Derek Smith
@dereksmithmd.bsky.social
Anesthesia | Sports | Novels | Outdoors.
Reposted by Derek Smith
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
doi.org/10.1016/j.jc...
Intravenous steroids improve quality of recovery post operatively across QoR dimensions.
Intravenous steroids improve quality of recovery post operatively across QoR dimensions.
December 7, 2024 at 9:21 PM
doi.org/10.1016/j.jc...
Intravenous steroids improve quality of recovery post operatively across QoR dimensions.
Intravenous steroids improve quality of recovery post operatively across QoR dimensions.
Reposted by Derek Smith
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 Derek Smith
Hepatorenal syndrome is a hemodynamic renal injury
Cirrhosis is a Precarious balance: driving with two feet
1. The gas pedal (output): gut pooling 🔽return; output preserved by catecholes
2. The tank: To🔼return, we🔼ADH,Aldo
3. The brakes: RAAS/catechole good till they aint
Empty tank▶️all brakes▶️HRS
Cirrhosis is a Precarious balance: driving with two feet
1. The gas pedal (output): gut pooling 🔽return; output preserved by catecholes
2. The tank: To🔼return, we🔼ADH,Aldo
3. The brakes: RAAS/catechole good till they aint
Empty tank▶️all brakes▶️HRS
November 29, 2024 at 1:23 PM
Hepatorenal syndrome is a hemodynamic renal injury
Cirrhosis is a Precarious balance: driving with two feet
1. The gas pedal (output): gut pooling 🔽return; output preserved by catecholes
2. The tank: To🔼return, we🔼ADH,Aldo
3. The brakes: RAAS/catechole good till they aint
Empty tank▶️all brakes▶️HRS
Cirrhosis is a Precarious balance: driving with two feet
1. The gas pedal (output): gut pooling 🔽return; output preserved by catecholes
2. The tank: To🔼return, we🔼ADH,Aldo
3. The brakes: RAAS/catechole good till they aint
Empty tank▶️all brakes▶️HRS
Reposted by Derek Smith
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 1:17 PM
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....
Anyone have any experience with Dexmetomidine conscious sedations for procedures? Loading dose, rate, patient selection? Looking particularly for IR related procedures we’ve been asked to cover. Appreciate any insight!
#Ansky
#Ansky
November 26, 2024 at 1:46 PM
Anyone have any experience with Dexmetomidine conscious sedations for procedures? Loading dose, rate, patient selection? Looking particularly for IR related procedures we’ve been asked to cover. Appreciate any insight!
#Ansky
#Ansky
Reposted by Derek Smith
How should patients be positioned for optimal intubating conditions?
@chrimesy.com & @doctimcook.bsky.social describe the combination of flextension with torso elevation to 'ramp' the patient.
Check out the infographic!
#AnSky #AirwaySky
https://buff.ly/4eSw2Yo
@chrimesy.com & @doctimcook.bsky.social describe the combination of flextension with torso elevation to 'ramp' the patient.
Check out the infographic!
#AnSky #AirwaySky
https://buff.ly/4eSw2Yo
November 25, 2024 at 12:18 PM
How should patients be positioned for optimal intubating conditions?
@chrimesy.com & @doctimcook.bsky.social describe the combination of flextension with torso elevation to 'ramp' the patient.
Check out the infographic!
#AnSky #AirwaySky
https://buff.ly/4eSw2Yo
@chrimesy.com & @doctimcook.bsky.social describe the combination of flextension with torso elevation to 'ramp' the patient.
Check out the infographic!
#AnSky #AirwaySky
https://buff.ly/4eSw2Yo
Reposted by Derek Smith
Reposted by Derek Smith
Why do people wear shoe covers in the operating room?
💥 The reason may surprise you!
A 🧵 about the #HistoryOfMedicine and the dangers of blindly following traditions.
onepagericu.com/blog/cx1l66q...
1/
💥 The reason may surprise you!
A 🧵 about the #HistoryOfMedicine and the dangers of blindly following traditions.
onepagericu.com/blog/cx1l66q...
1/
Dissipating The Myth of Shoe Covers — ICU One Pager
If you work in a hospital chances are you've put on shoes covers. This is a well intentioned practice largely predicated on a misunderstanding about the history of medicine. Originally, shoe covers we...
onepagericu.com
November 23, 2024 at 5:16 PM
Why do people wear shoe covers in the operating room?
💥 The reason may surprise you!
A 🧵 about the #HistoryOfMedicine and the dangers of blindly following traditions.
onepagericu.com/blog/cx1l66q...
1/
💥 The reason may surprise you!
A 🧵 about the #HistoryOfMedicine and the dangers of blindly following traditions.
onepagericu.com/blog/cx1l66q...
1/
Reposted by Derek Smith
The original study was benchtop using a test lung.
We then did a lesser cited follow up clinical study.
Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries.
High FiO2 negates any potential environmental benefits.
www.bjanaesthesia.org/article/S000...
