Anthony Lau, PharmD BCPS
@alaurx.bsky.social
EM Pharmacist & Hockey Goalie & Travelist | Living & appreciating life to the fullest | Sharing what I learn everyday. Opinions are my own, RTs not endorsements #MedSky #EMsky #PharmSky
Reposted by Anthony Lau, PharmD BCPS
there's been LOTS of back-and-forth about vaso in sepsis
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
November 13, 2025 at 6:52 PM
there's been LOTS of back-and-forth about vaso in sepsis
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
1/ Newer data is reshaping post-MI β-blocker strategy. REBOOT shows no benefit when EF>40% in patients receiving modern invasive/medical therapy, while pooled data from BETAMI, DANBLOCK, and CAPITAL-RCT suggest benefit in the EF 40–49% range. #medsky #pharmsky #emimcc #cardiosky
a woman says " no need for that " while wearing a jacket
ALT: a woman says " no need for that " while wearing a jacket
media.tenor.com
November 15, 2025 at 6:27 AM
1/ Newer data is reshaping post-MI β-blocker strategy. REBOOT shows no benefit when EF>40% in patients receiving modern invasive/medical therapy, while pooled data from BETAMI, DANBLOCK, and CAPITAL-RCT suggest benefit in the EF 40–49% range. #medsky #pharmsky #emimcc #cardiosky
Reposted by Anthony Lau, PharmD BCPS
Fascinating paper suggesting the assumption that there is a sigmoid dose response relationship and threshold effect ( "all-or-nothing") for loop diuretics rests on repeated misinterpretation of original studies from the 70s and 80s. #nephsky #cardiosky #emimcc academic.oup.com/ehjcvp/artic...
What are the pharmacodynamics of loop diuretics?
A recent editorial was entitled ‘Loop diuretics in heart failure: few facts and lots of prejudice’.1 I would argue that we have forgotten or distorted some
academic.oup.com
November 9, 2025 at 6:40 PM
Fascinating paper suggesting the assumption that there is a sigmoid dose response relationship and threshold effect ( "all-or-nothing") for loop diuretics rests on repeated misinterpretation of original studies from the 70s and 80s. #nephsky #cardiosky #emimcc academic.oup.com/ehjcvp/artic...
Reposted by Anthony Lau, PharmD BCPS
Nothing normal about “normal” saline
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
Nothing Normal About "Normal" Saline #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
November 12, 2025 at 2:33 PM
Nothing normal about “normal” saline
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Incr safe apneic time important in improving 1st pass success
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
Safe Apneic Time #emergencymedicine #criticalcare #intubation #airway
YouTube video by EMSwami
youtube.com
November 5, 2025 at 3:03 PM
Incr safe apneic time important in improving 1st pass success
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Endovasc Stroke Tx + Airway
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
Intubating in Large Vessel Occlusion Stroke #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
youtube.com
November 3, 2025 at 3:02 PM
Endovasc Stroke Tx + Airway
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
-High risk airway decomp: High NIHSS, AMS or Posterior Stroke
-Etomidate a great agent: HD stable
-Avoid hypocarbia (cerebral vasoconstriction)
-After intubation, lie patient flat. Studies (PMID: 40465238) show improved outcomes
youtube.com/shorts/LChtQ...
#EMIMCC
Inspired by @pulmcrit.bsky.social’s recent post on PCN allergies! Thought I’d repost a skeetorial on PCN allergies to add to the great discussion. Link below:
bsky.app/profile/alau...
#medsky #pharmsky #EMsky #RNsky #GPsky #FOAMed #EMIMCC #IDsky
bsky.app/profile/alau...
#medsky #pharmsky #EMsky #RNsky #GPsky #FOAMed #EMIMCC #IDsky
I continue to be shocked by how PCN allergies are misunderstood
This is from UpToDate on neutropenic fever
It's wrong
With PCN allergy, you can absolutely use cefepime, piptazo, or meropenem
The R-chain structure that determines allergy is different
emcrit.org/ibcc/penicil... #EMIMCC #IDsky
This is from UpToDate on neutropenic fever
It's wrong
With PCN allergy, you can absolutely use cefepime, piptazo, or meropenem
The R-chain structure that determines allergy is different
emcrit.org/ibcc/penicil... #EMIMCC #IDsky
October 30, 2025 at 8:53 PM
Inspired by @pulmcrit.bsky.social’s recent post on PCN allergies! Thought I’d repost a skeetorial on PCN allergies to add to the great discussion. Link below:
bsky.app/profile/alau...
#medsky #pharmsky #EMsky #RNsky #GPsky #FOAMed #EMIMCC #IDsky
bsky.app/profile/alau...
