Josh Kimbrell
@joshkimbre.bsky.social
Paramedic and medical student interested in resuscitation science and health equity. #Medsky
Reposted by Josh Kimbrell
Phenomenal write up for anyone working in EMS/Code Team/RRT quality and safety. I will be referencing this. TCP is always thrown out as "what they should have done"-- but lit is showing this is a low success maneuver. I'll still do it-- but good to escalate chronotropes and prep for TVP.
Transcutaneous pacing (TCP) is an intervention for unstable bradycardia. Electrical stimulus is provided ~1/s to increase heart rate. With transvenous pacers and chronotropic meds, TCP is mostly limited to the prehospital setting and low-resource centers.
We suck at TCP. #emimcc #medsky #cardiosky
We suck at TCP. #emimcc #medsky #cardiosky
January 11, 2026 at 7:20 PM
Phenomenal write up for anyone working in EMS/Code Team/RRT quality and safety. I will be referencing this. TCP is always thrown out as "what they should have done"-- but lit is showing this is a low success maneuver. I'll still do it-- but good to escalate chronotropes and prep for TVP.
Transcutaneous pacing (TCP) is an intervention for unstable bradycardia. Electrical stimulus is provided ~1/s to increase heart rate. With transvenous pacers and chronotropic meds, TCP is mostly limited to the prehospital setting and low-resource centers.
We suck at TCP. #emimcc #medsky #cardiosky
We suck at TCP. #emimcc #medsky #cardiosky
January 10, 2026 at 12:12 AM
Transcutaneous pacing (TCP) is an intervention for unstable bradycardia. Electrical stimulus is provided ~1/s to increase heart rate. With transvenous pacers and chronotropic meds, TCP is mostly limited to the prehospital setting and low-resource centers.
We suck at TCP. #emimcc #medsky #cardiosky
We suck at TCP. #emimcc #medsky #cardiosky
Reposted by Josh Kimbrell
If you're going to use transcutaneous pacing, dial up the milliamps!
That dial goes up above 100 for a reason.
Study headed up by Tanner Smida and @joshkimbre.bsky.social
(COI: I'm co-author 8/13)
www.resuscitationjournal.com/article/S030...
That dial goes up above 100 for a reason.
Study headed up by Tanner Smida and @joshkimbre.bsky.social
(COI: I'm co-author 8/13)
www.resuscitationjournal.com/article/S030...
![Methods
Four emergency medical services agencies contributed patients who received TCP from 2017-2024. Data were abstracted from electronic health records and cardiac monitor files. Sustained electrical capture was defined as a wide QRS complex with a T-wave after each pacer impulse for at least 90% of a 60 second period, followed by electrical capture for 90% of the remainder of the TCP attempt. Multivariable logistic regression modeling was used to estimate the association between variables of interest and sustained electrical capture.
Results
Of 299 patients, 29 (9.7%) had sustained electrical capture. Our cohort was a median 73 [62, 82] years of age, 48.5% (n=145) female, and 33.8% (n=101) had post-ROSC TCP. The median body weight was 78.3 [68-95.3] kilograms, pre-TCP heart rate was 38 [30, 45] beats per minute (bpm) and maximum TCP current was 90 [70-110] mA. Lower weight (aOR: 0.95 [0.93, 0.98] per kg; n=208), lower pre-TCP heart rate (aOR: 0.96 [0.93, 0.99] per bpm; n=297), and higher delivered current (aOR: 1.25 [1.08, 1.45] per 10 mA; n=208) were associated with higher odds of sustained electrical capture](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:vim26qfkrqvvp65z6eajaldy/bafkreibao6j6lnpvohxzenrynrurpespsi7dliggsajwmye67z5lafkmry@jpeg)
December 25, 2025 at 8:33 PM
If you're going to use transcutaneous pacing, dial up the milliamps!
That dial goes up above 100 for a reason.
Study headed up by Tanner Smida and @joshkimbre.bsky.social
(COI: I'm co-author 8/13)
www.resuscitationjournal.com/article/S030...
That dial goes up above 100 for a reason.
Study headed up by Tanner Smida and @joshkimbre.bsky.social
(COI: I'm co-author 8/13)
www.resuscitationjournal.com/article/S030...
Reposted by Josh Kimbrell
When intubating with VL, the cords should be as far away as possible, while still visible. Large cords=close camera=blocked tube delivery. #EMsky #EMS @mdaware.org @joshkimbre.bsky.social
November 21, 2025 at 1:16 AM
When intubating with VL, the cords should be as far away as possible, while still visible. Large cords=close camera=blocked tube delivery. #EMsky #EMS @mdaware.org @joshkimbre.bsky.social
Been away for awhile having the time of my life. I usually stick to medicine here but figured y'all could take a peek at my personal life today.
November 16, 2025 at 2:51 PM
Been away for awhile having the time of my life. I usually stick to medicine here but figured y'all could take a peek at my personal life today.
