Leon Chen, DNP
@ccmdnp.bsky.social
Critical care DNP | Associate Professor@ColumbiaUniversity | Associate Editor@JAANP | FCCP | FAANP | FCCM | #POCUS enthusiast and educator | Husband | Dad x2 | https://www.nursing.columbia.edu/profile/leon-l-chen-dnp posts reflect personal opinions only
Reposted by Leon Chen, DNP
if you’re really struggling to choose between two therapeutic options…
it probably doesn’t matter which one you pick 😆
it probably doesn’t matter which one you pick 😆
January 14, 2025 at 11:16 PM
if you’re really struggling to choose between two therapeutic options…
it probably doesn’t matter which one you pick 😆
it probably doesn’t matter which one you pick 😆
Reposted by Leon Chen, DNP
when admitting a hypothermic patient, check a TSH and random serum cortisol
don’t need a new blood draw (just add it on to the last blood draw sitting in the lab)
don’t waste a ton of neurons on this, just check it like a reflex arc.
in ~1/50 cases you’ll look like a diagnostic genius 🤣 #EMIMCC
don’t need a new blood draw (just add it on to the last blood draw sitting in the lab)
don’t waste a ton of neurons on this, just check it like a reflex arc.
in ~1/50 cases you’ll look like a diagnostic genius 🤣 #EMIMCC
a black background with a white nike swoosh on it
ALT: a black background with a white nike swoosh on it
media.tenor.com
January 1, 2025 at 2:29 PM
when admitting a hypothermic patient, check a TSH and random serum cortisol
don’t need a new blood draw (just add it on to the last blood draw sitting in the lab)
don’t waste a ton of neurons on this, just check it like a reflex arc.
in ~1/50 cases you’ll look like a diagnostic genius 🤣 #EMIMCC
don’t need a new blood draw (just add it on to the last blood draw sitting in the lab)
don’t waste a ton of neurons on this, just check it like a reflex arc.
in ~1/50 cases you’ll look like a diagnostic genius 🤣 #EMIMCC
Reposted by Leon Chen, DNP
Common things are common. An uncommon presentation of a common disease is still more common than an uncommon disease.
January 1, 2025 at 4:01 PM
Common things are common. An uncommon presentation of a common disease is still more common than an uncommon disease.
Reposted by Leon Chen, DNP
Femoral Central Lines are awesome!
1) Infection rate equal to rate with IJ (subclavian are cleaner)
2) Easier to place in the awake patient
3) 0% PTX rate (IJ ~ 0.5%, Subclavian ~ 1.5%)
4) Single prep for CVL + Art line
#MedSky #EMIMCC
bit.ly/41JI8jt
1) Infection rate equal to rate with IJ (subclavian are cleaner)
2) Easier to place in the awake patient
3) 0% PTX rate (IJ ~ 0.5%, Subclavian ~ 1.5%)
4) Single prep for CVL + Art line
#MedSky #EMIMCC
bit.ly/41JI8jt
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December 19, 2024 at 8:11 PM
Femoral Central Lines are awesome!
1) Infection rate equal to rate with IJ (subclavian are cleaner)
2) Easier to place in the awake patient
3) 0% PTX rate (IJ ~ 0.5%, Subclavian ~ 1.5%)
4) Single prep for CVL + Art line
#MedSky #EMIMCC
bit.ly/41JI8jt
1) Infection rate equal to rate with IJ (subclavian are cleaner)
2) Easier to place in the awake patient
3) 0% PTX rate (IJ ~ 0.5%, Subclavian ~ 1.5%)
4) Single prep for CVL + Art line
#MedSky #EMIMCC
bit.ly/41JI8jt
Reposted by Leon Chen, DNP
Kudos to @fda.gov for rejecting full approval of andexanet alfa
ANNEXA-1: Andexanet alfa w/ a strong signal for HARM compared to usual care in patients on a DOAC w/ ICH w/ no evidence of clinical benefit
#MedSky #EMIMCC
youtube.com/shorts/EOqzP...
ANNEXA-1: Andexanet alfa w/ a strong signal for HARM compared to usual care in patients on a DOAC w/ ICH w/ no evidence of clinical benefit
#MedSky #EMIMCC
youtube.com/shorts/EOqzP...
