Steven Ilko 🏥 🚁💨
@zentensivistilko.bsky.social
EM/ACCM/E-AEC Zen-tensivist. Humanist. Philosophizer/Belly-Button Starer. Med interests: MCS, HEMS-CC, de-prescribing, and communication. My opinions are my own, not of my employer(s).
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.
3 weeks into recovery!
Had a child sitting with their family and I could hear them talking about my walker and scars. Mom made it a teaching moment, and had her kid ask me some questions-- to talk to me and not about me. She was so kind and got us a gift card. The world needs more parents like this.
Had a child sitting with their family and I could hear them talking about my walker and scars. Mom made it a teaching moment, and had her kid ask me some questions-- to talk to me and not about me. She was so kind and got us a gift card. The world needs more parents like this.
January 10, 2026 at 3:29 AM
3 weeks into recovery!
Had a child sitting with their family and I could hear them talking about my walker and scars. Mom made it a teaching moment, and had her kid ask me some questions-- to talk to me and not about me. She was so kind and got us a gift card. The world needs more parents like this.
Had a child sitting with their family and I could hear them talking about my walker and scars. Mom made it a teaching moment, and had her kid ask me some questions-- to talk to me and not about me. She was so kind and got us a gift card. The world needs more parents like this.
Day 10/10 of self-administered enoxaparin inj.
I don't particularly enjoy the sensation of subq needles and meds. However the burn was only minimal and short lasting. I do however appreciate not developing a DVT and the pharmacologic profile is phenomenal
Final rating: 8/10 - would stab self again
I don't particularly enjoy the sensation of subq needles and meds. However the burn was only minimal and short lasting. I do however appreciate not developing a DVT and the pharmacologic profile is phenomenal
Final rating: 8/10 - would stab self again
January 2, 2026 at 6:17 PM
Day 10/10 of self-administered enoxaparin inj.
I don't particularly enjoy the sensation of subq needles and meds. However the burn was only minimal and short lasting. I do however appreciate not developing a DVT and the pharmacologic profile is phenomenal
Final rating: 8/10 - would stab self again
I don't particularly enjoy the sensation of subq needles and meds. However the burn was only minimal and short lasting. I do however appreciate not developing a DVT and the pharmacologic profile is phenomenal
Final rating: 8/10 - would stab self again
Walking into 2026. (well... walkering for me)
Wishing everyone a happy and healthy New Year
Wishing everyone a happy and healthy New Year
January 1, 2026 at 5:12 PM
Walking into 2026. (well... walkering for me)
Wishing everyone a happy and healthy New Year
Wishing everyone a happy and healthy New Year
As a doc, 13 days as an inpatient gives you some perspective of what our patients go through in severe injury/illness. What an experience. Thankful to have my health, my mental acuity. Here is a photo of the thank you card my partner and I left our Ortho unit. More reflections to come as I recover.
December 23, 2025 at 11:39 PM
As a doc, 13 days as an inpatient gives you some perspective of what our patients go through in severe injury/illness. What an experience. Thankful to have my health, my mental acuity. Here is a photo of the thank you card my partner and I left our Ortho unit. More reflections to come as I recover.
Turns out my superb pre-hospital trauma care was in reality 4 deployments of WMDs. Do I contact FEMA as a victim of terrorism?
www.whitehouse.gov/presidential...
www.whitehouse.gov/presidential...
DESIGNATING FENTANYL AS A WEAPON OF MASS DESTRUCTION
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered: Section 1. Purpose and
www.whitehouse.gov
December 18, 2025 at 12:24 AM
Turns out my superb pre-hospital trauma care was in reality 4 deployments of WMDs. Do I contact FEMA as a victim of terrorism?
www.whitehouse.gov/presidential...
www.whitehouse.gov/presidential...
There is no greater betrayal of your own body than waking up in 10/10 pain from hypnic jerks while in an ex-fix. Not even naps are safe
December 15, 2025 at 8:06 PM
There is no greater betrayal of your own body than waking up in 10/10 pain from hypnic jerks while in an ex-fix. Not even naps are safe
Navigating a critical injury far from home. 1/5 stars. Don't recommend. Thankful for all the support shown by my colleagues and family. It means so much.
December 15, 2025 at 5:45 PM
Navigating a critical injury far from home. 1/5 stars. Don't recommend. Thankful for all the support shown by my colleagues and family. It means so much.
Humbled to say the least. The doc becomes the patient. On the road to recovery!
December 14, 2025 at 12:34 AM
Humbled to say the least. The doc becomes the patient. On the road to recovery!
