@IM_Crit_
@imcrit.bsky.social
Intensivist I Internal Medicine | ☕️, 🍩, 🥐, 🍫 addict |
#emimcc
#emimcc
In science, the most beautiful theory can be slayed by an ugly fact. In medicine, a beautiful therapy can be killed by an ugly trial
February 14, 2026 at 11:52 PM
In science, the most beautiful theory can be slayed by an ugly fact. In medicine, a beautiful therapy can be killed by an ugly trial
Public Health message:
RFK Jr: I'm not scared of a germ. I used to snort cocaine off of toilet seats.
February 13, 2026 at 2:47 AM
Public Health message:
Reposted by @IM_Crit_
Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts:
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
February 6, 2026 at 8:07 PM
Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts:
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
Reposted by @IM_Crit_
#Bronchoscopy:
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
February 7, 2026 at 4:52 PM
#Bronchoscopy:
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Reposted by @IM_Crit_
ICU Secrets:
“If you aren’t escalating care, you should start de-escalating”...
“If you aren’t escalating care, you should start de-escalating”...
February 8, 2026 at 2:17 PM
ICU Secrets:
“If you aren’t escalating care, you should start de-escalating”...
“If you aren’t escalating care, you should start de-escalating”...
Reposted by @IM_Crit_
The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc
February 8, 2026 at 4:37 PM
The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc
The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc
February 8, 2026 at 4:37 PM
The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc
ICU Secrets:
“If you aren’t escalating care, you should start de-escalating”...
“If you aren’t escalating care, you should start de-escalating”...
February 8, 2026 at 2:17 PM
ICU Secrets:
“If you aren’t escalating care, you should start de-escalating”...
“If you aren’t escalating care, you should start de-escalating”...
#Bronchoscopy:
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
February 7, 2026 at 4:52 PM
#Bronchoscopy:
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients?
The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings
Reposted by @IM_Crit_
February 7, 2026 at 4:29 AM
February 7, 2026 at 4:29 AM
Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts:
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
February 6, 2026 at 8:07 PM
Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts:
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):
“If you know the question, you know half”
H. Boyer
H. Boyer
February 6, 2026 at 3:31 AM
“If you know the question, you know half”
H. Boyer
H. Boyer
Temporary MCS:
Abiomed issued an Urgent Medical Device Correction with updated use instructions for all Impella RP with SmartAssist and Impella RP Flex with SmartAssist devices
www.fda.gov/medical-devi...
Abiomed issued an Urgent Medical Device Correction with updated use instructions for all Impella RP with SmartAssist and Impella RP Flex with SmartAssist devices
www.fda.gov/medical-devi...
Early Alert: Heart Pump Issue from Abiomed
The differential pressure sensor in certain Impella devices may malfunction and cause sensor values to drift.
www.fda.gov
February 5, 2026 at 2:17 PM
Temporary MCS:
Abiomed issued an Urgent Medical Device Correction with updated use instructions for all Impella RP with SmartAssist and Impella RP Flex with SmartAssist devices
www.fda.gov/medical-devi...
Abiomed issued an Urgent Medical Device Correction with updated use instructions for all Impella RP with SmartAssist and Impella RP Flex with SmartAssist devices
www.fda.gov/medical-devi...
On a separate note, the American Society of Echocardiography @ASE360 has one of the least user-friendly websites. In order to either find relevant educational material or claim MOCE/CME credit for completing National Board of Echo requirements, you have to spend 30'...
#pocus
#pocus
February 4, 2026 at 4:43 PM
On a separate note, the American Society of Echocardiography @ASE360 has one of the least user-friendly websites. In order to either find relevant educational material or claim MOCE/CME credit for completing National Board of Echo requirements, you have to spend 30'...
#pocus
#pocus
Reposted by @IM_Crit_
This is how it's done!
BERNIE SANDERS: Do vaccines cause autism?
BHATTACHARYA: I do not believe that the measles vaccine causes autism
SANDERS: Nah. Uh uh. I didn't ask measles. Do vaccines cause autism?
BHATTACHARYA: I have not seen a study that suggests any single vaccine causes autism
BHATTACHARYA: I do not believe that the measles vaccine causes autism
SANDERS: Nah. Uh uh. I didn't ask measles. Do vaccines cause autism?
BHATTACHARYA: I have not seen a study that suggests any single vaccine causes autism
February 4, 2026 at 3:23 AM
This is how it's done!
This is how it's done!
BERNIE SANDERS: Do vaccines cause autism?
BHATTACHARYA: I do not believe that the measles vaccine causes autism
SANDERS: Nah. Uh uh. I didn't ask measles. Do vaccines cause autism?
BHATTACHARYA: I have not seen a study that suggests any single vaccine causes autism
BHATTACHARYA: I do not believe that the measles vaccine causes autism
SANDERS: Nah. Uh uh. I didn't ask measles. Do vaccines cause autism?
BHATTACHARYA: I have not seen a study that suggests any single vaccine causes autism
February 4, 2026 at 3:23 AM
This is how it's done!
