Pete Hart
@intensiveperson.bsky.social
Reposted by Pete Hart
Sustained, exhaled carbon dioxide by waveform capnography is an essential component of tracheal intubation.
But what if there is bronchospasm?
Tracheal intubation can be confirmed using flexible bronchoscopy.
#AnSky
doi.org/10.1002/anr3...
But what if there is bronchospasm?
Tracheal intubation can be confirmed using flexible bronchoscopy.
#AnSky
doi.org/10.1002/anr3...
October 24, 2025 at 10:02 AM
Sustained, exhaled carbon dioxide by waveform capnography is an essential component of tracheal intubation.
But what if there is bronchospasm?
Tracheal intubation can be confirmed using flexible bronchoscopy.
#AnSky
doi.org/10.1002/anr3...
But what if there is bronchospasm?
Tracheal intubation can be confirmed using flexible bronchoscopy.
#AnSky
doi.org/10.1002/anr3...
This week in RSI news: www.judiciary.uk/prevention-o...
William King: Prevention of future deaths report - Courts and Tribunals Judiciary
Date of report: 08/10/2025 Ref: 2025-0496 Deceased name: William King Coroner name: Sean Cummings Coroner Area: Milton Keynes Category: Hospital Death (Clinical Procedures and medical management) rel...
www.judiciary.uk
October 21, 2025 at 9:13 PM
This week in RSI news: www.judiciary.uk/prevention-o...
Reposted by Pete Hart
The amazing team at @sciencevs.bsky.social dropped a #Tylenol podcast a few days ago, giving explanation of why the link has been made and how it's not quite as it seems
A great example of bias and confounding, and how meta-analysis isn't always the pinnacle of evidence
#EpiSky #MedSky
A great example of bias and confounding, and how meta-analysis isn't always the pinnacle of evidence
#EpiSky #MedSky
Does Tylenol Cause Autism?
Podcast Episode · Science Vs · 09/18/2025 · 28m
podcasts.apple.com
September 22, 2025 at 10:28 PM
The amazing team at @sciencevs.bsky.social dropped a #Tylenol podcast a few days ago, giving explanation of why the link has been made and how it's not quite as it seems
A great example of bias and confounding, and how meta-analysis isn't always the pinnacle of evidence
#EpiSky #MedSky
A great example of bias and confounding, and how meta-analysis isn't always the pinnacle of evidence
#EpiSky #MedSky
This has been a long time coming. However, there is a, bizarre lack of emphasis (as in 2016) on confirmation of venous placement, with plenty of words dedicated to tip positioning on CXR and only one reference to pressure transduction (seemingly as a preliminary check where the CXR will be (1/2)
Should you request a PICC, a tunnelled CVC or a midline for your patient?
What factors should influence your choice of vascular access device?
#AnSky #MedSky
doi.org/10.1111/anae...
What factors should influence your choice of vascular access device?
#AnSky #MedSky
doi.org/10.1111/anae...
September 20, 2025 at 8:11 PM
This has been a long time coming. However, there is a, bizarre lack of emphasis (as in 2016) on confirmation of venous placement, with plenty of words dedicated to tip positioning on CXR and only one reference to pressure transduction (seemingly as a preliminary check where the CXR will be (1/2)
Just a little too late for last week's #MedSkyDebate! Look forward to digging into this... Thanks to @medicluke.bsky.social for sharing it.
Pre-hospital placement of a large-calibre central venous catheter can be a life-saving measure.
The insertion site attempted most frequently was the right subclavian vein using a landmark-guided technique.
#AnSky #MedSky
doi.org/10.1111/anae...
The insertion site attempted most frequently was the right subclavian vein using a landmark-guided technique.
#AnSky #MedSky
doi.org/10.1111/anae...
September 15, 2025 at 8:09 PM
Just a little too late for last week's #MedSkyDebate! Look forward to digging into this... Thanks to @medicluke.bsky.social for sharing it.
Reposted by Pete Hart
If you wanted to minimise risk of awareness, we could give our patients enough anaesthesia to be at near burst suppression, but then what would be the NNT and what harms would we cause from this?
September 6, 2025 at 12:32 PM
If you wanted to minimise risk of awareness, we could give our patients enough anaesthesia to be at near burst suppression, but then what would be the NNT and what harms would we cause from this?
Reposted by Pete Hart
If however you accept Pandit's definition of anaesthesia - "a chemically induced state which renders surgery acceptable to the patient" - then you can have awareness and even recall under anaesthesia provided those conditions are concurrently and subsequently acceptable to the patient.
