Gary Macy
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gmacy1.bsky.social
Gary Macy
@gmacy1.bsky.social
210 followers 440 following 0 posts
Nurse Practitioner, Neurocritical Care
Posts Replies Media Videos
Reposted by Gary Macy
pulmcrit.bsky.social
Joshua Faber (EM resident in NYC) created a chatbot designed to query the entire IBCC and link to relevant chapters

This seems pretty neat to me

Similar to AI in general, the specific answer may not always be correct, but it links to relevant chapters

Thoughts?

try it out: icbcc.onrender.com
September 23, 2025 at 12:13 AM
Reposted by Gary Macy
jama.com
Superficial vein thrombosis (SuVT) is characterized by thrombus in the superficial veins, typically in the lower or upper extremities.

This Review summarizes the diagnosis and treatment of SuVT.

ja.ma/4gtRzc6
Diagram from JAMA, Sept 15, 2025, titled "Superficial Vein Thrombosis: A Review." It shows common sites and pathophysiology of SuVT in upper and lower extremities, detailing vein names, thrombus formation, inflammation, and impeded blood flow.
September 20, 2025 at 1:00 PM
Reposted by Gary Macy
anaesjournal.bsky.social
Check out these coagulation and platelet recommendations for insertion and removal of central venous access devices!

Super helpful!

#AnSky #MedSky

doi.org/10.1111/anae...
September 18, 2025 at 2:01 PM
Reposted by Gary Macy
anaesjournal.bsky.social
Sometimes you have to give noradrenaline in a hurry!

Here are the working party recommendations for administering peripheral noradrenaline.

#AnSky #MedSky

doi.org/10.1111/anae...
September 18, 2025 at 3:02 PM
Reposted by Gary Macy
dentongavin.bsky.social
Role PAs and NPs in USA ICU podcasts.apple.com/gb/podcast/c...
44. Critical Partners: The Vital Roles of NPs and PAs in Critical Care
Podcast Episode · Critical Care Time · 10/03/2025 · 1h
podcasts.apple.com
March 10, 2025 at 3:28 PM
Reposted by Gary Macy
ajwpharm.bsky.social
More data on the safety of AC resumption after ICH - shocking news, patients had fewer strokes but more recurrent ICHs

Median time from ICH to enrollment was 49 days!

www.thelancet.com/journals/lan...
March 6, 2025 at 2:49 AM
Reposted by Gary Macy
anandiyermd.bsky.social
Putting my “Extubation Checklist” back out & into the @bsky.app ether.

I have refined this MASCOTS tool over the years to help trainees identify frequently missed elements during extubation.

Welcome ongoing feedback!

@laxswamy.bsky.social
@criticalcaretime.bsky.social
@nickmark.bsky.social
February 9, 2025 at 5:30 PM
Reposted by Gary Macy
katiewiskar.bsky.social
Next to fluids, IV diuretics are some of the most commonly mis-prescribed medications in acute medicine 💉🩸

Let's unpack 5 common diuretic prescribing mistakes, and how to correct these 🧵

#emimcc
January 17, 2025 at 6:19 PM
Reposted by Gary Macy
eddyjoemd.bsky.social
Do you need some help in working up and diagnosing your patient with whatever caused their ARDS? Then this paper can be helpful as it reviews some practical steps. 🎩 tip to the authors.

eddyjoemd.com/foamed/
January 12, 2025 at 11:15 AM
Reposted by Gary Macy
jama.com
This JAMA Clinical Guidelines Synopsis summarizes the 2024 Society of Critical Care Medicine guidelines on use of corticosteroids in sepsis, acute respiratory distress syndrome, and community-acquired pneumonia.

