Segun Olusanya (He/Him)
@drfreeze.bsky.social
Aka iceman_ex. Husband, Intensivist, Ultrascoundrel. @ics-updates.bsky.social. All about the #medsky, #foamed and #foamcc. Meme: papers ratio over 9000
Reposted by Segun Olusanya (He/Him)
Medicine has progressed so so far in the past 20yrs.
I do understand the need for in-depth subspecialisation.
Whether it be EP vs interventional or luminal vs hepatology or diabetes vs hormone axis.
there is too much in one field for one person to cover all of.
I agree re post-nominal hurdles.
I do understand the need for in-depth subspecialisation.
Whether it be EP vs interventional or luminal vs hepatology or diabetes vs hormone axis.
there is too much in one field for one person to cover all of.
I agree re post-nominal hurdles.
February 7, 2026 at 10:50 PM
Medicine has progressed so so far in the past 20yrs.
I do understand the need for in-depth subspecialisation.
Whether it be EP vs interventional or luminal vs hepatology or diabetes vs hormone axis.
there is too much in one field for one person to cover all of.
I agree re post-nominal hurdles.
I do understand the need for in-depth subspecialisation.
Whether it be EP vs interventional or luminal vs hepatology or diabetes vs hormone axis.
there is too much in one field for one person to cover all of.
I agree re post-nominal hurdles.
Reposted by Segun Olusanya (He/Him)
Perhaps there’s cultural values here?
Do patients in other countries want their clinician to engage beyond rapid decision making?
Is there an expectation on getting what you pay for?
Are we “less efficient” because we value greater personalisation?
1/3
Do patients in other countries want their clinician to engage beyond rapid decision making?
Is there an expectation on getting what you pay for?
Are we “less efficient” because we value greater personalisation?
1/3
February 7, 2026 at 8:47 AM
Perhaps there’s cultural values here?
Do patients in other countries want their clinician to engage beyond rapid decision making?
Is there an expectation on getting what you pay for?
Are we “less efficient” because we value greater personalisation?
1/3
Do patients in other countries want their clinician to engage beyond rapid decision making?
Is there an expectation on getting what you pay for?
Are we “less efficient” because we value greater personalisation?
1/3
Reposted by Segun Olusanya (He/Him)
Even with training concerns etc, I agree UK produces excellent doctors. No one is perfect, but the fact we are comparatively less influenced by money when decision making for individual patients is so, so valuable. The idea that I am paid the same irrespective of how much I do to a patient is vital.
February 7, 2026 at 8:14 AM
Even with training concerns etc, I agree UK produces excellent doctors. No one is perfect, but the fact we are comparatively less influenced by money when decision making for individual patients is so, so valuable. The idea that I am paid the same irrespective of how much I do to a patient is vital.
Reposted by Segun Olusanya (He/Him)
To paraphrase Inigo Montoyo,
"Pragmatic, they keep using that word, I do not think it means what they think it means."
"Pragmatic, they keep using that word, I do not think it means what they think it means."
February 7, 2026 at 8:42 AM
To paraphrase Inigo Montoyo,
"Pragmatic, they keep using that word, I do not think it means what they think it means."
"Pragmatic, they keep using that word, I do not think it means what they think it means."
Reposted by Segun Olusanya (He/Him)
I currently have two cardiologists from Ningxia Province shadowing me for three months, on a state-sponsored visit to the UK to learn about our (often dysfunctional) healthcare system. It has been absolutely fascinating talking to them, and has reminded me what we do well in the UK >
Many of China’s medical facilities are shoddy, but in recent years its best hospitals have gained top-notch doctors and equipment. For some procedures they are world-class—and usually cheaper than in the West
Why more foreigners are seeking health care in China
The growth of medical tourism is making locals uneasy
econ.st
February 7, 2026 at 7:30 AM
I currently have two cardiologists from Ningxia Province shadowing me for three months, on a state-sponsored visit to the UK to learn about our (often dysfunctional) healthcare system. It has been absolutely fascinating talking to them, and has reminded me what we do well in the UK >
www.jacc.org/doi/epdf/10....
Do we need critical care cardiology in the UK?
Ping @waqasakhtar.bsky.social
Do we need critical care cardiology in the UK?
