TheVentilatorWhisperer
@ventwhisperer.bsky.social
Zentensivist in training | Let's learn together | Follow for critical care content.
New ESICM guidelines on circulatory shock. www.esicm.org/esicm-guidel...
October 31, 2025 at 6:02 PM
New ESICM guidelines on circulatory shock. www.esicm.org/esicm-guidel...
Reposted by TheVentilatorWhisperer
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
Andromeda Shock 2 Trial is out.
October 29, 2025 at 5:56 PM
Andromeda Shock 2 Trial is out.
Reposted by TheVentilatorWhisperer
Decay in Physiologic Knowledge Since Med School Among Critical Care Fellows
1st-yr PCCM/CCM fellows perform worse than med students on assessment of pulmonary physiologic concepts, suggests decay in knowledge during training
@atscommunity.bsky.social #medsky
tinyurl.com/tfwutc76
1st-yr PCCM/CCM fellows perform worse than med students on assessment of pulmonary physiologic concepts, suggests decay in knowledge during training
@atscommunity.bsky.social #medsky
tinyurl.com/tfwutc76
August 7, 2025 at 5:38 PM
Decay in Physiologic Knowledge Since Med School Among Critical Care Fellows
1st-yr PCCM/CCM fellows perform worse than med students on assessment of pulmonary physiologic concepts, suggests decay in knowledge during training
@atscommunity.bsky.social #medsky
tinyurl.com/tfwutc76
1st-yr PCCM/CCM fellows perform worse than med students on assessment of pulmonary physiologic concepts, suggests decay in knowledge during training
@atscommunity.bsky.social #medsky
tinyurl.com/tfwutc76
Have been learning about hemodynamic coupling, currently reviewing interface IV (RV-PA coupling).
This is a great review article on RV failure.
pmc.ncbi.nlm.nih.gov/articles/PMC...
This is a great review article on RV failure.
pmc.ncbi.nlm.nih.gov/articles/PMC...
Management of Acute Right Ventricular Failure in the Intensive Care Unit
Right ventricular (RV) failure occurs when the RV fails to maintain enough blood flow through the pulmonary circulation to achieve adequate left ventricular filling. This can occur suddenly in a previ...
pmc.ncbi.nlm.nih.gov
April 14, 2025 at 5:03 PM
Have been learning about hemodynamic coupling, currently reviewing interface IV (RV-PA coupling).
This is a great review article on RV failure.
pmc.ncbi.nlm.nih.gov/articles/PMC...
This is a great review article on RV failure.
pmc.ncbi.nlm.nih.gov/articles/PMC...
Reposted by TheVentilatorWhisperer
is contrast nephropathy in the room with us right now?
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
April 10, 2025 at 11:46 PM
is contrast nephropathy in the room with us right now?
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
Reposted by TheVentilatorWhisperer
1/
One of the BIGGEST #POCUS misconceptions is that B lines 🟰 pulmonary edema 🤦♀️
Did you know that there is actually a wide DDx for B lines?
Check out my latest video about #LungUltrasound for interstitial syndromes 👀; or read on for the highlights 👇 🧵
#emimcc
www.youtube.com/watch?v=eSuA...
One of the BIGGEST #POCUS misconceptions is that B lines 🟰 pulmonary edema 🤦♀️
Did you know that there is actually a wide DDx for B lines?
Check out my latest video about #LungUltrasound for interstitial syndromes 👀; or read on for the highlights 👇 🧵
#emimcc
www.youtube.com/watch?v=eSuA...
Lung Ultrasound for Interstitial Syndromes
YouTube video by UBC IM POCUS
www.youtube.com
February 6, 2025 at 6:33 PM
1/
One of the BIGGEST #POCUS misconceptions is that B lines 🟰 pulmonary edema 🤦♀️
Did you know that there is actually a wide DDx for B lines?
Check out my latest video about #LungUltrasound for interstitial syndromes 👀; or read on for the highlights 👇 🧵
#emimcc
www.youtube.com/watch?v=eSuA...
One of the BIGGEST #POCUS misconceptions is that B lines 🟰 pulmonary edema 🤦♀️
Did you know that there is actually a wide DDx for B lines?
Check out my latest video about #LungUltrasound for interstitial syndromes 👀; or read on for the highlights 👇 🧵
#emimcc
www.youtube.com/watch?v=eSuA...
Been doing some reading and listening on advanced resuscitation/hemodynamics. Dr. Per Olav Berve gave a fantastic lecture at the Big Sick in 2018.
