Simone Gherardi
@drghem.bsky.social
EM doc based in Italy. Here for FOAMed and EM&CC community "Zebras are not unicorns" #Meu
Reposted by Simone Gherardi
DBP and pulse pressure are somewhat redundant. I added pulse pressure but they will generally trend in opposite directions provided the MAP is held in a somewhat fixed position around 70mm
I guess the evaluation of congestion is kinda assumed... also I wanted to de-emphasize the whole fluids thing
I guess the evaluation of congestion is kinda assumed... also I wanted to de-emphasize the whole fluids thing
November 14, 2025 at 1:29 AM
DBP and pulse pressure are somewhat redundant. I added pulse pressure but they will generally trend in opposite directions provided the MAP is held in a somewhat fixed position around 70mm
I guess the evaluation of congestion is kinda assumed... also I wanted to de-emphasize the whole fluids thing
I guess the evaluation of congestion is kinda assumed... also I wanted to de-emphasize the whole fluids thing
"CRT, like a star, is not the destination but a guide for the journey". AS-2 it's not just a trial, it's a manifesto, an act of faith #EMIMCC #Andromeda #AndromedaShock2 #Sepsis
criticalcarereviews.com/blog/current
criticalcarereviews.com/blog/current
Faith, Evidence and the Stars
The most up-to-date critical care website in the world.
criticalcarereviews.com
November 9, 2025 at 9:02 PM
"CRT, like a star, is not the destination but a guide for the journey". AS-2 it's not just a trial, it's a manifesto, an act of faith #EMIMCC #Andromeda #AndromedaShock2 #Sepsis
criticalcarereviews.com/blog/current
criticalcarereviews.com/blog/current
Reposted by Simone Gherardi
ICU Snapshots:
Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU
Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU
November 2, 2025 at 7:55 PM
ICU Snapshots:
Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU
Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU
emcrit.org/pulmcrit/202... #EMIMCC Some @pulmcrit.bsky.social 's highlights about aha vs erc cardiac arrest guidelines #Emcritters
PulmCrit - 2025 AHA & ESICM guidelines on post-arrest care
The ESICM and AHA both just released new guidelines on post-arrest care. It's always interesting when two professionals produce "evidence-based"
emcrit.org
October 27, 2025 at 9:00 PM
emcrit.org/pulmcrit/202... #EMIMCC Some @pulmcrit.bsky.social 's highlights about aha vs erc cardiac arrest guidelines #Emcritters
Reposted by Simone Gherardi
The 2025 European Resuscitation Council Guidelines have been released
All 11 plus the executive summary included below
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
All 11 plus the executive summary included below
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
October 22, 2025 at 12:00 PM
The 2025 European Resuscitation Council Guidelines have been released
All 11 plus the executive summary included below
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
All 11 plus the executive summary included below
CCR Journal Watch
https://criticalcarereviews.com/latest-evidence/journal-watch
September 11, 2025 at 8:09 AM
Reposted by Simone Gherardi
ICU Practice - Return to Basics:
When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient?
Oxygen mask/nasal cannula?
Non-invasive ventilation?
When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient?
Oxygen mask/nasal cannula?
Non-invasive ventilation?
September 2, 2025 at 9:28 PM
ICU Practice - Return to Basics:
When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient?
Oxygen mask/nasal cannula?
Non-invasive ventilation?
When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient?
Oxygen mask/nasal cannula?
Non-invasive ventilation?
Give diuretics as boluses
look at Chloride, k+ and pH
Multimodal diuresis
Not every form of "heart failure" need diuretics in the firsts hours
#EMIMCC
#DiuresisJedi
#Deresuscitation
look at Chloride, k+ and pH
Multimodal diuresis
Not every form of "heart failure" need diuretics in the firsts hours
#EMIMCC
#DiuresisJedi
#Deresuscitation
August 9, 2025 at 3:17 PM
Give diuretics as boluses
look at Chloride, k+ and pH
Multimodal diuresis
Not every form of "heart failure" need diuretics in the firsts hours
#EMIMCC
#DiuresisJedi
#Deresuscitation
look at Chloride, k+ and pH
Multimodal diuresis
Not every form of "heart failure" need diuretics in the firsts hours
#EMIMCC
#DiuresisJedi
#Deresuscitation
A case in which V Tach should be prevented with adrenaline and chronotropism #EMIMCC
ICU/ED Snapshots:
Elderly patient with history of atrial fibrillation / HTN (treated with apixaban & b-blocker) came to the ED complaining of dizziness/weakness. Found to have AKI (creat: 2.0) & hyperkalemia (K: 6.0). BP was 128/59. ECG showed:
Elderly patient with history of atrial fibrillation / HTN (treated with apixaban & b-blocker) came to the ED complaining of dizziness/weakness. Found to have AKI (creat: 2.0) & hyperkalemia (K: 6.0). BP was 128/59. ECG showed:
July 28, 2025 at 8:28 PM
A case in which V Tach should be prevented with adrenaline and chronotropism #EMIMCC
Those "softer" skills usually given for granted or misunderstood, "you have or you dont". In many place where I've trained or worked one spokes about leading as an abstraction and something you don't create or striving for #EMIMCC @emcases.bsky.social
emergencymedicinecases.com/leadership-e...
emergencymedicinecases.com/leadership-e...