Andexanet Alfa Is Just Expensive Garbage #emergencymedicine #resuscitation #criticalcare
YouTube video by EMSwami
youtube.com
December 20, 2024 at 8:29 PM
Kudos to @fda.gov for rejecting full approval of andexanet alfa
ANNEXA-1: Andexanet alfa w/ a strong signal for HARM compared to usual care in patients on a DOAC w/ ICH w/ no evidence of clinical benefit
#MedSky #EMIMCC
youtube.com/shorts/EOqzP...
ANNEXA-1: Andexanet alfa w/ a strong signal for HARM compared to usual care in patients on a DOAC w/ ICH w/ no evidence of clinical benefit
#MedSky #EMIMCC
youtube.com/shorts/EOqzP...
Reposted by Leon Chen, DNP
Good example of rule of threes. RVOT, aortic root and left atrium should look about the same diameter in PLAX, here one is too big #pocus
December 17, 2024 at 8:28 PM
Good example of rule of threes. RVOT, aortic root and left atrium should look about the same diameter in PLAX, here one is too big #pocus
Reposted by Leon Chen, DNP
Published in JAMA Surgery, part of the JAMA Network of journals
Chest tube management. Everything you wanted to know, but didn't know to ask! #Surgery #SurgSky #MedSky #MedEd @jama.com
jamanetwork.com/journals/jam...
jamanetwork.com/journals/jam...
Chest Tube Management
This narrative review evaluates existing research in chest tube placement to highlight best practices and safe application and to provide direction for future use.
jamanetwork.com
December 9, 2024 at 2:51 AM
Published in JAMA Surgery, part of the JAMA Network of journals
Reposted by Leon Chen, DNP
@sccmcriticalcare.bsky.social @neurocritical.bsky.social @neurocritcarej.bsky.social @criticalcarereviews.com @atscommunity.bsky.social @americanheart.bsky.social is a good list to start!
December 6, 2024 at 1:22 AM
Reposted by Leon Chen, DNP
People will inevitably tell you that their favorite inodilator (usually milrinone) is better since there are fewer arrhythmias compared to the other (usually dobut)
DOREMI says 🤷♂️ #emimcc
DOREMI says 🤷♂️ #emimcc
December 4, 2024 at 1:07 AM
People will inevitably tell you that their favorite inodilator (usually milrinone) is better since there are fewer arrhythmias compared to the other (usually dobut)
DOREMI says 🤷♂️ #emimcc
DOREMI says 🤷♂️ #emimcc
Reposted by Leon Chen, DNP
ICU Stories:
Middle-aged patient w multiple co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/atrial fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/ hypotension. Urine was purulent. CT showed hydronephrosis & bladder wall thickening:
Middle-aged patient w multiple co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/atrial fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/ hypotension. Urine was purulent. CT showed hydronephrosis & bladder wall thickening:
November 29, 2024 at 9:09 PM
ICU Stories:
Middle-aged patient w multiple co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/atrial fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/ hypotension. Urine was purulent. CT showed hydronephrosis & bladder wall thickening:
Middle-aged patient w multiple co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/atrial fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/ hypotension. Urine was purulent. CT showed hydronephrosis & bladder wall thickening:
Reposted by Leon Chen, DNP
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 Leon Chen, DNP
The HAPPEN trial
Go hard or go home because high intensity NIPPV (10-15ml/kg IBW TVs) vs low intensity (6-10) in COPD exacerbations reduced the rate of patients meeting predefined criteria for intubation by 9% (ARR).
jamanetwork.com/journals/jam...
Go hard or go home because high intensity NIPPV (10-15ml/kg IBW TVs) vs low intensity (6-10) in COPD exacerbations reduced the rate of patients meeting predefined criteria for intubation by 9% (ARR).
jamanetwork.com/journals/jam...
Effect of Noninvasive Positive Pressure Ventilation on the Need for Endotracheal Intubation in COPD
This randomized clinical trial compares the effect of high-intensity noninvasive positive pressure ventilation (NPPV) vs low-intensity NPPV on the need for endotracheal intubation in patients with an ...
jamanetwork.com
December 1, 2024 at 2:15 AM
The HAPPEN trial
Go hard or go home because high intensity NIPPV (10-15ml/kg IBW TVs) vs low intensity (6-10) in COPD exacerbations reduced the rate of patients meeting predefined criteria for intubation by 9% (ARR).
jamanetwork.com/journals/jam...
Go hard or go home because high intensity NIPPV (10-15ml/kg IBW TVs) vs low intensity (6-10) in COPD exacerbations reduced the rate of patients meeting predefined criteria for intubation by 9% (ARR).
jamanetwork.com/journals/jam...