Takeaways:
1. Diastolic BP goal > 25 using late diastolic peak on A-line
2. EtCo2 monitoring during code, use the peak alveolar plateau readings.
Takeaways:
1. Diastolic BP goal > 25 using late diastolic peak on A-line
2. EtCo2 monitoring during code, use the peak alveolar plateau readings.
January 15, 2025 at 5:24 PM
Been doing some reading and listening on advanced resuscitation/hemodynamics. Dr. Per Olav Berve gave a fantastic lecture at the Big Sick in 2018.
Takeaways:
1. Diastolic BP goal > 25 using late diastolic peak on A-line
2. EtCo2 monitoring during code, use the peak alveolar plateau readings.
Takeaways:
1. Diastolic BP goal > 25 using late diastolic peak on A-line
2. EtCo2 monitoring during code, use the peak alveolar plateau readings.
How does everyone feel about the Peerless trial?
Large-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial | Circul...
Background: There is a lack of randomized controlled trial (RCT) data comparing outcomes
of different catheter-based interventions for intermediate-risk pulmonary embolism
(PE). Methods: PEERLESS is a...
www.ahajournals.org
December 11, 2024 at 12:36 AM
How does everyone feel about the Peerless trial?
Sometimes we get so wrapped up in aggressive management and intervention. I think early palliative care discussions are really important for the patient, their family, and for us. The idea of zentensive care fits well with this.
Less is more.
Less is more.
The Zentensivist Manifesto. Defining the Art of Critical Care | ATS Scholar
www.atsjournals.org
November 28, 2024 at 1:49 PM
Sometimes we get so wrapped up in aggressive management and intervention. I think early palliative care discussions are really important for the patient, their family, and for us. The idea of zentensive care fits well with this.
Less is more.
Less is more.
ICU Case Discussion: Part 1
Young patient presents with AMS, found with numerous empty pill bottles including NSAIDs, muscles relaxants, and metformin. Lactic acid >15 mmol/L. pH 6.9. Kussmaul breathing. Suspicion of metformin overdose. What is everyone's fluid of choice?
#CriticalCare #ICU
Young patient presents with AMS, found with numerous empty pill bottles including NSAIDs, muscles relaxants, and metformin. Lactic acid >15 mmol/L. pH 6.9. Kussmaul breathing. Suspicion of metformin overdose. What is everyone's fluid of choice?
#CriticalCare #ICU
November 28, 2024 at 5:29 AM
ICU Case Discussion: Part 1
Young patient presents with AMS, found with numerous empty pill bottles including NSAIDs, muscles relaxants, and metformin. Lactic acid >15 mmol/L. pH 6.9. Kussmaul breathing. Suspicion of metformin overdose. What is everyone's fluid of choice?
#CriticalCare #ICU
Young patient presents with AMS, found with numerous empty pill bottles including NSAIDs, muscles relaxants, and metformin. Lactic acid >15 mmol/L. pH 6.9. Kussmaul breathing. Suspicion of metformin overdose. What is everyone's fluid of choice?
#CriticalCare #ICU
Reposted by TheVentilatorWhisperer
Reposted by TheVentilatorWhisperer
Optimist: The cup is half full
Pessimist: The cup is half empty
Intensivist: We need VEXUS to determine how congested this cup really is.
#icusky #medsky
Pessimist: The cup is half empty
Intensivist: We need VEXUS to determine how congested this cup really is.
#icusky #medsky
Optimist: The cup is half full
Pessimist: the cup is half empty
The nephrologist: It's only half a cup? We can dialyze that off, no problem.
Pessimist: the cup is half empty
The nephrologist: It's only half a cup? We can dialyze that off, no problem.
Optimist: The cup is half full
Pessimist: The cup is half empty
@traumasoapboxes.bsky.social: The cup is completely empty and needs blood, not saline
Pessimist: The cup is half empty
@traumasoapboxes.bsky.social: The cup is completely empty and needs blood, not saline
November 23, 2024 at 8:42 PM
Reposted by TheVentilatorWhisperer
Optimist: The cup is half full
Pessimist: The cup is half empty
Pragmatist: There’s an IV fluid shortage, the cup’s volume status is fine.
Pessimist: The cup is half empty
Pragmatist: There’s an IV fluid shortage, the cup’s volume status is fine.
November 23, 2024 at 11:29 PM
Optimist: The cup is half full
Pessimist: The cup is half empty
Pragmatist: There’s an IV fluid shortage, the cup’s volume status is fine.
Pessimist: The cup is half empty
Pragmatist: There’s an IV fluid shortage, the cup’s volume status is fine.