According to the guidelines:
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
February 4, 2026 at 2:53 AM
According to the guidelines:
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
"initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"
Reposted by @IM_Crit_
What do you think #cardiosky?
ICU Scenarios:
A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis?
Yes
No
A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis?
Yes
No
February 3, 2026 at 10:07 AM
What do you think #cardiosky?
ICU Scenarios:
A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis?
Yes
No
A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis?
Yes
No
February 3, 2026 at 3:14 AM
ICU Scenarios:
A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis?
Yes
No
A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis?
Yes
No
I know you know but as a friendly reminder:
For patients who are "NPO after midnight" in preparation for a "procedure" the following morning, maintenance IV fluids are generally not indicated... Even the "NPO" is usually an overkill, but this is for another tweet...
#Medsky
For patients who are "NPO after midnight" in preparation for a "procedure" the following morning, maintenance IV fluids are generally not indicated... Even the "NPO" is usually an overkill, but this is for another tweet...
#Medsky
February 3, 2026 at 1:20 AM
I know you know but as a friendly reminder:
For patients who are "NPO after midnight" in preparation for a "procedure" the following morning, maintenance IV fluids are generally not indicated... Even the "NPO" is usually an overkill, but this is for another tweet...
#Medsky
For patients who are "NPO after midnight" in preparation for a "procedure" the following morning, maintenance IV fluids are generally not indicated... Even the "NPO" is usually an overkill, but this is for another tweet...
#Medsky
Reposted by @IM_Crit_
When managing patients with ischemic #stroke, can we please adopt a single BP target? Currently, BP should be <185/110 mmHg prior to thrombolysis & <180/105 after, which feels unnecessarily complicated. Wouldn't it be simpler to use one target, such as <180/100 mmHg, for both?
February 1, 2026 at 4:54 PM
When managing patients with ischemic #stroke, can we please adopt a single BP target? Currently, BP should be <185/110 mmHg prior to thrombolysis & <180/105 after, which feels unnecessarily complicated. Wouldn't it be simpler to use one target, such as <180/100 mmHg, for both?
When managing patients with ischemic #stroke, can we please adopt a single BP target? Currently, BP should be <185/110 mmHg prior to thrombolysis & <180/105 after, which feels unnecessarily complicated. Wouldn't it be simpler to use one target, such as <180/100 mmHg, for both?
February 1, 2026 at 4:54 PM
When managing patients with ischemic #stroke, can we please adopt a single BP target? Currently, BP should be <185/110 mmHg prior to thrombolysis & <180/105 after, which feels unnecessarily complicated. Wouldn't it be simpler to use one target, such as <180/100 mmHg, for both?
Reposted by @IM_Crit_
Updated the acute ischemic stroke chapter based on 2026 ASA/AHA guidelines
Chapter focuses on supportive care (*not* who gets lysis/EVT)
This has not changed very much
Top blue numbered section is designed to be used as a checklist when you settle these pts into ICU
emcrit.org/ibcc/ais/ #EMIMCC
Chapter focuses on supportive care (*not* who gets lysis/EVT)
This has not changed very much
Top blue numbered section is designed to be used as a checklist when you settle these pts into ICU
emcrit.org/ibcc/ais/ #EMIMCC
January 31, 2026 at 7:26 PM
Updated the acute ischemic stroke chapter based on 2026 ASA/AHA guidelines
Chapter focuses on supportive care (*not* who gets lysis/EVT)
This has not changed very much
Top blue numbered section is designed to be used as a checklist when you settle these pts into ICU
emcrit.org/ibcc/ais/ #EMIMCC
Chapter focuses on supportive care (*not* who gets lysis/EVT)
This has not changed very much
Top blue numbered section is designed to be used as a checklist when you settle these pts into ICU
emcrit.org/ibcc/ais/ #EMIMCC
#Minocycline therapy initiated within 72 h of acute ischemic #stroke provided a significant functional outcome benefit compared with placebo at 90 days
#foamed #foamcc #meded #Medsky #emimcc
@pulmcrit.bsky.social has to update the chapter!
www.thelancet.com/journals/lan...
#foamed #foamcc #meded #Medsky #emimcc
@pulmcrit.bsky.social has to update the chapter!
www.thelancet.com/journals/lan...
Efficacy and safety of minocycline in patients with acute ischaemic stroke (EMPHASIS): a multicentre, double-blind, randomised controlled trial
Minocycline therapy initiated within 72 h of acute ischaemic stroke provided a significant
functional outcome benefit compared with placebo at 90 days, without safety concerns.
Future studies are need...
www.thelancet.com
February 1, 2026 at 4:28 PM
#Minocycline therapy initiated within 72 h of acute ischemic #stroke provided a significant functional outcome benefit compared with placebo at 90 days
#foamed #foamcc #meded #Medsky #emimcc
@pulmcrit.bsky.social has to update the chapter!
www.thelancet.com/journals/lan...
#foamed #foamcc #meded #Medsky #emimcc
@pulmcrit.bsky.social has to update the chapter!
www.thelancet.com/journals/lan...