Ping @waqasakhtar.bsky.social
Modern Cardiac ICU Care Delivery and the Role of the Cardiac ICU Cardiologist
www.jacc.org
February 7, 2026 at 7:58 AM
www.jacc.org/doi/epdf/10....
Do we need critical care cardiology in the UK?
Ping @waqasakhtar.bsky.social
Do we need critical care cardiology in the UK?
Ping @waqasakhtar.bsky.social
Reposted by Segun Olusanya (He/Him)
Totally agree with you Seg
Less MAP
Less fluids
Less vasopressors
And more patience
Less MAP
Less fluids
Less vasopressors
And more patience
February 7, 2026 at 7:34 AM
Totally agree with you Seg
Less MAP
Less fluids
Less vasopressors
And more patience
Less MAP
Less fluids
Less vasopressors
And more patience
Reposted by Segun Olusanya (He/Him)
The term 'refractory' is often just an excuse to try crazy things that come out of nowhere.
And the lower we set the refractory threshold, the more crazy things we can do.
Thank God patients are strong and resilient.
And the lower we set the refractory threshold, the more crazy things we can do.
Thank God patients are strong and resilient.
February 7, 2026 at 7:19 AM
The term 'refractory' is often just an excuse to try crazy things that come out of nowhere.
And the lower we set the refractory threshold, the more crazy things we can do.
Thank God patients are strong and resilient.
And the lower we set the refractory threshold, the more crazy things we can do.
Thank God patients are strong and resilient.
Refractory septic shock: our pragmatic approach
AKA the “Tommy’s Tonic”
Now updated for 2026
link.springer.com/content/pdf/...
Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social
AKA the “Tommy’s Tonic”
Now updated for 2026
link.springer.com/content/pdf/...
Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social
link.springer.com
February 7, 2026 at 6:49 AM
Refractory septic shock: our pragmatic approach
AKA the “Tommy’s Tonic”
Now updated for 2026
link.springer.com/content/pdf/...
Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social
AKA the “Tommy’s Tonic”
Now updated for 2026
link.springer.com/content/pdf/...
Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social
Reposted by Segun Olusanya (He/Him)
Reposted by Segun Olusanya (He/Him)
Some correspondence from a retired academic lawyer on consent!
"... the law, while dynamic, is almost always reactive. Expecting it to change to fit a particular narrative is likely to end in disappointment."
#AnSky #LawSky
doi.org/10.1111/anae...
"... the law, while dynamic, is almost always reactive. Expecting it to change to fit a particular narrative is likely to end in disappointment."
#AnSky #LawSky
doi.org/10.1111/anae...
February 6, 2026 at 4:27 PM
Some correspondence from a retired academic lawyer on consent!
"... the law, while dynamic, is almost always reactive. Expecting it to change to fit a particular narrative is likely to end in disappointment."
#AnSky #LawSky
doi.org/10.1111/anae...
"... the law, while dynamic, is almost always reactive. Expecting it to change to fit a particular narrative is likely to end in disappointment."
#AnSky #LawSky
doi.org/10.1111/anae...
Reposted by Segun Olusanya (He/Him)
On our ICU, the cons of the week does teaching most days. As my colleagues cover most clinical topics, I focus on management, leadership and education.
Or as I described it the other day "hi, I'm Raj and I like to teach about abstract nouns".
Or as I described it the other day "hi, I'm Raj and I like to teach about abstract nouns".
February 6, 2026 at 6:01 AM
On our ICU, the cons of the week does teaching most days. As my colleagues cover most clinical topics, I focus on management, leadership and education.
Or as I described it the other day "hi, I'm Raj and I like to teach about abstract nouns".
Or as I described it the other day "hi, I'm Raj and I like to teach about abstract nouns".
Reposted by Segun Olusanya (He/Him)
"The greatest flaw in clinical medicine might be our desire to banish uncertainty."
In this Editor's Choice, @kamranabbasi.bsky.social reflects on the tyranny of clinical fear
www.bmj.com/content/392/...
In this Editor's Choice, @kamranabbasi.bsky.social reflects on the tyranny of clinical fear
www.bmj.com/content/392/...
February 5, 2026 at 5:14 PM
"The greatest flaw in clinical medicine might be our desire to banish uncertainty."
In this Editor's Choice, @kamranabbasi.bsky.social reflects on the tyranny of clinical fear
www.bmj.com/content/392/...