Reposted by Steven Ilko 🏥 🚁💨
Recently, I've been asked whether every baby actually needs HBV vaccination, largely with the implication that doing this is "one size fits all," and that's not a good approach.
Implicit in this assumption is the idea that every individual's physiology is so unique that it demands unique care.
Implicit in this assumption is the idea that every individual's physiology is so unique that it demands unique care.
December 7, 2025 at 9:08 PM
Recently, I've been asked whether every baby actually needs HBV vaccination, largely with the implication that doing this is "one size fits all," and that's not a good approach.
Implicit in this assumption is the idea that every individual's physiology is so unique that it demands unique care.
Implicit in this assumption is the idea that every individual's physiology is so unique that it demands unique care.
Democratic leadership is dead. The legislative branch of the US government is a complicit arm of the autocratic takeover of government dreamed by the right in the 80s, launched by Cheney post 9/11, continued by institution Dems, and now the cult of personality is here. The branches are trimmed.
November 10, 2025 at 5:50 PM
Democratic leadership is dead. The legislative branch of the US government is a complicit arm of the autocratic takeover of government dreamed by the right in the 80s, launched by Cheney post 9/11, continued by institution Dems, and now the cult of personality is here. The branches are trimmed.
Reposted by Steven Ilko 🏥 🚁💨
Our latest blog is out:
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
November 7, 2025 at 7:54 PM
Our latest blog is out:
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
Today I became double board certified, and won trivia.
a man is speaking into a microphone in front of a crowd and says i 'm a nerd
ALT: a man is speaking into a microphone in front of a crowd and says i 'm a nerd
media.tenor.com
November 7, 2025 at 4:35 AM
Today I became double board certified, and won trivia.
The fact that the AOC and Sanders Town Hall isn't all over social media tells me exactly what I need to know... Was SO REFRESHING listening to politicians prioritizing people and values. No hate.
October 16, 2025 at 11:55 PM
The fact that the AOC and Sanders Town Hall isn't all over social media tells me exactly what I need to know... Was SO REFRESHING listening to politicians prioritizing people and values. No hate.
Having recently read Mark Bray's book about Antifascist movements... Not at all surprised that these fascist **cks decided he's a threat. Read. Love. Commune. Fight.
October 10, 2025 at 2:06 AM
Having recently read Mark Bray's book about Antifascist movements... Not at all surprised that these fascist **cks decided he's a threat. Read. Love. Commune. Fight.
As an US EM/CCM doc attuned to what's happening politically, and how it's impacting people daily, I struggle to find the energy and bandwidth to contribute to fighting the fight when I'm facing it at work 20+ days a month and honestly, feels like I'm losing. Anyone else feeling this? Recs? #emimcc
October 8, 2025 at 7:16 PM
As an US EM/CCM doc attuned to what's happening politically, and how it's impacting people daily, I struggle to find the energy and bandwidth to contribute to fighting the fight when I'm facing it at work 20+ days a month and honestly, feels like I'm losing. Anyone else feeling this? Recs? #emimcc
Why must we the health professionals take advice from the non-health professionals; especially when it is to seek advice from health professionals -- professionals whom the non-health professionals DIDN'T take advice from. The weaponized incompetence is here, dizzying, and deadly in magnitude.
The CDC says people must consult a health professional before COVID shot
flip.it/4YotQn
@dennisrenmd.bsky.social
flip.it/4YotQn
@dennisrenmd.bsky.social
The CDC says people must consult a health professional before COVID shot
The Centers for Disease Control and Prevention accepted a controversial recommendation from outside vaccine advisers to tighten guidelines for the COVID vaccine.
flip.it
October 7, 2025 at 1:14 AM
Why must we the health professionals take advice from the non-health professionals; especially when it is to seek advice from health professionals -- professionals whom the non-health professionals DIDN'T take advice from. The weaponized incompetence is here, dizzying, and deadly in magnitude.
Watching Miller / Trump use the Kirk Memorial to divide, sow malice and show how much they hate anyone who stands for democracy, equity and free society is jarring. I've never been more scared, nor more proud to stand on my beliefs. They show how afraid they are of us, and what we can do.
a poster that says " stay connected build community " on it
ALT: a poster that says " stay connected build community " on it
media.tenor.com
September 22, 2025 at 1:13 PM
Watching Miller / Trump use the Kirk Memorial to divide, sow malice and show how much they hate anyone who stands for democracy, equity and free society is jarring. I've never been more scared, nor more proud to stand on my beliefs. They show how afraid they are of us, and what we can do.