ja.ma/42bw8Y2
January 8, 2025 at 5:00 PM
Reposted by Gary Macy
zentensivist.bsky.social
New paper

ccforum.biomedcentral.com/articles/10....
Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in mechanically ventilated patients with low tidal volume in ICU: a systematic review and meta...
Background Pulse pressure variation (PPV) is limited in low tidal volume mechanical ventilation. We conducted this systematic review and meta-analysis to evaluate whether passive leg raising (PLR)-ind...
ccforum.biomedcentral.com
January 10, 2025 at 2:57 PM
Reposted by Gary Macy
copddoc.bsky.social
"The RCP didn’t listen, took its power for granted, and was hit hard."
www.bmj.com/content/387/... @bmj.com
The storm that blew the Royal College of Physicians off course
A storm blew through the Royal College of Physicians of London (RCP) this year. A disastrous extraordinary general meeting, only the third in the college’s 500 year history, led to the resignations of...
www.bmj.com
December 13, 2024 at 10:53 AM
Reposted by Gary Macy
damienbarraudmd.bsky.social
Approximatively 0 in emergency settings
January 10, 2025 at 1:43 PM
Reposted by Gary Macy
copddoc.bsky.social
From @rcphysicians.bsky.social "Physician associates should not prescribe medications, must “clearly explain” their role to patients, families, and carers, and should carry out only “basic clinical and administrative tasks” under the supervision of a senior doctor." www.bmj.com/content/387/...
Physician associates: RCP guidance limits role to “basic clinical and administrative tasks”
Physician associates (PAs) must “never function as a senior decision maker,” and resident doctors should never be made responsible for supervising them, says interim guidance from the Royal College of...
www.bmj.com
January 10, 2025 at 2:01 PM
Reposted by Gary Macy
edgarvlermamd.bsky.social
Early Doctors Diagnosed Disease by Looking at Urine
#Nephpearls #NephSky
- Nowadays, as nephrologists, we still look at the urine to provide us answers to diagnostic inquiries

👉 daily.jstor.org/early-doctor...

👉 pubmed.ncbi.nlm.nih.gov/30626576/
January 5, 2025 at 12:24 AM
Reposted by Gary Macy
juancarlosqvelez.bsky.social
1/n HydrANCAzine (hydralazine-induced ANCA-associated vasculitis has turn into an important cause of crescentic glomerulonephritis. Wonder how does hydralazine do it? Here is a tweetorial (BlueSkytorial?). I’ll start with an animation that summarizes and simplifies a proposed mechanism.
December 24, 2024 at 4:59 PM
Reposted by Gary Macy
medicine.stitches.today
A liberal transfusion strategy did not improve neurologic outcomes compared to a restrictive strategy in aneurysmal subarachnoid hemorrhage patients.

by English SW, Delaney A (...) Tuttle A et 4 al. in N Engl J Med #MedSky

📖 read the article: https://www.nejm.org/doi/10.1056/NEJMoa2410962
December 18, 2024 at 6:37 PM
Reposted by Gary Macy
ajwpharm.bsky.social
Of note, "severe" hemorrhagic transformation (PH2) was a contraindication, suggesting petechial bleeding isn't a reason to delay AC

Additionally, early initiation was considered <4 days regardless of stroke severity (but only ~12% were NIHSS >15), and pre-morbid AC was not a contraindication
December 18, 2024 at 7:12 PM
Reposted by Gary Macy
hswapnil.medsky.social
For the torrid torsemide groupies (ahem @captainchloride.bsky.social @kidneyboy.bsky.social )

A dash of cold water from Qais Al-Awqati

JASN editorial: journals.lww.com/jasn/fulltex...