Reposted by Josh Kimbrell
you couldn't waterboard this out of me
October 30, 2025 at 3:24 PM
you couldn't waterboard this out of me
Reposted by Josh Kimbrell
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
October 29, 2025 at 3:19 PM
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
Reposted by Josh Kimbrell
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
October 29, 2025 at 3:37 PM
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 Josh Kimbrell
Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.
"One intangible advantage of capillary refill time is that performing it brings the clinician back to the bedside to reassess the patient. This act may be itself the holy grail of early sepsis management."
great piece on #sepsis
great piece on #sepsis
💬 Editorial: While capillary refill time shows promise for early #SepticShock management, integrating it into broader, multimodal resuscitation strategies remains key to improving outcomes.
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
October 29, 2025 at 4:08 PM
Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.
Reposted by Josh Kimbrell
New ACLS guidelines highlight the perils of failed capture during pacing.
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
October 26, 2025 at 3:45 PM
New ACLS guidelines highlight the perils of failed capture during pacing.
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
@joshkimbre.bsky.social
Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines share.google/43YFnH7VcuFJ...
I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...
authors.elsevier.com
August 25, 2025 at 6:08 PM
I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...
Reposted by Josh Kimbrell
The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine.
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
July 5, 2025 at 4:06 AM
The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine.
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.
Available: paramedicinejournal.org
Reposted by Josh Kimbrell
📢 Check out our study in Academic Emergency Medicine: Systematic review of +32K patients in US EDs finds:
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
June 17, 2025 at 3:37 PM
📢 Check out our study in Academic Emergency Medicine: Systematic review of +32K patients in US EDs finds:
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...
Reposted by Josh Kimbrell
Wow 😳
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Among patients with opioid-associated out-of-hospital cardiac arrest, chest compression and ventilation CPR was associated with a higher odds of favorable neurologic outcomes at hospital discharge.
ja.ma/4l7We4q
ja.ma/4l7We4q
June 17, 2025 at 4:54 PM
Wow 😳
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.
In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC
Reposted by Josh Kimbrell
Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
onlinelibrary.wiley.com
June 3, 2025 at 12:03 PM
Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...
buffalo.zoom.us/j/9848537719...
April 9, 2025 at 1:42 PM
Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...
buffalo.zoom.us/j/9848537719...
Why is Transcutaneous Pacing so difficult, and how can we do it better?
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
Episode 179 - Transcutaneous Pacing Pearls and Pitfalls
MCHD Paramedic Podcast · Episode
open.spotify.com
March 24, 2025 at 11:31 PM
Why is Transcutaneous Pacing so difficult, and how can we do it better?
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!
#EMSSky
open.spotify.com/episode/2rji...
We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest.
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
Measuring Intra-Arrest Transport in Out-of-Hospital Cardiac Arrest: A Methodological Study of Registry-Compatible Definitions
For out-of-hospital cardiac arrest (OHCA) with refractory arrest, transport to hospital with ongoing cardiopulmonary resuscitation (CPR)—“intra-arrest…
www.sciencedirect.com
February 6, 2025 at 1:37 AM
We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest.
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
#EMSsky #emimcc
www.sciencedirect.com/science/arti...
We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023.
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
Prehospital Cricothyrotomy for Emergency Airway Management
www.sciencedirect.com
February 6, 2025 at 1:28 AM
We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023.
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful
www.sciencedirect.com/science/arti...
#EMSsky #EMIMCC
Reposted by Josh Kimbrell
If you have a patient arrive with a STEMI who took their daily 81mg aspirin that morning, how much more do you give them?
I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost
#Pharmsky #EMsky #Medsky
I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost
#Pharmsky #EMsky #Medsky
January 24, 2025 at 2:13 AM
Reposted by Josh Kimbrell
Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky
Study: Only 25% of pulse oximeters tested for skin-tone bias post-FDA guidance
These devices, crucial for measuring blood oxygen levels, have shown discrepancies in accuracy when used on darker skin, leading to potential health risks for non-white patients, the study states
www.ems1.com
January 13, 2025 at 7:29 PM
Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky
Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
January 12, 2025 at 1:05 AM
Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025.
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
January 9, 2025 at 5:28 PM
Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025.
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"What do I do if I'm concerned about someone's drinking? Speak up!"
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
January 9, 2025 at 5:17 PM
"What do I do if I'm concerned about someone's drinking? Speak up!"
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
Dr. Ventura describes being shocked when her colleagues were concerned about her alcohol use. Speak up if you're concerned.
#NAEMSP2025 #EMSsky
"It's okay to not be okay."
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
January 9, 2025 at 5:06 PM
"It's okay to not be okay."
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky
Taking time to be at your best will make you a better physician/paramedic, and if you're suffering with substance use, PTSD, and burnout as an EMS clinician--you're not alone.
Dr. Amanda Ventura at #NAEMSP2025 presents a powerful talk on alcohol in medicine. #EMSsky