September 5, 2025 at 9:48 PM
If however you accept Pandit's definition of anaesthesia - "a chemically induced state which renders surgery acceptable to the patient" - then you can have awareness and even recall under anaesthesia provided those conditions are concurrently and subsequently acceptable to the patient.
Reposted by Pete Hart
Our practice of anaesthesia has been empirically derived over the last two centuries.
We have yet to identify the neurophysiological basis of anaesthesia because we have yet to identify the neurophysiological basis of consciousness.
So what we do is fundamentally a sophisticated guess.
We have yet to identify the neurophysiological basis of anaesthesia because we have yet to identify the neurophysiological basis of consciousness.
So what we do is fundamentally a sophisticated guess.
September 5, 2025 at 9:09 PM
Our practice of anaesthesia has been empirically derived over the last two centuries.
We have yet to identify the neurophysiological basis of anaesthesia because we have yet to identify the neurophysiological basis of consciousness.
So what we do is fundamentally a sophisticated guess.
We have yet to identify the neurophysiological basis of anaesthesia because we have yet to identify the neurophysiological basis of consciousness.
So what we do is fundamentally a sophisticated guess.
Hey @chrimesy.com, we tried really hard to finally write a case report that doesn't massively misrepresent the PUMA guidance: how did we do? 🫣😜 (Congrats @jrobinson22.bsky.social on your first publication!)
onlinelibrary.wiley.com/share/author...
onlinelibrary.wiley.com/share/author...
onlinelibrary.wiley.com
August 27, 2025 at 4:15 PM
Hey @chrimesy.com, we tried really hard to finally write a case report that doesn't massively misrepresent the PUMA guidance: how did we do? 🫣😜 (Congrats @jrobinson22.bsky.social on your first publication!)
onlinelibrary.wiley.com/share/author...
onlinelibrary.wiley.com/share/author...
The Mallampati classification is considered by many to be a core part of airway assessment, but it has poor inter-rater reliability; this may in part stem from the myriad conflicting versions in textbooks and other resources. I'll start this #badmallampati thread with the OG descriptions:
That’s a bit different from the original 1985 description.
Even after 3 got altered & 4 added w the Samsoon modification in 1987, I’ve never heard of the tonsils getting involved!
Even after 3 got altered & 4 added w the Samsoon modification in 1987, I’ve never heard of the tonsils getting involved!
August 1, 2025 at 1:12 PM
The Mallampati classification is considered by many to be a core part of airway assessment, but it has poor inter-rater reliability; this may in part stem from the myriad conflicting versions in textbooks and other resources. I'll start this #badmallampati thread with the OG descriptions:
Reposted by Pete Hart
I think this is the crucial thing. Drawing up emergency drugs isn't about the physical act of drawing up drugs. It's about cognitive load in a high-stress situations.
July 13, 2025 at 4:05 PM
I think this is the crucial thing. Drawing up emergency drugs isn't about the physical act of drawing up drugs. It's about cognitive load in a high-stress situations.
Reposted by Pete Hart
As an ethnic minority in the UK where there is a rise in right-wing populism, I'd like to stake my credentials as a citizen on the basis that when asked what emergency drugs I draw up for anaesthesia, rather than picking vasopressors or muscle relaxants, I said "tea".
July 12, 2025 at 12:14 PM
As an ethnic minority in the UK where there is a rise in right-wing populism, I'd like to stake my credentials as a citizen on the basis that when asked what emergency drugs I draw up for anaesthesia, rather than picking vasopressors or muscle relaxants, I said "tea".
Reposted by Pete Hart
I’m petrified about today’s science news. Genetically modifying crabs to have cheetah genes? This could go sideways fast.
July 8, 2025 at 9:45 AM
I’m petrified about today’s science news. Genetically modifying crabs to have cheetah genes? This could go sideways fast.
Reposted by Pete Hart
The challenges of using ultrasound to measure the trachea: a brief report
#pocus #airway
ccforum.biomedcentral.com/articles/10....
#pocus #airway
ccforum.biomedcentral.com/articles/10....
The challenges of using ultrasound to measure the trachea: a brief report - Critical Care
Background Tracheostomy is a common procedure in intensive care medicine, involving the insertion of an artificial airway through the front of the neck into the trachea. The size of tracheostomy tube ...
ccforum.biomedcentral.com
July 7, 2025 at 10:49 AM
The challenges of using ultrasound to measure the trachea: a brief report
#pocus #airway
ccforum.biomedcentral.com/articles/10....
#pocus #airway
ccforum.biomedcentral.com/articles/10....