We then did a lesser cited follow up clinical study.
Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries.
High FiO2 negates any potential environmental benefits.
www.bjanaesthesia.org/article/S000...
DEFINE_ME
www.bjanaesthesia.org
November 24, 2024 at 12:10 PM
The original study was benchtop using a test lung.
We then did a lesser cited follow up clinical study.
Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries.
High FiO2 negates any potential environmental benefits.
www.bjanaesthesia.org/article/S000...
We then did a lesser cited follow up clinical study.
Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries.
High FiO2 negates any potential environmental benefits.
www.bjanaesthesia.org/article/S000...
Reposted by Derek Smith
This great lab study from 2020 surprised me at the time - challenging our assumptions about fresh gas flow rates and economic/environmental costs. #AnSky
[ Higher FGF (~6L/min) during TIVA reduces costs without sig environmental impact. ]
Summary → www.metajournal.com/articles/103...
[ Higher FGF (~6L/min) during TIVA reduces costs without sig environmental impact. ]
Summary → www.metajournal.com/articles/103...
November 24, 2024 at 12:57 AM
This great lab study from 2020 surprised me at the time - challenging our assumptions about fresh gas flow rates and economic/environmental costs. #AnSky
[ Higher FGF (~6L/min) during TIVA reduces costs without sig environmental impact. ]
Summary → www.metajournal.com/articles/103...
[ Higher FGF (~6L/min) during TIVA reduces costs without sig environmental impact. ]
Summary → www.metajournal.com/articles/103...
Reposted by Derek Smith
1/
So much of medicine is about telling a story 📖
Like anything, building your story and presenting it is a skill that comes with practice 🎖️
🧵 - Here are 5 common mistakes I see when trainees are presenting consults 👩⚕️⚕️🩺
#emimcc
So much of medicine is about telling a story 📖
Like anything, building your story and presenting it is a skill that comes with practice 🎖️
🧵 - Here are 5 common mistakes I see when trainees are presenting consults 👩⚕️⚕️🩺
#emimcc
November 21, 2024 at 5:57 PM
1/
So much of medicine is about telling a story 📖
Like anything, building your story and presenting it is a skill that comes with practice 🎖️
🧵 - Here are 5 common mistakes I see when trainees are presenting consults 👩⚕️⚕️🩺
#emimcc
So much of medicine is about telling a story 📖
Like anything, building your story and presenting it is a skill that comes with practice 🎖️
🧵 - Here are 5 common mistakes I see when trainees are presenting consults 👩⚕️⚕️🩺
#emimcc
Reposted by Derek Smith
#Ansky: who here is doing intrathecal morphine instead of thoracic epidurals for post op pain management? The Spring ASRA meeting had a compelling lecture on how many institutions are abandoning thoracic epidural analgesia in favor of ITM. @ropivacaine.bsky.social @dr-rajgupta.bsky.social
November 20, 2024 at 4:29 PM
#Ansky: who here is doing intrathecal morphine instead of thoracic epidurals for post op pain management? The Spring ASRA meeting had a compelling lecture on how many institutions are abandoning thoracic epidural analgesia in favor of ITM. @ropivacaine.bsky.social @dr-rajgupta.bsky.social
Reposted by Derek Smith
🚨 Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections
BALANCE trial publication is here !
#IDsky #Medsky
@idjclub.bsky.social
www.nejm.org/doi/full/10....
BALANCE trial publication is here !
#IDsky #Medsky
@idjclub.bsky.social
www.nejm.org/doi/full/10....
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections | NEJM
Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. In a multicenter, non...
www.nejm.org
November 20, 2024 at 1:10 PM
🚨 Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections
BALANCE trial publication is here !
#IDsky #Medsky
@idjclub.bsky.social
www.nejm.org/doi/full/10....
BALANCE trial publication is here !
#IDsky #Medsky
@idjclub.bsky.social
www.nejm.org/doi/full/10....
Reposted by Derek Smith
You've probably heard that Bicarbonate has to turn into CO2 to raise the pH.
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
November 19, 2024 at 1:46 PM
You've probably heard that Bicarbonate has to turn into CO2 to raise the pH.
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
“Don’t give bicarb if you can’t increase ventilation.” But why?!
How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?
A 🧵 all about our ICU frenemy NaHCO3
1/
Reposted by Derek Smith
So I’m a trauma anaesthetist and I do a lot of these for rib fractures.
I think people miss the point. The block chosen depends on anticoagualtion, injury pattern, concurrent injuries (e.g. spine), mobility, surgical trajectory etc.
The block you want to do is not always the block you can do.
I think people miss the point. The block chosen depends on anticoagualtion, injury pattern, concurrent injuries (e.g. spine), mobility, surgical trajectory etc.
The block you want to do is not always the block you can do.
November 17, 2024 at 4:44 PM
So I’m a trauma anaesthetist and I do a lot of these for rib fractures.
