@klb888.bsky.social
Aging emergency physician, PoCUS tragic, Grandma.
Reposted
October 7, 2025 at 9:23 AM
Reposted
Is it really true that LUS predicts worsening renal function, while measures of venous congestion and right heart function do not? Unlikely. Rather, this is a good teaching example of P-fracking and unfair competition. Follow for my thoughts 👇 #pocusky #cardiosky #emimcc
Lung congestion as assessed by point-of-care ultrasonography was associated with worsening #renalfunction in acute heart failure patients - yet other ultrasound measurements were not. #POCUS
@csnscn.bsky.social @cjkhd.bsky.social @mcgilluniversity.bsky.social
doi.org/10.1177/2054...
@csnscn.bsky.social @cjkhd.bsky.social @mcgilluniversity.bsky.social
doi.org/10.1177/2054...
September 21, 2025 at 7:50 PM
Is it really true that LUS predicts worsening renal function, while measures of venous congestion and right heart function do not? Unlikely. Rather, this is a good teaching example of P-fracking and unfair competition. Follow for my thoughts 👇 #pocusky #cardiosky #emimcc
Although I love PoCUS to bits, and have danced with IVC for > 20 years, my first question would be 'are you thirsty', and if yes, offer a drink.
Saturday night, community hospital: 68-year-old "failure to thrive" patient with BP 90/60 - do you wait 6 hours for labs and imaging, or grab the ultrasound probe for a 2-minute answer?
#HospitalMedicine #POCUS
@cmount.bsky.social
#HospitalMedicine #POCUS
@cmount.bsky.social
September 9, 2025 at 8:40 PM
Although I love PoCUS to bits, and have danced with IVC for > 20 years, my first question would be 'are you thirsty', and if yes, offer a drink.
Agree wholeheartedly - without accessible image archives, ultrasound is just a more sensitive stethoscope.
Important point re #POCUS as a CXR replacement.
If you haven’t enabled image upload to your radiology viewing systems, then there is no objective evidence of what has been seen.
Additionally, many will need follow up imaging, for which POCUS has limitations.
If you haven’t enabled image upload to your radiology viewing systems, then there is no objective evidence of what has been seen.
Additionally, many will need follow up imaging, for which POCUS has limitations.
My thoughts on community-acquired PNA in 2025
🫁 Disagree with POCUS as CXR replacement
🫁 Steroid now officially recommended in severe CAP
🫁 Doxy is the new azithro
🫁 DRIP score to guide beta-lactam backbone
🫁 3-7 day duration, clinical stopping criteria
blog: emcrit.org/pulmcrit/202... #EMIMCC
🫁 Disagree with POCUS as CXR replacement
🫁 Steroid now officially recommended in severe CAP
🫁 Doxy is the new azithro
🫁 DRIP score to guide beta-lactam backbone
🫁 3-7 day duration, clinical stopping criteria
blog: emcrit.org/pulmcrit/202... #EMIMCC
July 25, 2025 at 9:35 PM
Agree wholeheartedly - without accessible image archives, ultrasound is just a more sensitive stethoscope.
Reposted
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....
Reposted
🩸 19 days postpartum with sudden vaginal bleeding.
She had no fever, vitals were stable..but the clots were massive. Target sign on POCUS.
❓What’s the diagnosis?
📖 Want the full story?
doi.org/10.1016/j.an...
#EM #OBGYN #FOAMed #FOAM #MedicalEducation #MedEd #POCUS #Ultrasound #Residency
She had no fever, vitals were stable..but the clots were massive. Target sign on POCUS.
❓What’s the diagnosis?
📖 Want the full story?
doi.org/10.1016/j.an...
#EM #OBGYN #FOAMed #FOAM #MedicalEducation #MedEd #POCUS #Ultrasound #Residency
July 14, 2025 at 3:34 PM
🩸 19 days postpartum with sudden vaginal bleeding.
She had no fever, vitals were stable..but the clots were massive. Target sign on POCUS.
❓What’s the diagnosis?
📖 Want the full story?
doi.org/10.1016/j.an...
#EM #OBGYN #FOAMed #FOAM #MedicalEducation #MedEd #POCUS #Ultrasound #Residency
She had no fever, vitals were stable..but the clots were massive. Target sign on POCUS.
❓What’s the diagnosis?
📖 Want the full story?
doi.org/10.1016/j.an...
#EM #OBGYN #FOAMed #FOAM #MedicalEducation #MedEd #POCUS #Ultrasound #Residency
Reposted
BRB, I just need to file a patent real quick for a combination of droperidol plus magnesium (dropnesium) as the ideal drug for everything.
migraine? dropnesium.
nausea/vomiting with low Mg? dropnesium.
agitation with unknown QT? dropnesium.
#EMIMCC
migraine? dropnesium.
nausea/vomiting with low Mg? dropnesium.
agitation with unknown QT? dropnesium.