Nice study confirming my prior beliefs about ketamine and its role in reducing post-op delirium. Unmeasured confounding always a possibility but pretty impressive efforts made to minimise this! TL;DR optimum intra-op ketamine dose to reduce delirium risk (compared to no ket) is 0.25-0.34mg/kg ABW.
Does the use of intraoperative ketamine affect the incidence of postoperative delirium?
Does the dose matter?
Compared with patients not receiving ketamine, a low dose (≤ 0.35 mg.kg-1) was associated with lower risks of postoperative delirium.
#AnSky #PainSky #MedSky
doi.org/10.1111/anae...
Does the dose matter?
Compared with patients not receiving ketamine, a low dose (≤ 0.35 mg.kg-1) was associated with lower risks of postoperative delirium.
#AnSky #PainSky #MedSky
doi.org/10.1111/anae...
July 7, 2025 at 8:54 AM
Nice study confirming my prior beliefs about ketamine and its role in reducing post-op delirium. Unmeasured confounding always a possibility but pretty impressive efforts made to minimise this! TL;DR optimum intra-op ketamine dose to reduce delirium risk (compared to no ket) is 0.25-0.34mg/kg ABW.
Reposted by Pete Hart
OpenEvidence is generally very good, but it's occasionally horrifically wrong
One place it falls down a lot is drug allergy (where it's often too conservative)
There are NO absolute contraindications to acetylcysteine for acetaminophen OD
Reported "allergy" = anaphylactoid rxns... (#1/3) #EMIMCC
One place it falls down a lot is drug allergy (where it's often too conservative)
There are NO absolute contraindications to acetylcysteine for acetaminophen OD
Reported "allergy" = anaphylactoid rxns... (#1/3) #EMIMCC
July 6, 2025 at 2:26 PM
OpenEvidence is generally very good, but it's occasionally horrifically wrong
One place it falls down a lot is drug allergy (where it's often too conservative)
There are NO absolute contraindications to acetylcysteine for acetaminophen OD
Reported "allergy" = anaphylactoid rxns... (#1/3) #EMIMCC
One place it falls down a lot is drug allergy (where it's often too conservative)
There are NO absolute contraindications to acetylcysteine for acetaminophen OD
Reported "allergy" = anaphylactoid rxns... (#1/3) #EMIMCC
Reposted by Pete Hart
White text on white background instructing LLMs to give positive reviews is apparently now common enough to show up in searches for boilerplate text.
July 5, 2025 at 7:51 PM
White text on white background instructing LLMs to give positive reviews is apparently now common enough to show up in searches for boilerplate text.
Interesting study. Importantly, although the study only excluded obese patients with a BMI >60, they didn't actually recruit any patients with a BMI between 40 and 60. I suspect we can do better at individualising PEEP than simply BMI/3...
Adjustment of positive end-expiratory pressure based on body mass index during general anaesthesia: a randomised controlled trial
#AnSky
doi.org/10.1111/anae...
#AnSky
doi.org/10.1111/anae...
June 25, 2025 at 5:02 PM
Interesting study. Importantly, although the study only excluded obese patients with a BMI >60, they didn't actually recruit any patients with a BMI between 40 and 60. I suspect we can do better at individualising PEEP than simply BMI/3...
Another excellent reason not to use cricoid pressure (badly): the patient perspective.
I was like ‘Shit, this guy is trying to strangle me!’ Then blackness.
June 15, 2025 at 2:06 PM
Another excellent reason not to use cricoid pressure (badly): the patient perspective.
Reposted by Pete Hart
My major concern is ‘ear to sternal notch’ which is misunderstood as being relative to the horizontal rather than coronal plane resulting in neck hyperextension & poor positioning.
(apologies, underscoring your point, the 2nd image was made when I’d understood ramping to mean torso elevation).
(apologies, underscoring your point, the 2nd image was made when I’d understood ramping to mean torso elevation).
June 8, 2025 at 4:23 PM
My major concern is ‘ear to sternal notch’ which is misunderstood as being relative to the horizontal rather than coronal plane resulting in neck hyperextension & poor positioning.
(apologies, underscoring your point, the 2nd image was made when I’d understood ramping to mean torso elevation).
(apologies, underscoring your point, the 2nd image was made when I’d understood ramping to mean torso elevation).
A long overdue (but topical), nuanced and thorough discussion of "RSI" whose final conclusion I happen to entirely agree with. Well done @sthjournalclub.bsky.social
Editorial: Rapid sequence induction: a modern-day example of Theseus' Paradox?