In this Editor's Choice, @kamranabbasi.bsky.social reflects on the tyranny of clinical fear
www.bmj.com/content/392/...
Reposted by Segun Olusanya (He/Him)
So you learn how to be skilled at that. I couldn’t make you better, but that does not mean you are abandoned. I said it, I meant it and I did it. I am happy to grasp that nettle because of the relief it brings to the family and the certainty it brings to the referring team.
February 5, 2026 at 9:35 AM
So you learn how to be skilled at that. I couldn’t make you better, but that does not mean you are abandoned. I said it, I meant it and I did it. I am happy to grasp that nettle because of the relief it brings to the family and the certainty it brings to the referring team.
Reposted by Segun Olusanya (He/Him)
Nobody is happy, so put that to the fore. Make your case to the team, and, make it to the family. You are managing more than on social unit. We get good at it because we get a lot of practice at an uncomfortable art hidden in plain sight. In my unit 3 or 4 people would die a week.
February 5, 2026 at 9:32 AM
Nobody is happy, so put that to the fore. Make your case to the team, and, make it to the family. You are managing more than on social unit. We get good at it because we get a lot of practice at an uncomfortable art hidden in plain sight. In my unit 3 or 4 people would die a week.
Reposted by Segun Olusanya (He/Him)
Lots of time it seems that the referring team is looking for absolution. We’ll do everything but ICU said no, so now we can’t. You are right to say it is not very brave. Other times the referring team is just going to keep chopping at the tree in front of them as the forest burns. …
February 5, 2026 at 9:20 AM
Lots of time it seems that the referring team is looking for absolution. We’ll do everything but ICU said no, so now we can’t. You are right to say it is not very brave. Other times the referring team is just going to keep chopping at the tree in front of them as the forest burns. …
Reposted by Segun Olusanya (He/Him)
Is STOP-BANG too subjective? Is there an alternative?
The B-APNEIC score showed strong predictive accuracy for severe obstructive sleep apnoea and could serve as a simple, objective alternative to STOP-BANG.
#AnSky
doi.org/10.1111/anae...
The B-APNEIC score showed strong predictive accuracy for severe obstructive sleep apnoea and could serve as a simple, objective alternative to STOP-BANG.
#AnSky
doi.org/10.1111/anae...
February 5, 2026 at 9:06 AM
Is STOP-BANG too subjective? Is there an alternative?
The B-APNEIC score showed strong predictive accuracy for severe obstructive sleep apnoea and could serve as a simple, objective alternative to STOP-BANG.
#AnSky
doi.org/10.1111/anae...
The B-APNEIC score showed strong predictive accuracy for severe obstructive sleep apnoea and could serve as a simple, objective alternative to STOP-BANG.
#AnSky
doi.org/10.1111/anae...
Reposted by Segun Olusanya (He/Him)
referring cons. Think if there's this much complexity, both cons should review the pt at the bedside, regardless of time.
Sadly, an older cons colleague would frequently ask this of physicians. In however many years, only gone in once on this basis.
Sadly, an older cons colleague would frequently ask this of physicians. In however many years, only gone in once on this basis.
February 5, 2026 at 6:21 AM
referring cons. Think if there's this much complexity, both cons should review the pt at the bedside, regardless of time.
Sadly, an older cons colleague would frequently ask this of physicians. In however many years, only gone in once on this basis.
Sadly, an older cons colleague would frequently ask this of physicians. In however many years, only gone in once on this basis.
Reposted by Segun Olusanya (He/Him)
I work in a small team of cons so usually if it's going to be cons-cons discussion, it will be a multiconsultant discussion. Plus, we would (I hope) always inform pt's of ceilings of care before they leave ICU. That's just standard practice, right?
I'm not really sure what to do about the random
I'm not really sure what to do about the random
February 5, 2026 at 6:21 AM
I work in a small team of cons so usually if it's going to be cons-cons discussion, it will be a multiconsultant discussion. Plus, we would (I hope) always inform pt's of ceilings of care before they leave ICU. That's just standard practice, right?
I'm not really sure what to do about the random
I'm not really sure what to do about the random
Reposted by Segun Olusanya (He/Him)
Missed this very interesting discussion. Great points made esp re communication. I fear this ‘decision paralysis’ (ie “I can’t possibly decide this pt with severe COPD should not go to ICU, ICU team to review and discuss with family” is plain old defensive medicine. It’s poor care.
