergencymedicine #criticalcare
YouTube video by EMSwami
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Intubating in elevated ICP
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
Reposted by Anand Swaminathan
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Jul 30;97:193-199. doi: 10.1016/j.ajem.2025.07.061. Epub ahead of print.
first10em.com
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
Beta Blockers in Thyroid Storm #emergencymedicine #criticalcare
YouTube video by EMSwami
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Thyroid storm patients often have high output cardiac failure
-POCUS: LV slamming away more likely to be high output failure
-Beta blockade: slows rate, improves LV filling + cardiac output
-Can use esmolol instead of propranolol as it’s got a short 1/2 life
youtube.com/shorts/Alwol...
#EMIMCC
-POCUS: LV slamming away more likely to be high output failure
-Beta blockade: slows rate, improves LV filling + cardiac output
-Can use esmolol instead of propranolol as it’s got a short 1/2 life
youtube.com/shorts/Alwol...
#EMIMCC
Morrison's Pouch in FAST #emergencymedicine #criticalcare #trauma #pocus
YouTube video by EMSwami
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Morrison’s Pouch (RUQ view in FAST)
-Highest yield for finding free fluid
-Must see the liver tip as this is where blood pools first
-Increase sensitivity w/ head down + w/ R lateral decub positioing
youtube.com/shorts/c1Nid...
#EMIMCC
-Highest yield for finding free fluid
-Must see the liver tip as this is where blood pools first
-Increase sensitivity w/ head down + w/ R lateral decub positioing
youtube.com/shorts/c1Nid...
#EMIMCC
Head of Bed Elevated for Airway Management #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
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Bed-Up-Head-Elevated (BUHE) positioning is an easy, effective way to increase safe apneic time and reduce intubation related complications PMID: 26866753
youtube.com/shorts/BnZz0...
#EMIMCC
youtube.com/shorts/BnZz0...
#EMIMCC
HypoK in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
DKA Tip #3: HypoK the big killer
-All DKA patients total body K depleted
-Some p/w hyperK due to acidosis shifting K
-K < 3.5, replete prior to starting insulin. > 3.5 start insulin + K together
-Skip bolus: no faster resolution of DKA but incr risk of hypoK
youtube.com/shorts/PK_qF...
#EMIMCC
-All DKA patients total body K depleted
-Some p/w hyperK due to acidosis shifting K
-K < 3.5, replete prior to starting insulin. > 3.5 start insulin + K together
-Skip bolus: no faster resolution of DKA but incr risk of hypoK
youtube.com/shorts/PK_qF...
#EMIMCC
Ketones in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
DKA Tip #2: Urine dip can mislead
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
Insulin in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
Role of insulin in DKA isn’t to drop sugar, it’s to shut of ketogenesis + close AG
-Don't stop insulin just because glucose hits 250 mg/dl
-Stop when AG closes, acidosis mainly resolved (bicarb greater than 18), long acting insulin on board + glucose controlled
youtube.com/shorts/z7prN...
#EMIMCC
-Don't stop insulin just because glucose hits 250 mg/dl
-Stop when AG closes, acidosis mainly resolved (bicarb greater than 18), long acting insulin on board + glucose controlled
youtube.com/shorts/z7prN...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Oct 10
youtube.com
SVT Diagnosis + Management
-Narrow, exquisitely regular w/ absence of p waves
-Routine Tn not required - results in incr downstream testing w/o improving outcomes
-Skip adenosine + go w/ diltiazem 0.15 mg/kg -
equal success rate, better tolerated, less recurrence
youtube.com/shorts/gghX9...
#EMIMCC
-Narrow, exquisitely regular w/ absence of p waves
-Routine Tn not required - results in incr downstream testing w/o improving outcomes
-Skip adenosine + go w/ diltiazem 0.15 mg/kg -
equal success rate, better tolerated, less recurrence
youtube.com/shorts/gghX9...