I think people miss the point. The block chosen depends on anticoagualtion, injury pattern, concurrent injuries (e.g. spine), mobility, surgical trajectory etc.
The block you want to do is not always the block you can do.
I think people miss the point. The block chosen depends on anticoagualtion, injury pattern, concurrent injuries (e.g. spine), mobility, surgical trajectory etc.
The block you want to do is not always the block you can do.
Reposted by Derek Smith
I remember spring 2020 heading in to the hospital thinking "I wonder if I'll die from this"
I remember reusing N95s and wearing trash bags as PPE.
I remember a refrigerated truck sitting in the hospital parking lot as a makeshift morgue because ours was overflowing.
But I mostly remember the public downplaying and ignoring COVID, because Trump did.
I remember a refrigerated truck sitting in the hospital parking lot as a makeshift morgue because ours was overflowing.
But I mostly remember the public downplaying and ignoring COVID, because Trump did.
I mainly remember the 600,000 needless American deaths from these “incredible” Trump health policies.
November 18, 2024 at 2:56 PM
I remember spring 2020 heading in to the hospital thinking "I wonder if I'll die from this"
Reposted by Derek Smith
If you are new to #RegionalAnaesthesia #RegionalAnesthesia and are looking for some content on YouTube to learn some Sonoanatomy, please do check out my channel.
All the Plan A Blocks, plus more!
@rauk.bsky.social #AnSky #RAsky
youtube.com/@dramitpawa?...
All the Plan A Blocks, plus more!
@rauk.bsky.social #AnSky #RAsky
youtube.com/@dramitpawa?...
Dr Amit Pawa
Dr Amit Pawa is a Consultant Anaesthetist at Guy's & St Thomas' NHS Foundation Trust, and an Interim Clinical Professor at Cleveland Clinic
He is an Ultrasound Regional Anaesthesia (USRA) enthusias...
youtube.com
November 14, 2024 at 10:26 AM
If you are new to #RegionalAnaesthesia #RegionalAnesthesia and are looking for some content on YouTube to learn some Sonoanatomy, please do check out my channel.
All the Plan A Blocks, plus more!
@rauk.bsky.social #AnSky #RAsky
youtube.com/@dramitpawa?...
All the Plan A Blocks, plus more!
@rauk.bsky.social #AnSky #RAsky
youtube.com/@dramitpawa?...
Reposted by Derek Smith
Check out the OAA ‘s new app: Quick Reference Handbook for Obstetric Emergencies :
apps.apple.com/us/app/quick...
apps.apple.com/us/app/quick...
November 13, 2024 at 11:26 PM
Check out the OAA ‘s new app: Quick Reference Handbook for Obstetric Emergencies :
apps.apple.com/us/app/quick...
apps.apple.com/us/app/quick...
Reposted by Derek Smith
Combined spinal-epidural (CSE) vs dural puncture epidural (DPE) for labour analgesia
Conclusion: No statistically significant differences in the quality of analgesia between the CSE and DPE techniques.
#AnSky #MedSky #ObSky
https://buff.ly/3O2C7Xb
Conclusion: No statistically significant differences in the quality of analgesia between the CSE and DPE techniques.
#AnSky #MedSky #ObSky
https://buff.ly/3O2C7Xb
November 13, 2024 at 3:00 PM
Combined spinal-epidural (CSE) vs dural puncture epidural (DPE) for labour analgesia
Conclusion: No statistically significant differences in the quality of analgesia between the CSE and DPE techniques.
#AnSky #MedSky #ObSky
https://buff.ly/3O2C7Xb
Conclusion: No statistically significant differences in the quality of analgesia between the CSE and DPE techniques.
#AnSky #MedSky #ObSky
https://buff.ly/3O2C7Xb
Reposted by Derek Smith
Combined spinal-epidural (CSE) v dural puncture epidural (DPE) - which is superior?
Block quality was assessed by the following:
• Poor block quality composite
• Asymmetric block
• Top-up intervention
• Catheter adjustment
• Failed catheter/epidural
#AnSky #Medsky #ObSky
https://buff.ly/3O2C7Xb
Block quality was assessed by the following:
• Poor block quality composite
• Asymmetric block
• Top-up intervention
• Catheter adjustment
• Failed catheter/epidural
#AnSky #Medsky #ObSky
https://buff.ly/3O2C7Xb
November 13, 2024 at 11:36 AM
Combined spinal-epidural (CSE) v dural puncture epidural (DPE) - which is superior?
Block quality was assessed by the following:
• Poor block quality composite
• Asymmetric block
• Top-up intervention
• Catheter adjustment
• Failed catheter/epidural
#AnSky #Medsky #ObSky
https://buff.ly/3O2C7Xb
Block quality was assessed by the following:
• Poor block quality composite
• Asymmetric block
• Top-up intervention
• Catheter adjustment
• Failed catheter/epidural
#AnSky #Medsky #ObSky
https://buff.ly/3O2C7Xb