Reposted by Steven Ilko 🏥 🚁💨
updated IBCC chapter on anaphylaxis, some new additions:
🆕 methylene blue for anaphylaxis refractory to epi & fluid
🆕 sugammadex for anaphylaxis 2/2 roc or vec
🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help?
(emcrit.org/ibcc/anaphyl...) #EMIMCC
🆕 methylene blue for anaphylaxis refractory to epi & fluid
🆕 sugammadex for anaphylaxis 2/2 roc or vec
🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help?
(emcrit.org/ibcc/anaphyl...) #EMIMCC
September 18, 2025 at 10:11 PM
updated IBCC chapter on anaphylaxis, some new additions:
🆕 methylene blue for anaphylaxis refractory to epi & fluid
🆕 sugammadex for anaphylaxis 2/2 roc or vec
🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help?
(emcrit.org/ibcc/anaphyl...) #EMIMCC
🆕 methylene blue for anaphylaxis refractory to epi & fluid
🆕 sugammadex for anaphylaxis 2/2 roc or vec
🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help?
(emcrit.org/ibcc/anaphyl...) #EMIMCC
It's time to start building. Building community. Building resiliency. Building the world we want to see. When the state demands we step in line and maintain social order-- an order that robs our most vulnerable-- it is our duty, to raise the🖕with one hand, and use the other to lift each other up.
September 17, 2025 at 3:14 PM
It's time to start building. Building community. Building resiliency. Building the world we want to see. When the state demands we step in line and maintain social order-- an order that robs our most vulnerable-- it is our duty, to raise the🖕with one hand, and use the other to lift each other up.
I have a small number of rules for my trainees in ED and ICU:
1) Don't lie.
2) Treat the unit and the people in it like you're a guest in their home.
3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2)
pubmed.ncbi.nlm.nih.gov/33485698/
#emimcc
1) Don't lie.
2) Treat the unit and the people in it like you're a guest in their home.
3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2)
pubmed.ncbi.nlm.nih.gov/33485698/
#emimcc
The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department - PubMed
Awareness with paralysis occurs in a significant minority of ED patients who receive mechanical ventilation. Potential associations of awareness with paralysis with ED care and increased perceived thr...
pubmed.ncbi.nlm.nih.gov
September 15, 2025 at 1:17 AM
I have a small number of rules for my trainees in ED and ICU:
1) Don't lie.
2) Treat the unit and the people in it like you're a guest in their home.
3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2)
pubmed.ncbi.nlm.nih.gov/33485698/
#emimcc
1) Don't lie.
2) Treat the unit and the people in it like you're a guest in their home.
3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2)
pubmed.ncbi.nlm.nih.gov/33485698/
#emimcc
Still chuckling from an angry phone call I fielded earlier in the ICU. Mid-yelling at my residents/apps/nurses. "I'm tired of talking to these 30 something year old infant residents! We will only talk to the much more experienced and older attending physicians". My 32 year old ass...
a baby is laughing while sitting on a bed with boxes .
ALT: a baby is laughing while sitting on a bed with boxes .
media.tenor.com
September 6, 2025 at 2:55 AM
Still chuckling from an angry phone call I fielded earlier in the ICU. Mid-yelling at my residents/apps/nurses. "I'm tired of talking to these 30 something year old infant residents! We will only talk to the much more experienced and older attending physicians". My 32 year old ass...
Reposted by Steven Ilko 🏥 🚁💨
scout images for CT scans are hidden gold
the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan)
for example, the scout of a CT C-spine may be great to confirm ET tube position
#EMIMCC
the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan)
for example, the scout of a CT C-spine may be great to confirm ET tube position
#EMIMCC
August 31, 2025 at 10:00 PM
scout images for CT scans are hidden gold
the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan)
for example, the scout of a CT C-spine may be great to confirm ET tube position
#EMIMCC
the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan)
for example, the scout of a CT C-spine may be great to confirm ET tube position
#EMIMCC
Reposted by Steven Ilko 🏥 🚁💨
🆕💫PROTECT RCT
Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social
journal.chestnet.org/article/S001...
Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social
journal.chestnet.org/article/S001...
Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT)
This trial was inconclusive regarding the impact of ceftriaxone prophylaxis to reduce
the incidence of EOP after OHCA but ceftriaxone was associated with less frequent
administration of open-label ant...
journal.chestnet.org
August 28, 2025 at 10:19 PM
🆕💫PROTECT RCT
Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social
journal.chestnet.org/article/S001...
Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social
journal.chestnet.org/article/S001...
Escaped the US for a second ... Fingers crossed they let me back in ...
August 27, 2025 at 2:40 PM
Escaped the US for a second ... Fingers crossed they let me back in ...