#EMIMCC
Precharging the Defibrillator #emergencymedicine #criticalcare #cardiacarrest #resuscitaiton
YouTube video by EMSwami
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Early defibrillation + high-quality CPR improve OHCA outcomes
-Key is to maximize compression fraction
-Poor defibrillation coordination can eat at your hands on time
-Precharging defib reduces hands off time + increases compression fraction
youtube.com/shorts/y_j2w...
#EMIMCC
-Key is to maximize compression fraction
-Poor defibrillation coordination can eat at your hands on time
-Precharging defib reduces hands off time + increases compression fraction
youtube.com/shorts/y_j2w...
#EMIMCC
SALAD Technique #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
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Suction Assisted Laryngoscopy for Airway Decontamination (SALAD) solves the challenge of the soiled airway by maintaining continuous suctioning during airway securing attempts.
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus
youtube.com/shorts/vpvmy...
#EMIMCC
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus
youtube.com/shorts/vpvmy...
#EMIMCC
Blunt Cardiac Injury #emergencymedicine #criticalcare #trauma
YouTube video by EMSwami
youtube.com
Blunt Cardiac Injury
Suspect: blunt traumatic hemothorax, pulmonary contusions, esophageal/aortic injury
Not assoc w/ isolated sternal fracture
w/u: Tn and ECG - If either abnormal, admit to tele and get a comprehensive echo looking for wall motion abnormality
youtube.com/shorts/UTHbm...
#EMIMCC
Suspect: blunt traumatic hemothorax, pulmonary contusions, esophageal/aortic injury
Not assoc w/ isolated sternal fracture
w/u: Tn and ECG - If either abnormal, admit to tele and get a comprehensive echo looking for wall motion abnormality
youtube.com/shorts/UTHbm...
#EMIMCC
Reduced Dose Insulin in HyperK #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
IV insulin is a backbone tx in hyperK
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose
youtube.com/shorts/Sz9Zy...
#EMIMCC
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose
youtube.com/shorts/Sz9Zy...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Sep 29
Cric Practice #emergencymedicine #criticalcare #intubation #airway
YouTube video by EMSwami
youtube.com
Finger-Scalpel-Bougie Approach to Cric
-If you're doing emergency airway management, you MUST be comfortable doing a cric
-Key w/ cric: have a simple approach + practice
-Don’t waste time w/ needle based approaches - they are more likely to fail
youtube.com/shorts/8fDsT...
#EMIMCC
-If you're doing emergency airway management, you MUST be comfortable doing a cric
-Key w/ cric: have a simple approach + practice
-Don’t waste time w/ needle based approaches - they are more likely to fail
youtube.com/shorts/8fDsT...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Sep 26
Thank you!
Anand Swaminathan
@emswami.bsky.social
· Sep 26
Pericarditis and ECG Changes #emergencymedicine #criticalcare #cardiology
YouTube video by EMSwami
youtube.com
Diagnosing Pericarditis:
-Pericardium is electrocardiographically silent
-Pericarditis w/ ECG changes = pericarditis w/ epicarditis or pericarditis w/ myocarditis.
-If troponin markedly elevated, trending up or patient looks toxic, admit to workup myocarditis
youtube.com/shorts/jI6Zp...
#EMIMCC
-Pericardium is electrocardiographically silent
-Pericarditis w/ ECG changes = pericarditis w/ epicarditis or pericarditis w/ myocarditis.
-If troponin markedly elevated, trending up or patient looks toxic, admit to workup myocarditis
youtube.com/shorts/jI6Zp...
#EMIMCC
Anand Swaminathan
@emswami.bsky.social
· Sep 24
Replace Blood With Blood #emergencymedicine #criticalcare #trauma
YouTube video by EMSwami
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Replace blood w/ blood
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors
youtube.com/shorts/u0J9i...
#EMIMCC
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors
youtube.com/shorts/u0J9i...
#EMIMCC