Reposted by TheVentilatorWhisperer
Now seems like a good time to remember that #vaccines are the greatest #publichealth intervention in history, saving 154 million lives in the 50 years since the start of the Expanded Programme on Immunization in 1974. #EpiSky #IDSky #PedsIDSky
doi.org/10.1016/S014...
doi.org/10.1016/S014...
November 23, 2024 at 6:36 PM
Now seems like a good time to remember that #vaccines are the greatest #publichealth intervention in history, saving 154 million lives in the 50 years since the start of the Expanded Programme on Immunization in 1974. #EpiSky #IDSky #PedsIDSky
doi.org/10.1016/S014...
doi.org/10.1016/S014...
A few days ago we talked about different types of shock, including obstructive shock. This is a great article on acute PE risk stratification and it includes some helpful diagrams.
#Medsky #CriticalCare #ICU #CriticalCareMedicine
#Medsky #CriticalCare #ICU #CriticalCareMedicine
Risk Stratification of Acute Pulmonary Embolism - Current Treatment Options in Cardiovascular Medicine
Purpose of review Acute pulmonary embolism (PE) is a heterogeneous disease process whose presentation varies widely between individuals who are asymptomatic, develop cardiogenic shock, or experience a...
link.springer.com
November 23, 2024 at 5:41 PM
A few days ago we talked about different types of shock, including obstructive shock. This is a great article on acute PE risk stratification and it includes some helpful diagrams.
#Medsky #CriticalCare #ICU #CriticalCareMedicine
#Medsky #CriticalCare #ICU #CriticalCareMedicine
Slow correction of hyponatremia associated with increased mortality. Interested to hear how everyone feels about these findings.
November 19, 2024 at 9:39 PM
Slow correction of hyponatremia associated with increased mortality. Interested to hear how everyone feels about these findings.
I'm on nights this month and always struggle with switching back and forth. Anyone have any tips for successfully switching back to days? I've thought about trying bright light therapy.
November 18, 2024 at 4:42 PM
I'm on nights this month and always struggle with switching back and forth. Anyone have any tips for successfully switching back to days? I've thought about trying bright light therapy.
Ultrasound has to be one of the greatest tools in an intensivists arsenal. So many questions can be answered with it.
Echo, vexus, VTI, I love it all.
Echo, vexus, VTI, I love it all.
November 18, 2024 at 1:18 PM
Ultrasound has to be one of the greatest tools in an intensivists arsenal. So many questions can be answered with it.
Echo, vexus, VTI, I love it all.
Echo, vexus, VTI, I love it all.
Working on putting together a post on my approach to undifferentiated shock. Stay tuned.
November 18, 2024 at 1:44 AM
Working on putting together a post on my approach to undifferentiated shock. Stay tuned.
Case discussion: Patient is admitted with right lower extremity compartment syndrome and profound shock requiring max dosing on 4 vasopressors. Too unstable for OR. After discussions with surgical team, opted to perform a Cryoamputation. The patient's leg is demarcated and covered in dry ice.
November 17, 2024 at 7:34 AM
Case discussion: Patient is admitted with right lower extremity compartment syndrome and profound shock requiring max dosing on 4 vasopressors. Too unstable for OR. After discussions with surgical team, opted to perform a Cryoamputation. The patient's leg is demarcated and covered in dry ice.
Lets talk about ARDS.
Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., ... & Network, O. S. S. (2015). Driving pressure and survival in the acute respiratory distress syndrome. The New England journal of medicine, 372(8), 1 747-755.
Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., ... & Network, O. S. S. (2015). Driving pressure and survival in the acute respiratory distress syndrome. The New England journal of medicine, 372(8), 1 747-755.
November 17, 2024 at 12:48 AM
Lets talk about ARDS.
Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., ... & Network, O. S. S. (2015). Driving pressure and survival in the acute respiratory distress syndrome. The New England journal of medicine, 372(8), 1 747-755.
Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., ... & Network, O. S. S. (2015). Driving pressure and survival in the acute respiratory distress syndrome. The New England journal of medicine, 372(8), 1 747-755.
Just had our difficult airway training session as well as Minnesota tube placement. Almost immediately got the chance to employ my new skills.
Do you guys tend to use traditional three way stop cock or Lopez valves with your Minnesota tubes?
Do you guys tend to use traditional three way stop cock or Lopez valves with your Minnesota tubes?
November 16, 2024 at 11:37 PM
Just had our difficult airway training session as well as Minnesota tube placement. Almost immediately got the chance to employ my new skills.
Do you guys tend to use traditional three way stop cock or Lopez valves with your Minnesota tubes?
Do you guys tend to use traditional three way stop cock or Lopez valves with your Minnesota tubes?