Reposted by Leon Chen, DNP
important thread 👇
{norepi + vaso} can often induce a state of *normotensive* vasoconstrictive shock
this is why I dislike blind algorithms that start with NE, then pile on vaso on without considering global hemodynamics
for experts, there is no such thing as a “1st/2nd/3rd line” pressor #EMIMCC
{norepi + vaso} can often induce a state of *normotensive* vasoconstrictive shock
this is why I dislike blind algorithms that start with NE, then pile on vaso on without considering global hemodynamics
for experts, there is no such thing as a “1st/2nd/3rd line” pressor #EMIMCC
If the LV of the patient with sepsis is «hyperdynamic» when on noradrenaline, then EF dropps and the LV looks poorly when vasopressin is added, but recovers to normal with dobutamine, you likely haven’t «uncovered hidden LV dysfunction» or septic cardiomyopathy. #emimcc #pocus #echofirst 1/
November 30, 2024 at 2:25 PM
important thread 👇
{norepi + vaso} can often induce a state of *normotensive* vasoconstrictive shock
this is why I dislike blind algorithms that start with NE, then pile on vaso on without considering global hemodynamics
for experts, there is no such thing as a “1st/2nd/3rd line” pressor #EMIMCC
{norepi + vaso} can often induce a state of *normotensive* vasoconstrictive shock
this is why I dislike blind algorithms that start with NE, then pile on vaso on without considering global hemodynamics
for experts, there is no such thing as a “1st/2nd/3rd line” pressor #EMIMCC
Reposted by Leon Chen, DNP
'Critical Care Management of Acute Venous Thromboembolism: Integrating Pharmacotherapy, Thrombectomy, and Temporary Mechanical Support'
#tnkase #thrombectomy #FlowTriever #ecmo #PE #vte #dvt pulmonary embolism #pulmSky #emimcc
www.uscjournal.com/articles/cri...
#tnkase #thrombectomy #FlowTriever #ecmo #PE #vte #dvt pulmonary embolism #pulmSky #emimcc
www.uscjournal.com/articles/cri...
Critical Care Management of Acute Venous Thromboembolism: Integrating Pharmacotherapy, Thrombectomy, and Temporary Mechanical Support
Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, carries significant morbidity and mortality risks, and is conventionally managed with
www.uscjournal.com
November 28, 2024 at 7:57 PM
'Critical Care Management of Acute Venous Thromboembolism: Integrating Pharmacotherapy, Thrombectomy, and Temporary Mechanical Support'
#tnkase #thrombectomy #FlowTriever #ecmo #PE #vte #dvt pulmonary embolism #pulmSky #emimcc
www.uscjournal.com/articles/cri...
#tnkase #thrombectomy #FlowTriever #ecmo #PE #vte #dvt pulmonary embolism #pulmSky #emimcc
www.uscjournal.com/articles/cri...
Reposted by Leon Chen, DNP
Differentiating Syncope vs Seizure:
- LOC + loss of postural tone in both
- GTC movements often seen in syncope
- Tongue biting + incontinence can be seen in both as well
Post-ictal period is key. Brief confusion post-syncope but post-ictal = seizure
#MedSky #EMIMCC
youtube.com/shorts/5_zu_...
- LOC + loss of postural tone in both
- GTC movements often seen in syncope
- Tongue biting + incontinence can be seen in both as well
Post-ictal period is key. Brief confusion post-syncope but post-ictal = seizure
#MedSky #EMIMCC
youtube.com/shorts/5_zu_...
ECG in Seizure
YouTube video by Anand Swaminathan
youtube.com
November 29, 2024 at 2:53 PM
Differentiating Syncope vs Seizure:
- LOC + loss of postural tone in both
- GTC movements often seen in syncope
- Tongue biting + incontinence can be seen in both as well
Post-ictal period is key. Brief confusion post-syncope but post-ictal = seizure
#MedSky #EMIMCC
youtube.com/shorts/5_zu_...
- LOC + loss of postural tone in both
- GTC movements often seen in syncope
- Tongue biting + incontinence can be seen in both as well
Post-ictal period is key. Brief confusion post-syncope but post-ictal = seizure
#MedSky #EMIMCC
youtube.com/shorts/5_zu_...
