Andrew Merelman
@amerelman.bsky.social
EM resident physician | Critical care paramedic
Reposted by Andrew Merelman
Do you place ULNAR arterial lines?
Why in 2025 are people still obsessed with RADIAL art lines?
The ULNAR artery is usual bigger & farther from the nerve.
Yes, the RADIAL is more superficial & easier to landmark but with POCUS it doesn’t matter!
Is RADIAL a holdover from the pre-POCUS times?
1/
Why in 2025 are people still obsessed with RADIAL art lines?
The ULNAR artery is usual bigger & farther from the nerve.
Yes, the RADIAL is more superficial & easier to landmark but with POCUS it doesn’t matter!
Is RADIAL a holdover from the pre-POCUS times?
1/
February 4, 2025 at 2:24 AM
Do you place ULNAR arterial lines?
Why in 2025 are people still obsessed with RADIAL art lines?
The ULNAR artery is usual bigger & farther from the nerve.
Yes, the RADIAL is more superficial & easier to landmark but with POCUS it doesn’t matter!
Is RADIAL a holdover from the pre-POCUS times?
1/
Why in 2025 are people still obsessed with RADIAL art lines?
The ULNAR artery is usual bigger & farther from the nerve.
Yes, the RADIAL is more superficial & easier to landmark but with POCUS it doesn’t matter!
Is RADIAL a holdover from the pre-POCUS times?
1/
Reposted by Andrew Merelman
ICU Mini-Stories:
Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:
Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:
February 1, 2025 at 10:20 PM
ICU Mini-Stories:
Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:
Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:
Reposted by Andrew Merelman
February 2, 2025 at 8:49 AM
Reposted by Andrew Merelman
People often talk about the time critical nature of sepsis. But it may surprise you to hear that the evidence to support “early” antibiotics actually isn't a settled debate. Why is that? The key question is “early in relation to what”? 🧵 1/n
December 3, 2024 at 9:38 AM
People often talk about the time critical nature of sepsis. But it may surprise you to hear that the evidence to support “early” antibiotics actually isn't a settled debate. Why is that? The key question is “early in relation to what”? 🧵 1/n
Reposted by Andrew Merelman
ICU OnePager approach to achieving a negative fluid balance
☠️ why fluid balance matters
💦 strategies to limit volume in
🚽 using diuretics to get fluid out
📟 onepagericu.com/diuresis
☠️ why fluid balance matters
💦 strategies to limit volume in
🚽 using diuretics to get fluid out
📟 onepagericu.com/diuresis
December 4, 2024 at 12:30 AM
ICU OnePager approach to achieving a negative fluid balance
☠️ why fluid balance matters
💦 strategies to limit volume in
🚽 using diuretics to get fluid out
📟 onepagericu.com/diuresis
☠️ why fluid balance matters
💦 strategies to limit volume in
🚽 using diuretics to get fluid out
📟 onepagericu.com/diuresis
Reposted by Andrew Merelman
One of the biggest things I’ve learned teaching airway stuff has been the relationship between “practice” and “play”
When practice becomes play people drop their guard a little and all of a sudden learn so much more effectively.
Where else should we be doing “intentional play”?
When practice becomes play people drop their guard a little and all of a sudden learn so much more effectively.
Where else should we be doing “intentional play”?
December 3, 2024 at 3:59 PM
One of the biggest things I’ve learned teaching airway stuff has been the relationship between “practice” and “play”
When practice becomes play people drop their guard a little and all of a sudden learn so much more effectively.
Where else should we be doing “intentional play”?
When practice becomes play people drop their guard a little and all of a sudden learn so much more effectively.
Where else should we be doing “intentional play”?