#EMIMCC
July 11, 2025 at 6:57 PM
BRB, I just need to file a patent real quick for a combination of droperidol plus magnesium (dropnesium) as the ideal drug for everything.
migraine? dropnesium.
nausea/vomiting with low Mg? dropnesium.
agitation with unknown QT? dropnesium.
#EMIMCC
migraine? dropnesium.
nausea/vomiting with low Mg? dropnesium.
agitation with unknown QT? dropnesium.
#EMIMCC
Reposted
“A brilliant first day!”
Consultant Intensivist @drfreeze.bsky.social reflects on Day 1 of #SOA25 and shares what stood out.
🔜 Get ready for Day 2 as we dive deeper into ICU innovation and the future of critical care.
There’s still plenty more to come, so stay tuned! 🥳
Consultant Intensivist @drfreeze.bsky.social reflects on Day 1 of #SOA25 and shares what stood out.
🔜 Get ready for Day 2 as we dive deeper into ICU innovation and the future of critical care.
There’s still plenty more to come, so stay tuned! 🥳
July 1, 2025 at 6:51 PM
“A brilliant first day!”
Consultant Intensivist @drfreeze.bsky.social reflects on Day 1 of #SOA25 and shares what stood out.
🔜 Get ready for Day 2 as we dive deeper into ICU innovation and the future of critical care.
There’s still plenty more to come, so stay tuned! 🥳
Consultant Intensivist @drfreeze.bsky.social reflects on Day 1 of #SOA25 and shares what stood out.
🔜 Get ready for Day 2 as we dive deeper into ICU innovation and the future of critical care.
There’s still plenty more to come, so stay tuned! 🥳
Reposted
The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc
June 26, 2025 at 8:29 PM
The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc
Reposted
there are a lot of fine lines to be walked
one I think about a lot:
- confident enough to be assertive
- humble enough to listen with an open mind
@cliffreid.bsky.social has talked about this in the past: balancing confidence & experience. it’s hard.
one I think about a lot:
- confident enough to be assertive
- humble enough to listen with an open mind
@cliffreid.bsky.social has talked about this in the past: balancing confidence & experience. it’s hard.
May 18, 2025 at 4:37 PM
there are a lot of fine lines to be walked
one I think about a lot:
- confident enough to be assertive
- humble enough to listen with an open mind
@cliffreid.bsky.social has talked about this in the past: balancing confidence & experience. it’s hard.
one I think about a lot:
- confident enough to be assertive
- humble enough to listen with an open mind
@cliffreid.bsky.social has talked about this in the past: balancing confidence & experience. it’s hard.
Reposted
I completely agree that lactate isn’t a specific tissue oxygenation of perfusion marker. I love this paper. bsky.app/profile/load...
By the way, brilliant paper on primary mechanism of lactate production in health (and likely disease). Glycolysis i ls fast but inefficient, mithochondrial oxydation is slow but efficient www.nature.com/articles/s41...
Complex I is bypassed during high intensity exercise - Nature Communications
During high-intensity exercise, muscles convert glucose to lactate, in a process that is energetically less efficient than respiration. Here the authors develop a computational model based on muscle p...
www.nature.com
May 11, 2025 at 7:11 PM
I completely agree that lactate isn’t a specific tissue oxygenation of perfusion marker. I love this paper. bsky.app/profile/load...
Love it Josh. Do you ever do Resistive index - say in renal art or coeliac or hepatic as an index of increased arterial tone? Would it give any benefit over simple skin colour?
super interesting!
I boiled this down and simplifed/modified it to yield the summary below.
I think we all do this to some extent but maybe should be more systematic about it.
(and yes I'm publically admitting that I use femoral doppler instead of full VEXUS)
(emcrit.org/ibcc/shock/#...) #EMIMCC
I boiled this down and simplifed/modified it to yield the summary below.
I think we all do this to some extent but maybe should be more systematic about it.
(and yes I'm publically admitting that I use femoral doppler instead of full VEXUS)
(emcrit.org/ibcc/shock/#...) #EMIMCC
March 29, 2025 at 12:02 AM
Love it Josh. Do you ever do Resistive index - say in renal art or coeliac or hepatic as an index of increased arterial tone? Would it give any benefit over simple skin colour?
Reposted
a lively, functional microblogging site (eg twitter, bluesky) is required as the lifeblood of FOAMed.
I hope that we can rebuild what MedTwitter once was, here.
from a reflection https://first10em.com/i-have-been-doing-this-for-10-years/ by Justin Morgenstern @first10em.bsky.social
I hope that we can rebuild what MedTwitter once was, here.
from a reflection https://first10em.com/i-have-been-doing-this-for-10-years/ by Justin Morgenstern @first10em.bsky.social
March 17, 2025 at 11:29 PM
a lively, functional microblogging site (eg twitter, bluesky) is required as the lifeblood of FOAMed.