Stept and Safar described ‘rapid induction/intubation’ in 1970.
PUMA recently issued a consensus statement on RSI.
Let's compare.
@sthjournalclub.bsky.social
#AnSky #AirwaySky
doi.org/10.1111/anae...
Stept and Safar described ‘rapid induction/intubation’ in 1970.
PUMA recently issued a consensus statement on RSI.
Let's compare.
@sthjournalclub.bsky.social
#AnSky #AirwaySky
doi.org/10.1111/anae...
May 28, 2025 at 11:11 AM
A long overdue (but topical), nuanced and thorough discussion of "RSI" whose final conclusion I happen to entirely agree with. Well done @sthjournalclub.bsky.social
Reposted by Pete Hart
A normal CT head ≠ a low risk of raised ICP/herniation after LP in meningitis❗️
“80% of pts with ABM who herniate have no CT abnormalities”
🔑 Take-away:
Clinical signs (e.g. GCS <9, seizures, pupil changes) are the best indicators of WHO SHOULD NOT have a LP
journals.sagepub.com/doi/epub/10....
“80% of pts with ABM who herniate have no CT abnormalities”
🔑 Take-away:
Clinical signs (e.g. GCS <9, seizures, pupil changes) are the best indicators of WHO SHOULD NOT have a LP
journals.sagepub.com/doi/epub/10....
Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: An Updated Narrative Review
journals.sagepub.com
May 21, 2025 at 6:49 PM
A normal CT head ≠ a low risk of raised ICP/herniation after LP in meningitis❗️
“80% of pts with ABM who herniate have no CT abnormalities”
🔑 Take-away:
Clinical signs (e.g. GCS <9, seizures, pupil changes) are the best indicators of WHO SHOULD NOT have a LP
journals.sagepub.com/doi/epub/10....
“80% of pts with ABM who herniate have no CT abnormalities”
🔑 Take-away:
Clinical signs (e.g. GCS <9, seizures, pupil changes) are the best indicators of WHO SHOULD NOT have a LP
journals.sagepub.com/doi/epub/10....
Great articles on lactate interpretation. I call lactate a "marker of badness" and even that most nebulous of definitions is only true-ish before you start treatment with things that might cause the lactate to go up, but still help the patient.
New editorial in ICM about the dysutility of lactate as a perfusion goal in sepsis
I reviewed lactate physiology & why it’s not a perfusion index 10 years ago here: https://emcrit.org/pulmcrit/understanding-lactate-in-sepsis-using-it-to-our-advantage/
Talk more in 2035. Nothing will change #EMIMCC
I reviewed lactate physiology & why it’s not a perfusion index 10 years ago here: https://emcrit.org/pulmcrit/understanding-lactate-in-sepsis-using-it-to-our-advantage/
Talk more in 2035. Nothing will change #EMIMCC
May 12, 2025 at 3:40 PM
Great articles on lactate interpretation. I call lactate a "marker of badness" and even that most nebulous of definitions is only true-ish before you start treatment with things that might cause the lactate to go up, but still help the patient.
Reposted by Pete Hart
Assessing fluid responsiveness in spontaneously breathing MV patients is tough, so this work on SIGH35 by Messina et al. is really 👌
▪️ Apply a 35cm H20 ‘sigh breath’ for 4 secs and measure the change in pulse pressure from baseline to nadir
Simples.
1/
ccforum.biomedcentral.com/articles/10....
▪️ Apply a 35cm H20 ‘sigh breath’ for 4 secs and measure the change in pulse pressure from baseline to nadir
Simples.
1/
ccforum.biomedcentral.com/articles/10....
SIGH35 and end-expiratory occlusion test for assessing fluid responsiveness in critically ill patients undergoing pressure support ventilation - Critical Care
Background Assessing fluid responsiveness is problematic for critically ill patients with spontaneous breathing activity, such as during Pressure Support Ventilation (PSV), since spontaneous breathing...
ccforum.biomedcentral.com
May 7, 2025 at 12:29 PM
Assessing fluid responsiveness in spontaneously breathing MV patients is tough, so this work on SIGH35 by Messina et al. is really 👌
▪️ Apply a 35cm H20 ‘sigh breath’ for 4 secs and measure the change in pulse pressure from baseline to nadir
Simples.
1/
ccforum.biomedcentral.com/articles/10....
▪️ Apply a 35cm H20 ‘sigh breath’ for 4 secs and measure the change in pulse pressure from baseline to nadir
Simples.
1/
ccforum.biomedcentral.com/articles/10....
Reposted by Pete Hart