Reposted by Andrew Merelman
ICU Stories:
Patient with COPD-obstr sleep apnea (5 l/m O2 nasal cannula at baseline) / A. fib / diastolic heart failure / DM2 / vascular dz / HTN / CKD / morbid obesity (BMI 50) etc presents to the ED with dyspnea/cough/weakness x 2 days. Felt warm; did not check temperature. CXR in ED:
Patient with COPD-obstr sleep apnea (5 l/m O2 nasal cannula at baseline) / A. fib / diastolic heart failure / DM2 / vascular dz / HTN / CKD / morbid obesity (BMI 50) etc presents to the ED with dyspnea/cough/weakness x 2 days. Felt warm; did not check temperature. CXR in ED:
November 30, 2024 at 8:34 PM
ICU Stories:
Patient with COPD-obstr sleep apnea (5 l/m O2 nasal cannula at baseline) / A. fib / diastolic heart failure / DM2 / vascular dz / HTN / CKD / morbid obesity (BMI 50) etc presents to the ED with dyspnea/cough/weakness x 2 days. Felt warm; did not check temperature. CXR in ED:
Patient with COPD-obstr sleep apnea (5 l/m O2 nasal cannula at baseline) / A. fib / diastolic heart failure / DM2 / vascular dz / HTN / CKD / morbid obesity (BMI 50) etc presents to the ED with dyspnea/cough/weakness x 2 days. Felt warm; did not check temperature. CXR in ED:
Reposted by Andrew Merelman
Did you know? Black Friday is named in honor of Rebecca Black, who invented Friday in 2011.
November 29, 2024 at 2:31 PM
Did you know? Black Friday is named in honor of Rebecca Black, who invented Friday in 2011.
I’ve been using IV/IM olanzapine a lot, especially with the droperidol shortage, for agitation, nausea/vomiting/abd pain, migraine, with great results.
Skytorial: Five pearls on olanzapine 😁
Between agitation and nausea/vomiting, olanzapine has a wide range of use.
Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....
Between agitation and nausea/vomiting, olanzapine has a wide range of use.
Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....
a man in a plaid shirt sits at a picnic table with the words " settle down " on the bottom
ALT: a man in a plaid shirt sits at a picnic table with the words " settle down " on the bottom
media.tenor.com
November 27, 2024 at 6:17 PM
I’ve been using IV/IM olanzapine a lot, especially with the droperidol shortage, for agitation, nausea/vomiting/abd pain, migraine, with great results.
Reposted by Andrew Merelman
1w cough and increasing dyspnea. Upon pickup by paramedics sat70%, hypotensive. ⬆️CRP/WBC. Pneumonia/septic shock assumed, abx and bolus fluids initiated, intubated in the ER. Hypotensive despite high dose pressor, #Echo follows #FOAMed #FOAMcc
November 3, 2024 at 10:45 PM
1w cough and increasing dyspnea. Upon pickup by paramedics sat70%, hypotensive. ⬆️CRP/WBC. Pneumonia/septic shock assumed, abx and bolus fluids initiated, intubated in the ER. Hypotensive despite high dose pressor, #Echo follows #FOAMed #FOAMcc
Reposted by Andrew Merelman
Tell your friends!
Prehospital Sky as a feed is up and running! If you see things relevant to EMS please tag them #EMSsky for them to be cataloged!
Everyone is welcome, I hope this ends up high yield!
bsky.app/profile/did:...
Prehospital Sky as a feed is up and running! If you see things relevant to EMS please tag them #EMSsky for them to be cataloged!
Everyone is welcome, I hope this ends up high yield!
bsky.app/profile/did:...
November 19, 2024 at 11:08 PM
Tell your friends!
Prehospital Sky as a feed is up and running! If you see things relevant to EMS please tag them #EMSsky for them to be cataloged!
Everyone is welcome, I hope this ends up high yield!
bsky.app/profile/did:...
Prehospital Sky as a feed is up and running! If you see things relevant to EMS please tag them #EMSsky for them to be cataloged!
Everyone is welcome, I hope this ends up high yield!
bsky.app/profile/did:...
Reposted by Andrew Merelman
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia
This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.
jamanetwork.com
November 19, 2024 at 4:51 AM
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...