I hope that we can rebuild what MedTwitter once was, here.
from a reflection https://first10em.com/i-have-been-doing-this-for-10-years/ by Justin Morgenstern @first10em.bsky.social
I hope that we can rebuild what MedTwitter once was, here.
from a reflection https://first10em.com/i-have-been-doing-this-for-10-years/ by Justin Morgenstern @first10em.bsky.social
Reposted
Dr Rola and Haycock on APRV paper
'Zou et al. Physiologic APRV-TCAV Study: Our Thoughts'
#pulmsky #critcaresky #emimcc
.
vimeo.com/1061864674
'Zou et al. Physiologic APRV-TCAV Study: Our Thoughts'
#pulmsky #critcaresky #emimcc
.
vimeo.com/1061864674
Zou et al. Physiologic APRV-TCAV Study: Our Thoughts. #FOAMed #FOAMcc
This is "Zou et al. Physiologic APRV-TCAV Study: Our Thoughts. #FOAMed #FOAMcc" by @ThinkingCC / CCUS Institute on Vimeo, the home for high quality videos…
vimeo.com
March 3, 2025 at 12:02 AM
Dr Rola and Haycock on APRV paper
'Zou et al. Physiologic APRV-TCAV Study: Our Thoughts'
#pulmsky #critcaresky #emimcc
.
vimeo.com/1061864674
'Zou et al. Physiologic APRV-TCAV Study: Our Thoughts'
#pulmsky #critcaresky #emimcc
.
vimeo.com/1061864674
Reposted
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty
Some reflections from the day:
(1/n)
Some reflections from the day:
(1/n)
February 27, 2025 at 9:45 AM
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty
Some reflections from the day:
(1/n)
Some reflections from the day:
(1/n)
Reposted
Really nice article on TAPSE/TRVmax as a potential prognostic marker
From the team at Nepean ICU, led by Emma Bowcock
annalsofintensivecare.springeropen.com/articles/10....
From the team at Nepean ICU, led by Emma Bowcock
annalsofintensivecare.springeropen.com/articles/10....
The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy - Annals of Intensive Care
Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV...
annalsofintensivecare.springeropen.com
February 6, 2025 at 10:55 AM
Really nice article on TAPSE/TRVmax as a potential prognostic marker
From the team at Nepean ICU, led by Emma Bowcock
annalsofintensivecare.springeropen.com/articles/10....
From the team at Nepean ICU, led by Emma Bowcock
annalsofintensivecare.springeropen.com/articles/10....
Reposted
Sepsis is as specific a term as "advanced cancer"
January 30, 2025 at 7:53 PM
Sepsis is as specific a term as "advanced cancer"
Reposted
💯💯
currently, sepsis just isn't a valid scientific construct
the definition of sepsis has changed so many times I can't keep up. studies use various different definitions; reviews conflate heterogeneous results.
there is no diagnostic test for sepsis
sepsis is more of a rumor than hard science🤷♂️
currently, sepsis just isn't a valid scientific construct
the definition of sepsis has changed so many times I can't keep up. studies use various different definitions; reviews conflate heterogeneous results.
there is no diagnostic test for sepsis
sepsis is more of a rumor than hard science🤷♂️
a couple of penguins wearing hats and glasses standing next to each other
ALT: a couple of penguins wearing hats and glasses standing next to each other
media.tenor.com
January 30, 2025 at 2:54 PM
💯💯
currently, sepsis just isn't a valid scientific construct
the definition of sepsis has changed so many times I can't keep up. studies use various different definitions; reviews conflate heterogeneous results.
there is no diagnostic test for sepsis
sepsis is more of a rumor than hard science🤷♂️
currently, sepsis just isn't a valid scientific construct
the definition of sepsis has changed so many times I can't keep up. studies use various different definitions; reviews conflate heterogeneous results.
there is no diagnostic test for sepsis
sepsis is more of a rumor than hard science🤷♂️
Yes for sure. Is context sensitive.
True, but logistically CXR is more feasible when you’re trying to simultaneously manage an ICU and see pulmonary consults in different units 🤷♂️
homer simpson from the simpsons is standing in front of a grassy field .
ALT: homer simpson from the simpsons is standing in front of a grassy field .
media.tenor.com
January 20, 2025 at 5:01 AM
Yes for sure. Is context sensitive.
Reposted
True, but logistically CXR is more feasible when you’re trying to simultaneously manage an ICU and see pulmonary consults in different units 🤷♂️
homer simpson from the simpsons is standing in front of a grassy field .
ALT: homer simpson from the simpsons is standing in front of a grassy field .
media.tenor.com
January 20, 2025 at 1:44 AM
True, but logistically CXR is more feasible when you’re trying to simultaneously manage an ICU and see pulmonary consults in different units 🤷♂️
It is not so hard to mark the surface distribution on an effusion, like one would a cellulitis.
would disagree. CXR can be useful to track out the size of an effusion over time - difficult to do with POCUS (especially if POCUS is being done by different operators over multiple days in different hospital units).
it’s not a competition. POCUS & CXR have synergistic strengths & weaknesses
it’s not a competition. POCUS & CXR have synergistic strengths & weaknesses
January 19, 2025 at 11:03 PM
It is not so hard to mark the surface distribution on an effusion, like one would a cellulitis.