February 5, 2026 at 7:00 AM
Missed this very interesting discussion. Great points made esp re communication. I fear this ‘decision paralysis’ (ie “I can’t possibly decide this pt with severe COPD should not go to ICU, ICU team to review and discuss with family” is plain old defensive medicine. It’s poor care.
Reposted by Segun Olusanya (He/Him)
Strongly feel parent team should take ownership. By all means have the discussion but this US-style idea that we are hopelessly subspecialised and cannot make rudimentary decisions about other areas is a bad trend. Disagreement is part of medicine; it should be resolved prior to discussing with pt
February 5, 2026 at 7:00 AM
Strongly feel parent team should take ownership. By all means have the discussion but this US-style idea that we are hopelessly subspecialised and cannot make rudimentary decisions about other areas is a bad trend. Disagreement is part of medicine; it should be resolved prior to discussing with pt
Reposted by Segun Olusanya (He/Him)
one of my strongest beliefs is that we're in our situation right now bc some of the most prominent talking heads (e.g. joe rogan, andrew schulz) are learning about politics in their 40s and 50s, instead of their teens and early 20s, and we have to go along for the ride as they learn basic things
February 4, 2026 at 10:10 PM
one of my strongest beliefs is that we're in our situation right now bc some of the most prominent talking heads (e.g. joe rogan, andrew schulz) are learning about politics in their 40s and 50s, instead of their teens and early 20s, and we have to go along for the ride as they learn basic things
Reposted by Segun Olusanya (He/Him)
It can be impossible to know which patient will buck the trend.
One patient I arranged an emergency same day wedding for is still alive 2 years later.
For some families we need to be blunt to help them understand their loved one is dying- inevitably there will be some we get wrong
One patient I arranged an emergency same day wedding for is still alive 2 years later.
For some families we need to be blunt to help them understand their loved one is dying- inevitably there will be some we get wrong
February 4, 2026 at 10:43 PM
It can be impossible to know which patient will buck the trend.
One patient I arranged an emergency same day wedding for is still alive 2 years later.
For some families we need to be blunt to help them understand their loved one is dying- inevitably there will be some we get wrong
One patient I arranged an emergency same day wedding for is still alive 2 years later.
For some families we need to be blunt to help them understand their loved one is dying- inevitably there will be some we get wrong
Savage
Sans discuter de l'utilité des stroke units ambulantes...
Sans même discuter du critère de jugement principal bizarre...
ON PEUT CONCLURE AVEC CERTITUDE QUE L'EXAMEN NEUROLOGIQUE PAR UN NEUROLOGUE NE SERT A RIEN, HEIN MON @qffwffq.bsky.social 😈
Sans même discuter du critère de jugement principal bizarre...
ON PEUT CONCLURE AVEC CERTITUDE QUE L'EXAMEN NEUROLOGIQUE PAR UN NEUROLOGUE NE SERT A RIEN, HEIN MON @qffwffq.bsky.social 😈
In mobile stroke units, a teleneurologist model of care is superior to an onboard neurologist model based on a composite hierarchical outcome of safety, timeliness, and physician efficiency. Learn more in an article published in 𝘕𝘌𝘑𝘔 𝘌𝘷𝘪𝘥𝘦𝘯𝘤𝘦: eviden.cc/4pYer7x
#MedSky #NeuroSky
#MedSky #NeuroSky
February 4, 2026 at 10:45 PM
Savage
Reposted by Segun Olusanya (He/Him)
Completely agree with you Dr Mannix.
I think most ICUs are great at this.
Really glad to see GPICSv3 also heavily invested in good EoL care.
My shared frustration is the walking away following a decision without providing the closure needed.
I think most ICUs are great at this.
Really glad to see GPICSv3 also heavily invested in good EoL care.
My shared frustration is the walking away following a decision without providing the closure needed.
February 4, 2026 at 7:40 PM
Completely agree with you Dr Mannix.
I think most ICUs are great at this.
Really glad to see GPICSv3 also heavily invested in good EoL care.
My shared frustration is the walking away following a decision without providing the closure needed.
I think most ICUs are great at this.
Really glad to see GPICSv3 also heavily invested in good EoL care.
My shared frustration is the walking away following a decision without providing the closure needed.