Leading: Building Teams, Trust and Purpose in Emergency Medicine
Dr. Thom Mayer, Dr. Carolyn Snider, Dr. Howard Ovens, Dr. Anton Helman discuss: Leading is about action, not designation. We are all leaders. Being consistent, kind, and honest. How vulnerability is p...
emergencymedicinecases.com
June 30, 2025 at 11:52 AM
Those "softer" skills usually given for granted or misunderstood, "you have or you dont". In many place where I've trained or worked one spokes about leading as an abstraction and something you don't create or striving for #EMIMCC @emcases.bsky.social
emergencymedicinecases.com/leadership-e...
emergencymedicinecases.com/leadership-e...
EMCrit Guest Post - In Defense of Dignity by Chris Hicks, MD
Chris Hicks weighs in on dignity
emcrit.org
June 26, 2025 at 12:48 PM
Ketorolac coming at 30 mg per vial 🤯🤯🤯#EMIMCC
short thread: NSAIDs in the ICU
as a rule I avoid NSAIDs due to risks of GI bleeding & especially AKI
but they may be OK for some patients, perhaps… (?)
🤷♂️chronic anuric renal failure
🤷♂️very low illness severity (not truly critically ill; stuck in ICU for logistic/monitoring issues)
🧵#1/3 #EMIMCC
as a rule I avoid NSAIDs due to risks of GI bleeding & especially AKI
but they may be OK for some patients, perhaps… (?)
🤷♂️chronic anuric renal failure
🤷♂️very low illness severity (not truly critically ill; stuck in ICU for logistic/monitoring issues)
🧵#1/3 #EMIMCC
a man in a blue shirt and tie is sitting in a classroom and says " my nemesis "
ALT: a man in a blue shirt and tie is sitting in a classroom and says " my nemesis "
media.tenor.com
June 15, 2025 at 1:51 PM
Ketorolac coming at 30 mg per vial 🤯🤯🤯#EMIMCC
Tracheo emergencies toolbox #EMIMCC youtu.be/-2bFRCx0cFQ?...
Ultimate Guide to Tracheostomy Emergencies: What Every Provider Must Know to Save a Life
YouTube video by The Protected Airway Collaborative
youtu.be
June 14, 2025 at 6:53 PM
Tracheo emergencies toolbox #EMIMCC youtu.be/-2bFRCx0cFQ?...
If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
June 14, 2025 at 9:42 AM
If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
Cardioman, you re right, not a STEMI. But.. need the same care aka straight to the cath lab. Time to change paradigm
#EMIMCC #OMI
#EMIMCC #OMI
61yo M from Ghana. Complaining CP since 3 hours.
This ECG looks tasty. Could mislead a lot of physicians.
@drghem.bsky.social @emcrit.bsky.social @eusem.bsky.social @criticalcarenow.bsky.social
(My first Bluesky post💙)
This ECG looks tasty. Could mislead a lot of physicians.
@drghem.bsky.social @emcrit.bsky.social @eusem.bsky.social @criticalcarenow.bsky.social
(My first Bluesky post💙)
June 7, 2025 at 8:09 PM
Reposted by Simone Gherardi
It's entirely possible that bronchodilation is due to the anticholinergic and ketamine isn't doing anything.
Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well.
Pending further data this seems reasonable.🤷♂️
Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well.
Pending further data this seems reasonable.🤷♂️
June 1, 2025 at 9:57 PM
It's entirely possible that bronchodilation is due to the anticholinergic and ketamine isn't doing anything.
Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well.
Pending further data this seems reasonable.🤷♂️
Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well.
Pending further data this seems reasonable.🤷♂️
Mmmmm love ketamine but always I ve always been skeptical on super powerfull bronchodilatatory properties #EMIMCC
for an intubated asthmatic whose bronchospasm won't break:
high-dose ketamine is good, but it should be given with an anticholinergic.
why give glycopyrrolate?
🤤reduces secretions from ketamine
👊it causes bronchodilation!
so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC
high-dose ketamine is good, but it should be given with an anticholinergic.
why give glycopyrrolate?