#medsky #pharmsky #EMsky #RNsky #GPsky #FOAMed #EMIMCC #IDsky
Reposted by Anthony Lau, PharmD BCPS
Intubating in elevated ICP
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
Intubating Increased ICP #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
October 27, 2025 at 1:35 PM
Intubating in elevated ICP
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
-BP control w/ clevidipine/nicardipine
-Fentanyl: blunt catechol response
-Osmotic agents: 30 cc of 23.4% hypertonic
-Etomidate + rocuronium (no fasciculations, longer safe apneic time)
-Sedation/analgesia ready(bucking tube spikes ICP)
youtube.com/shorts/747a9...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Silva et al: Safety of Peripherally Administered 23.4% Sodium Chloride
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Safety of Peripherally Administered 23.4% Sodium Chloride
Neurocritical Care - For patients with increased intracranial pressure, prompt initiation of hyperosmolar therapy with 23.4% sodium chloride may minimize permanent neurological damage and prevent...
link.springer.com
October 28, 2025 at 5:38 PM
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
I continue to be shocked by how PCN allergies are misunderstood
This is from UpToDate on neutropenic fever
It's wrong
With PCN allergy, you can absolutely use cefepime, piptazo, or meropenem
The R-chain structure that determines allergy is different
emcrit.org/ibcc/penicil... #EMIMCC #IDsky
This is from UpToDate on neutropenic fever
It's wrong
With PCN allergy, you can absolutely use cefepime, piptazo, or meropenem
The R-chain structure that determines allergy is different
emcrit.org/ibcc/penicil... #EMIMCC #IDsky
October 28, 2025 at 8:55 PM
I continue to be shocked by how PCN allergies are misunderstood
This is from UpToDate on neutropenic fever
It's wrong
With PCN allergy, you can absolutely use cefepime, piptazo, or meropenem
The R-chain structure that determines allergy is different
emcrit.org/ibcc/penicil... #EMIMCC #IDsky
This is from UpToDate on neutropenic fever
It's wrong
With PCN allergy, you can absolutely use cefepime, piptazo, or meropenem
The R-chain structure that determines allergy is different
emcrit.org/ibcc/penicil... #EMIMCC #IDsky
Reposted by Anthony Lau, PharmD BCPS
For #criticallyill patients who had both severe metabolic acidemia and moderate to severe acute kidney injury, sodium bicarbonate therapy did not significantly decrease day 90 all-cause mortality.
#LIVES2025 @esicm.bsky.social
ja.ma/3Ll9Exv
#LIVES2025 @esicm.bsky.social
ja.ma/3Ll9Exv
October 29, 2025 at 1:20 PM
For #criticallyill patients who had both severe metabolic acidemia and moderate to severe acute kidney injury, sodium bicarbonate therapy did not significantly decrease day 90 all-cause mortality.
#LIVES2025 @esicm.bsky.social
ja.ma/3Ll9Exv
#LIVES2025 @esicm.bsky.social
ja.ma/3Ll9Exv
Reposted by Anthony Lau, PharmD BCPS
The BICAR-ICU-2 trial just dropped!
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
October 29, 2025 at 2:59 PM
The BICAR-ICU-2 trial just dropped!
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
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 Anthony Lau, PharmD BCPS
unpopular opinion: if ICP is unequivocally elevated due to cardiac arrest (eg >25mm), that suggests severe brain injury with a poor prognosis, no matter what you do.
this explains why trials of higher MAP targets after cardiac arrest (eg BOX trial) are all neutral. #EMIMCC
this explains why trials of higher MAP targets after cardiac arrest (eg BOX trial) are all neutral. #EMIMCC
Read the latest Educational Pearl on Elevated ICP in the Post-ROSC Patient at https://umem.org/educational_pearls/4906/
October 22, 2025 at 7:50 PM
unpopular opinion: if ICP is unequivocally elevated due to cardiac arrest (eg >25mm), that suggests severe brain injury with a poor prognosis, no matter what you do.
this explains why trials of higher MAP targets after cardiac arrest (eg BOX trial) are all neutral. #EMIMCC
this explains why trials of higher MAP targets after cardiac arrest (eg BOX trial) are all neutral. #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Bed-Up-Head-Elevated (BUHE) positioning is an easy, effective way to increase safe apneic time and reduce intubation related complications PMID: 26866753
youtube.com/shorts/BnZz0...
#EMIMCC
youtube.com/shorts/BnZz0...
#EMIMCC
Head of Bed Elevated for Airway Management #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
youtube.com
October 20, 2025 at 1:31 PM
Bed-Up-Head-Elevated (BUHE) positioning is an easy, effective way to increase safe apneic time and reduce intubation related complications PMID: 26866753
youtube.com/shorts/BnZz0...