1/
Absorption: Torsemide is absorbed faster; this is what is often mentioned as the raison d'etre for its preference. However, it is worth pointing out that the molecular mechanism of absorption of the two drugs (and of most other drugs) is not well known. Many claim that it is paracellular and thus passive, but these assumptions are based on chemical structure not on biological transport studies. For instance, if a drug is hydrophobic (as torsemide is), it is claimed that it will diffuse more rapidly by the so-called Overton rule. As discussed elsewhere, these conclusions are often wrong.9 Plasma protein binding: Both drugs are highly bound by plasma proteins to as much as 99%. Drug metabolism: Torsemide is metabolized mostly (80%) by the liver (but metabolism is quite variable in different people) and the remainder excreted as is by the kidney. Furosemide is mostly eliminated by renal excretion. Plasma t1/2: Torsemide's t1/2 in the circulation is longer than that of furosemide, 4.9 versus 1.7 hours.6 While the longer t1/2 was another selling point, because furosemide's absorption is slower, it lasts in the circulation longer (but at lower concentrations), thus resembling drugs with a sustained release formulation, which might be an advantage. Renal drug secretion: Furosemide is secreted by OAT1 and OAT2 and less so by OAT4 and also by the ABC transporter MRP4. Torsemide's secretion is less well studied but seems also to be secreted by the organic anion transport system as evidenced by the inhibition of its secretion by probenecid.10 Drug concentration at the site of action: While the concentration of drugs in the thick ascending limb is not possible to estimate, the urine concentration is a reasonable surrogate. Rao et al. introduced a new critical parameter, kidney bioavailability, which is the urinary concentration of the diuretic. As expected from the faster absorption, torsemide appears earlier but does not last as long as furosemide. But what was interesting is that a higher percentage of the furosemide dose appeared in the urine compared with torsemide. Inhibitory potency: The half maximal inhibition of transport in the thick ascending limb is achieved by 4000 nM furosemide and 300 nM torsemide.2,5 Dose equivalence: One would think that this issue is too obvious to need to be mentioned let alone investigated. Rao et al. codified the use of Na excretion as a function of dose and found that 10 mg oral torsemide was equal to 40 mg of furosemide. Many studies, including the TRANSFORM one, used a 2:1 ratio; that is, they used twice the natriuretic potency of furosemide. The consequence of that was predictable; when the study began torsemide, it produced more natriuresis than furosemide on the first day.8 But 30 days later, their natriuresis was the same. As would be expected, patients who took torsemide at a 2:1 ratio had more volume depletion having taken twice the natriuretic dose and developed higher renin, aldosterone, and epinephrin levels.
December 6, 2024 at 1:26 PM
Reposted by Gary Macy
terrihough.bsky.social
Thank you and rest in peace, Dr. Gattinoni.
www.esicm.org/obituary-luc...
Obituary: Luciano Gattinoni - ESICM
In Memory of Professor Luciano Gattinoni
www.esicm.org
December 4, 2024 at 12:25 AM
Reposted by Gary Macy
juancarlosqvelez.bsky.social
2/2 for hepatorenal reflex: PMID 9203948. In this review, I tried to integrate these studies with a proposed unifying mechanism pubmed.ncbi.nlm.nih.gov/38649221/
Pathophysiology of Hepatorenal Syndrome - PubMed
Hepatorenal syndrome type 1 (HRS-1) is a unique form of acute kidney injury that affects individuals with decompensated cirrhosis with ascites. The primary mechanism leading to reduction of kidney fun...
pubmed.ncbi.nlm.nih.gov
November 27, 2024 at 12:03 AM
Reposted by Gary Macy
katiewiskar.bsky.social
1/
Back to the basics today: let's talk about common pitfalls in obtaining cardiac #POCUS images ❤️

Here are some very common image acquisition errors in basic views, as well as the simple moves to correct them ✅

🧵

#emimcc #POCUSky #echosky #MedSky
November 26, 2024 at 5:51 PM
Reposted by Gary Macy
thecurbsiders.bsky.social
Hi!!! If you follow us here please share if you are a longtime listener or if you just discovered us!

www.TheCurbsiders.com
a white cat is laying on its back on the floor and says `` hello . hello ... ''
ALT: a white cat is laying on its back on the floor and says `` hello . hello ... ''
media.tenor.com
November 20, 2024 at 6:40 PM
Reposted by Gary Macy
criticalcarereviews.com
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia. A SRMA

CCR Journal Watch
criticalcarereviews.com/latest-evide...

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
November 19, 2024 at 5:40 PM
Reposted by Gary Macy
kidneyboy.bsky.social
Okay so we can't upload animated gifs to Bluesky...yet, so I channeled my inner El-Koury and made this "movie" describing the mechanism for pseudohyponatremia
November 17, 2024 at 6:07 PM