JAMA Intern Med
Published Online: November 17, 2025
doi: 10.1001/jamainternmed.2025.6088

I have no COI

Nope, it was V fib but he has AICD, so I guess it was interrogated

Refresher:
Inspiratory flow rates for healthy subjects range from
20-40 l/min at rest up to ~100 l/min during respiratory distress episodes. Low-flow supplemental O2 devices (eg, nasal cannulas and face masks) provide pure O2 at variable flow rates of 1-15 l/min

#foamed #meded #Medsky #foamcc #pulmsky #emimcc

Certain formulas attempt to address this issue; however, it is important to note that the aforementioned rule and table may be incorrect or misleading

For an identical *prescribed* FiO2 (eg, nc 4 l/min), a patient with a respiratory rate of 30/min and a tidal volume of 1 liter will experience a markedly different *real* FiO2 than a patient breathing 12/min with a tidal volume of 400 ml

#foamed #foamcc #meded #Medsky #cccsky #emimcc #ECG

Was it obvious? Did the T waves look "suspicious" in ECG #1?

What did the ECG automated interpretation algorithm miss in ECG #1?

Nothing? Myocardial infarction? Pulmonary embolism? Other ideas?

It's nice to have some guidance and protocols in place but if they are not based on the study of each patient's physiology and lead to "one-size-fits-all" approach and therapeutic nihilism, I am walking away from them...

#foamed #foamcc #meded #Medsky #cccsky #emimcc

In our care, patient went from 1.0 mcg/kg/min of norepinephrine to no need for norepi in less than 24h. If you notice, I did not mention anything about lactate, capillary refill time, SvO2 , ScvO2 etc... We also did not use angiotensin II or methylene blue or hydroxycobalamin

Don't sweat too much about it... Especially if you are able to do POCUS & make sure that you don't mess up with interface I (LV to systemic arterial coupling), you can easily go above the usually suggested "max doses" of norepinephrine 0.2-0.5 mcg/kg/min

Are you familiar with the concept of “maximum dose of pressors" which is ingrained in most ED/ICU nurses' & physicians' brains because it is dictated by rigid hospital pharmacies' protocols & enforced by ED/ICU nurse supervisors & medical directors who practice defensive medicine?