#EMIMCC
youtube.com/shorts/BnZz0...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
CDI recurrence affects about 14% to 16% of patients with CDI, and the risk of recurrence increases with each CDI episode
🆕💫🌟 JAMA Insights
Recurrent Clostridioides difficile Infections
🟢Epidemiology and Risk factors
🟢Diagnosis
🟢Treatment
#IDSky #EMIMCC
jamanetwork.com/journals/jam...
🆕💫🌟 JAMA Insights
Recurrent Clostridioides difficile Infections
🟢Epidemiology and Risk factors
🟢Diagnosis
🟢Treatment
#IDSky #EMIMCC
jamanetwork.com/journals/jam...
October 20, 2025 at 5:00 PM
CDI recurrence affects about 14% to 16% of patients with CDI, and the risk of recurrence increases with each CDI episode
🆕💫🌟 JAMA Insights
Recurrent Clostridioides difficile Infections
🟢Epidemiology and Risk factors
🟢Diagnosis
🟢Treatment
#IDSky #EMIMCC
jamanetwork.com/journals/jam...
🆕💫🌟 JAMA Insights
Recurrent Clostridioides difficile Infections
🟢Epidemiology and Risk factors
🟢Diagnosis
🟢Treatment
#IDSky #EMIMCC
jamanetwork.com/journals/jam...
Wow! This is pretty innovative!! 🤯
The future of dental flossing may include vaccine delivery!
www.cell.com/cell/abstrac...
www.cell.com/cell/abstrac...
October 17, 2025 at 4:44 PM
Wow! This is pretty innovative!! 🤯
Reposted by Anthony Lau, PharmD BCPS
Reposted by Anthony Lau, PharmD BCPS
DKA Tip #3: HypoK the big killer
-All DKA patients total body K depleted
-Some p/w hyperK due to acidosis shifting K
-K < 3.5, replete prior to starting insulin. > 3.5 start insulin + K together
-Skip bolus: no faster resolution of DKA but incr risk of hypoK
youtube.com/shorts/PK_qF...
#EMIMCC
-All DKA patients total body K depleted
-Some p/w hyperK due to acidosis shifting K
-K < 3.5, replete prior to starting insulin. > 3.5 start insulin + K together
-Skip bolus: no faster resolution of DKA but incr risk of hypoK
youtube.com/shorts/PK_qF...
#EMIMCC
HypoK in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
October 17, 2025 at 1:32 PM
DKA Tip #3: HypoK the big killer
-All DKA patients total body K depleted
-Some p/w hyperK due to acidosis shifting K
-K < 3.5, replete prior to starting insulin. > 3.5 start insulin + K together
-Skip bolus: no faster resolution of DKA but incr risk of hypoK
youtube.com/shorts/PK_qF...
#EMIMCC
-All DKA patients total body K depleted
-Some p/w hyperK due to acidosis shifting K
-K < 3.5, replete prior to starting insulin. > 3.5 start insulin + K together
-Skip bolus: no faster resolution of DKA but incr risk of hypoK
youtube.com/shorts/PK_qF...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
DKA Tip #2: Urine dip can mislead
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
Ketones in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
October 15, 2025 at 3:33 PM
DKA Tip #2: Urine dip can mislead
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
-Body produces 3 ketones: acetoacetate, acetone + beta hydroxybutarate (BHB0
-UA only looks for acetoacetate. BHB dominates in early in DKA
-If worried about DKA, get a chem/blood gas for bicarb + pH + serum BHB
youtube.com/shorts/3KnuI...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Hot take:
You WANT the #creatinine to go up while diuresing in #cardiorenal syndrome AKI.
It’ll come back down when they’re better.
It’s a feature, not a bug.
#Medsky #Nephsky #cardiosky #cardiology #criticalcare @pulmcrit.bsky.social @imcrit.bsky.social #AKI #heartfailure #diuresis
You WANT the #creatinine to go up while diuresing in #cardiorenal syndrome AKI.
It’ll come back down when they’re better.
It’s a feature, not a bug.
#Medsky #Nephsky #cardiosky #cardiology #criticalcare @pulmcrit.bsky.social @imcrit.bsky.social #AKI #heartfailure #diuresis
October 12, 2025 at 4:54 PM
Hot take:
You WANT the #creatinine to go up while diuresing in #cardiorenal syndrome AKI.
It’ll come back down when they’re better.
It’s a feature, not a bug.
#Medsky #Nephsky #cardiosky #cardiology #criticalcare @pulmcrit.bsky.social @imcrit.bsky.social #AKI #heartfailure #diuresis
You WANT the #creatinine to go up while diuresing in #cardiorenal syndrome AKI.
