The ideal cutoff for adequate time-to-antibiotic delivery in septic shock is being discussed again 🤦‍♂️

Should we be required to give antibiotics in 1 hr? 3 hr? 15 minutes? 3.14159 minutes?

This is worth a short thread on the background of this topic

Buckle up, it's a mess... #EMIMCC #IDsky #1/6

Into the final countdown

➡️ Just 10 days until #CCR25
➡️ 12 major trial results presentations

🚩 Full, free livestream, but it's better in person

https://criticalcarereviews.com/meetings/ccr25

Just added a new section to IBCC on septic cardiomyopathy.

Lets talk about it.

We see this daily but don’t get much education on it.

It’s poorly defined but common (~1/3 of septic shock pts).

Diffuse often biventricular failure occurs starting after ~2-3 days, then resolves by ~7-10 days
#EMIMCC

I am running for Clinical VP of the RCP.

For those who don't know me, here is a potted bio.
🧵

A quick #VEXUS thread 🧵-

3 reasons why the portal vein is the most useful single venous doppler waveform 🥇

(if you're only going to do ONE site to look for venous congestion, this is probably the most useful one!)

#emimcc

Confession: I LOVE hyponatremia 🤓

(I know, I know. What can I say, I'm a true internist!)

HypoNa is often feared, maligned, and misunderstood - but I promise it doesn't have to be scary!

Here are my top 10 hyponatremia tips and tricks - a 🧵

#emimcc

Analysts know the issue re waiting time and LoS in EDs is hospital flow.
Now, IMO the important question is Why is flow poor?
Deeper dives into;

What is being admitted?
How much has hospital LoS changed? With granular data on social care wait vs inpatient investigation/treatment based LoS

We report 0.9% VTE within 90 days of hospital led acute ambulatory care attendance; similar to traditional medical inpatient care without thromprophylaxis. Further VTE research needed in this rapidly expanding area of medicine#VTE#SDEC @danlasserson.bsky.social
www.sciencedirect.com/science/arti...

Every. Single. Word. Of. This.

From Prof. @alisonleary1.bsky.social. Worth a read for all those wondering why retention of NHS staff and therefore their proficiency is so important in the pursuit of productivity and safety.

Here’s what I learned last week at #DAS2024 #FOAMed #MedSky #EMedSky #AnaeSky

www.stemlynsblog.org/difficult-ai...

Are you taking care of patients with influenza in your hospital? Then you will know that many colleagues find oseltamivir treatment completely useless (or harmful) while others would never consider not using it. This is a new study you may be interested in:

➡️ 8 major critical care trial results live from Melbourne

➡️ Full free livestream

➡️ Tuesday & Wednesday, December 10th & 11th

➡️ Times are UTC +11

➡️https://criticalcarereviews.com

1/
I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆

It's time for another #POCUS basics #skeetorial 🧵

Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️

#emimcc

I almost didn’t write this blog in *2015* about how contrast nephropathy isn’t real, because I thought it was already pretty obvious at that point (https://emcrit.org/pulmcrit/do-ct-scans-cause-contrast-nephropathy/)

nearly a decade later, we’re still struggling with knowledge translation 🙈

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

Since we’re entering the last month of 2024, here is a non-systematic review of #pulmcrit trials published this year that I found particularly noteworthy. Not comprehensive, so please include any that I may have missed!

(🧵1/11)

#emimcc #critcare #pulmsky #medsky

Rant #5 Please don't tell me what the PaO2 is...

Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings.

What is the SpO2 I genially ask? In our target range? Well that's fine then.

Staff member shifting uneasily, "but the PaO2..."

Here we go...

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

Is sharing our writing a thing here? 😊
Proud of this piece because it represents the work of so many trying to make medicine and communication better for our patients. #MedSky
www.mayoclinicproceedings.org/action/showP...