Reposted by Leon Chen, DNP
New paper just dropped in @jama.com showing the miracle that are HPV vaccines
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
November 29, 2024 at 1:32 PM
New paper just dropped in @jama.com showing the miracle that are HPV vaccines
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
Reposted by Leon Chen, DNP
Restrictive Cardiomyopathy
- Normal systolic fx
- Small LV chamber size
- Granular myocardium
- Mild atrial enlargement
- Normal systolic fx
- Small LV chamber size
- Granular myocardium
- Mild atrial enlargement
November 29, 2024 at 6:20 PM
Restrictive Cardiomyopathy
- Normal systolic fx
- Small LV chamber size
- Granular myocardium
- Mild atrial enlargement
- Normal systolic fx
- Small LV chamber size
- Granular myocardium
- Mild atrial enlargement
Reposted by Leon Chen, DNP
Eyeballing severity of MR. Best done in PLAX view. Measure the vena contracta (narrowest portion of jet at the mitral valve).
- Mild MR: < 0.3 cm
- Moderate MR: 0.3–0.69 cm
- Severe MR: ≥ 0.7 cm
#POCUS
- Mild MR: < 0.3 cm
- Moderate MR: 0.3–0.69 cm
- Severe MR: ≥ 0.7 cm
#POCUS
November 27, 2024 at 1:05 AM
Eyeballing severity of MR. Best done in PLAX view. Measure the vena contracta (narrowest portion of jet at the mitral valve).
- Mild MR: < 0.3 cm
- Moderate MR: 0.3–0.69 cm
- Severe MR: ≥ 0.7 cm
#POCUS
- Mild MR: < 0.3 cm
- Moderate MR: 0.3–0.69 cm
- Severe MR: ≥ 0.7 cm
#POCUS
Reposted by Leon Chen, DNP
One of the hardest skills to master as a #POCUS trainer is supporting learners to optimise their views without grabbing the probe.
The ability to understand how to manouvre someone else’s views is POCUS-Jedi level skills.
@katiewiskar.bsky.social does it here in a great skeetorial.
#emimcc
The ability to understand how to manouvre someone else’s views is POCUS-Jedi level skills.
@katiewiskar.bsky.social does it here in a great skeetorial.
#emimcc
November 26, 2024 at 11:12 PM
One of the hardest skills to master as a #POCUS trainer is supporting learners to optimise their views without grabbing the probe.
The ability to understand how to manouvre someone else’s views is POCUS-Jedi level skills.
@katiewiskar.bsky.social does it here in a great skeetorial.
#emimcc
The ability to understand how to manouvre someone else’s views is POCUS-Jedi level skills.
@katiewiskar.bsky.social does it here in a great skeetorial.
#emimcc
Reposted by Leon Chen, DNP
'we review the physiological basis of the VExUS assessment as a measure and marker of venous congestion from the organs’ standpoint and its role as part of the emerging concept of fluid tolerance' #pocus #pocusky #emimcc #cardiosky #vexus
theultrasoundjournal.springeropen.com/articles/10....
theultrasoundjournal.springeropen.com/articles/10....
VExUS: common misconceptions, clinical use and future directions - The Ultrasound Journal
There has been a significant interest in venous congestion in recent years, among which the VExUS score has been prominent, both in clinical practice and research efforts. We have noted some recurrent...
theultrasoundjournal.springeropen.com
November 26, 2024 at 6:27 PM
'we review the physiological basis of the VExUS assessment as a measure and marker of venous congestion from the organs’ standpoint and its role as part of the emerging concept of fluid tolerance' #pocus #pocusky #emimcc #cardiosky #vexus
theultrasoundjournal.springeropen.com/articles/10....
theultrasoundjournal.springeropen.com/articles/10....
Choose 20 books that have stayed with you or influenced you. One book per day for 20 days, in no particular order. No explanations, no reviews, just covers.
#Books
#BookSky
💙📚
#BookChallenge
2/20
#Books
#BookSky
💙📚
#BookChallenge
2/20
November 25, 2024 at 4:03 AM
Choose 20 books that have stayed with you or influenced you. One book per day for 20 days, in no particular order. No explanations, no reviews, just covers.
#Books
#BookSky
💙📚
#BookChallenge
2/20
#Books
#BookSky
💙📚
#BookChallenge
2/20
Reposted by Leon Chen, DNP
ICU Hemodynamics:
What changed in this case between a and b?
What changed in this case between a and b?
November 24, 2024 at 2:44 AM
ICU Hemodynamics:
What changed in this case between a and b?
What changed in this case between a and b?