It’ll come back down when they’re better.
It’s a feature, not a bug.
#Medsky #Nephsky #cardiosky #cardiology #criticalcare @pulmcrit.bsky.social @imcrit.bsky.social #AKI #heartfailure #diuresis
Reposted by Anthony Lau, PharmD BCPS
Role of insulin in DKA isn’t to drop sugar, it’s to shut of ketogenesis + close AG
-Don't stop insulin just because glucose hits 250 mg/dl
-Stop when AG closes, acidosis mainly resolved (bicarb greater than 18), long acting insulin on board + glucose controlled
youtube.com/shorts/z7prN...
#EMIMCC
-Don't stop insulin just because glucose hits 250 mg/dl
-Stop when AG closes, acidosis mainly resolved (bicarb greater than 18), long acting insulin on board + glucose controlled
youtube.com/shorts/z7prN...
#EMIMCC
Insulin in DKA #emergencymedicine #criticalcare #dka
YouTube video by EMSwami
youtube.com
October 13, 2025 at 1:40 PM
Role of insulin in DKA isn’t to drop sugar, it’s to shut of ketogenesis + close AG
-Don't stop insulin just because glucose hits 250 mg/dl
-Stop when AG closes, acidosis mainly resolved (bicarb greater than 18), long acting insulin on board + glucose controlled
youtube.com/shorts/z7prN...
#EMIMCC
-Don't stop insulin just because glucose hits 250 mg/dl
-Stop when AG closes, acidosis mainly resolved (bicarb greater than 18), long acting insulin on board + glucose controlled
youtube.com/shorts/z7prN...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
pharmacokinetics trick:
let’s say a med (eg metoprolol) is used q12hr as an outpatient
if you’re worried about causing instability, you *can* cut the dose in half and give it q6hr
there is no law that it MUST be given q12hr
smaller intervals = smoother effect & greater titratability
#EMIMCC
let’s say a med (eg metoprolol) is used q12hr as an outpatient
if you’re worried about causing instability, you *can* cut the dose in half and give it q6hr
there is no law that it MUST be given q12hr
smaller intervals = smoother effect & greater titratability
#EMIMCC
a close up of a man 's face with the word smoooooth written on it .
ALT: a close up of a man 's face with the word smoooooth written on it .
media.tenor.com
October 7, 2025 at 5:42 PM
pharmacokinetics trick:
let’s say a med (eg metoprolol) is used q12hr as an outpatient
if you’re worried about causing instability, you *can* cut the dose in half and give it q6hr
there is no law that it MUST be given q12hr
smaller intervals = smoother effect & greater titratability
#EMIMCC
let’s say a med (eg metoprolol) is used q12hr as an outpatient
if you’re worried about causing instability, you *can* cut the dose in half and give it q6hr
there is no law that it MUST be given q12hr
smaller intervals = smoother effect & greater titratability
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
normal mentation *doesn't* indicate adequate systemic perfusion
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
Sad Sad Bean GIF
ALT: Sad Sad Bean GIF
media.tenor.com
October 8, 2025 at 9:05 PM
normal mentation *doesn't* indicate adequate systemic perfusion
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Fresh blog: Six pearls on heparin-induced thrombocytopenia (HIT) in 2025
💎 enoxaparin causes 10x less HIT than UFH
💎 HEP score
💎 approach to intermediate 4T score?
💎 rising use of DOACs
💎 autoimmune HITT
💎 IVIG for immediate inhibition of HIT antibodies
blog emcrit.org/pulmcrit/hit... #EMIMCC
💎 enoxaparin causes 10x less HIT than UFH
💎 HEP score
💎 approach to intermediate 4T score?
💎 rising use of DOACs
💎 autoimmune HITT
💎 IVIG for immediate inhibition of HIT antibodies
blog emcrit.org/pulmcrit/hit... #EMIMCC
October 4, 2025 at 3:56 PM
Fresh blog: Six pearls on heparin-induced thrombocytopenia (HIT) in 2025
💎 enoxaparin causes 10x less HIT than UFH
💎 HEP score
💎 approach to intermediate 4T score?
💎 rising use of DOACs
💎 autoimmune HITT
💎 IVIG for immediate inhibition of HIT antibodies
blog emcrit.org/pulmcrit/hit... #EMIMCC
💎 enoxaparin causes 10x less HIT than UFH
💎 HEP score
💎 approach to intermediate 4T score?
💎 rising use of DOACs
💎 autoimmune HITT
💎 IVIG for immediate inhibition of HIT antibodies
blog emcrit.org/pulmcrit/hit... #EMIMCC