🤤reduces secretions from ketamine
👊it causes bronchodilation!
so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC
June 1, 2025 at 8:14 PM
Mmmmm love ketamine but always I ve always been skeptical on super powerfull bronchodilatatory properties #EMIMCC
Keep your ED infusion pump for something else! #EMIMCC
Loop diuretic infusions!
I was disappointed to encounter this recently in a review article on diuretics.
It states that if a patient doesn't respond to a bolus of loop diuretic, then you should try a continuous infusion.
This is a common misconception.
Let's discuss why it's wrong... #EMIMCC
I was disappointed to encounter this recently in a review article on diuretics.
It states that if a patient doesn't respond to a bolus of loop diuretic, then you should try a continuous infusion.
This is a common misconception.
Let's discuss why it's wrong... #EMIMCC
May 28, 2025 at 10:34 AM
Keep your ED infusion pump for something else! #EMIMCC
Inspirational talk for EM DAY 27 may. Add yours
. youtu.be/Au4L3H6oRaI?...
. youtu.be/GFX_tocJShA?...
. youtu.be/crjsmj4G0MU?...
. emcrit.org/odr/should-m...
#EMIMCC
. youtu.be/Au4L3H6oRaI?...
. youtu.be/GFX_tocJShA?...
. youtu.be/crjsmj4G0MU?...
. emcrit.org/odr/should-m...
#EMIMCC
Life 2.0 - What the dead can teach us about living | Matt Morgan | TBS Zermatt 2025
YouTube video by TBS Zermatt
youtu.be
May 27, 2025 at 10:49 AM
Inspirational talk for EM DAY 27 may. Add yours
. youtu.be/Au4L3H6oRaI?...
. youtu.be/GFX_tocJShA?...
. youtu.be/crjsmj4G0MU?...
. emcrit.org/odr/should-m...
#EMIMCC
. youtu.be/Au4L3H6oRaI?...
. youtu.be/GFX_tocJShA?...
. youtu.be/crjsmj4G0MU?...
. emcrit.org/odr/should-m...
#EMIMCC
May 20, 2025 at 8:46 PM
Things we do for no reason.
Kudos to @pulmcrit.bsky.social for the convertion model emcrit.org/pulmcrit/val... and PMID: 37989791 #EMIMCC #FOAMed
Kudos to @pulmcrit.bsky.social for the convertion model emcrit.org/pulmcrit/val... and PMID: 37989791 #EMIMCC #FOAMed
April 28, 2025 at 7:09 PM
Things we do for no reason.
Kudos to @pulmcrit.bsky.social for the convertion model emcrit.org/pulmcrit/val... and PMID: 37989791 #EMIMCC #FOAMed
Kudos to @pulmcrit.bsky.social for the convertion model emcrit.org/pulmcrit/val... and PMID: 37989791 #EMIMCC #FOAMed
April 25, 2025 at 4:22 PM
Sometimes I wonder if it's a toxidrome. Above all this is how EM guidelines should be made, starting from the undifferentiated. I'd just add a section on human factors #EMIMCC #FOAMed #Toxidrome
🚨 New: Best Practice Guidelines with the National Poisons Information Service (NPIS) - Management of Patients with Suspected but Unidentified Poisoning in the Emergency Department.
⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...
⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...
April 22, 2025 at 1:06 PM
Sometimes I wonder if it's a toxidrome. Above all this is how EM guidelines should be made, starting from the undifferentiated. I'd just add a section on human factors #EMIMCC #FOAMed #Toxidrome
For the #EMIMCC community some recent #FOAMed courses that I found very valuable:
.THE BIG SICK 2025 (for the nerdiest) youtube.com/@tbszermatt?...
.Emergency Cardiology Symposium and other #UMEM stuffs youtube.com/@umemergency...
.Paediatric emergecies www.youtube.com/live/eWuXeD2...
What else?
.THE BIG SICK 2025 (for the nerdiest) youtube.com/@tbszermatt?...
.Emergency Cardiology Symposium and other #UMEM stuffs youtube.com/@umemergency...
.Paediatric emergecies www.youtube.com/live/eWuXeD2...
What else?
Paediatric Emergencies 2024 Livestream
YouTube video by Paediatric Emergencies
www.youtube.com
April 20, 2025 at 7:35 PM
For the #EMIMCC community some recent #FOAMed courses that I found very valuable:
.THE BIG SICK 2025 (for the nerdiest) youtube.com/@tbszermatt?...
.Emergency Cardiology Symposium and other #UMEM stuffs youtube.com/@umemergency...
.Paediatric emergecies www.youtube.com/live/eWuXeD2...
What else?
.THE BIG SICK 2025 (for the nerdiest) youtube.com/@tbszermatt?...
.Emergency Cardiology Symposium and other #UMEM stuffs youtube.com/@umemergency...
.Paediatric emergecies www.youtube.com/live/eWuXeD2...
What else?