@kianboy.bsky.social
Reposted
I remember a young pt with HLH 2/2 connective tissue dz
we treated the HLH & everything was getting better but the EF dropped from ~45 to ~35
her EF fell b/c the HLH-induced vasodilation had been afterload-reducing her
falling EF reflected systemic recovery
eventually she fully recovered #EMIMCC
we treated the HLH & everything was getting better but the EF dropped from ~45 to ~35
her EF fell b/c the HLH-induced vasodilation had been afterload-reducing her
falling EF reflected systemic recovery
eventually she fully recovered #EMIMCC
January 7, 2025 at 12:17 PM
I remember a young pt with HLH 2/2 connective tissue dz
we treated the HLH & everything was getting better but the EF dropped from ~45 to ~35
her EF fell b/c the HLH-induced vasodilation had been afterload-reducing her
falling EF reflected systemic recovery
eventually she fully recovered #EMIMCC
we treated the HLH & everything was getting better but the EF dropped from ~45 to ~35
her EF fell b/c the HLH-induced vasodilation had been afterload-reducing her
falling EF reflected systemic recovery
eventually she fully recovered #EMIMCC
Reposted
Skytorial: Ketamine use for conscious sedation in bronchoscopy!
A new study in CHEST just came out on this 😀
I've thought about this a lot & tried it a few times.
Despite being a huge ketamine fanboy I don't recommend this for three reasons...(#1/4) #EMIMCC
A new study in CHEST just came out on this 😀
I've thought about this a lot & tried it a few times.
Despite being a huge ketamine fanboy I don't recommend this for three reasons...(#1/4) #EMIMCC
a man with a beard says ketamine obviously in front of him
ALT: a man with a beard says ketamine obviously in front of him
media.tenor.com
January 7, 2025 at 8:43 PM
Skytorial: Ketamine use for conscious sedation in bronchoscopy!
A new study in CHEST just came out on this 😀
I've thought about this a lot & tried it a few times.
Despite being a huge ketamine fanboy I don't recommend this for three reasons...(#1/4) #EMIMCC
A new study in CHEST just came out on this 😀
I've thought about this a lot & tried it a few times.
Despite being a huge ketamine fanboy I don't recommend this for three reasons...(#1/4) #EMIMCC
Reposted
ICU Studies - Refresher:
Are you using the IVC diameter to "predict" if an ICU patient is "fluid responsive" (FR)?
This was an important multi-center descriptive study conducted during a 2-yr period in 5 French ICUs
540 ventilated patients w shock of various origins underwent
Are you using the IVC diameter to "predict" if an ICU patient is "fluid responsive" (FR)?
This was an important multi-center descriptive study conducted during a 2-yr period in 5 French ICUs
540 ventilated patients w shock of various origins underwent
January 4, 2025 at 8:56 PM
ICU Studies - Refresher:
Are you using the IVC diameter to "predict" if an ICU patient is "fluid responsive" (FR)?
This was an important multi-center descriptive study conducted during a 2-yr period in 5 French ICUs
540 ventilated patients w shock of various origins underwent
Are you using the IVC diameter to "predict" if an ICU patient is "fluid responsive" (FR)?
This was an important multi-center descriptive study conducted during a 2-yr period in 5 French ICUs
540 ventilated patients w shock of various origins underwent
Reposted
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
One of my favorite @criticalcaretime.bsky.social infographics: Comparison of vasodilator scavengers.
When to choose
🟦 Methylene Blue
🟥 Hydroxocobalamin (Cyanokit)
For more discussion you can read here:
onepagericu.com/blog/mini-le...
When to choose
🟦 Methylene Blue
🟥 Hydroxocobalamin (Cyanokit)
For more discussion you can read here:
onepagericu.com/blog/mini-le...
November 15, 2024 at 3:36 PM
One of my favorite @criticalcaretime.bsky.social infographics: Comparison of vasodilator scavengers.
When to choose
🟦 Methylene Blue
🟥 Hydroxocobalamin (Cyanokit)
For more discussion you can read here:
onepagericu.com/blog/mini-le...
When to choose
🟦 Methylene Blue
🟥 Hydroxocobalamin (Cyanokit)
For more discussion you can read here:
onepagericu.com/blog/mini-le...
Reposted
Crit care docs, how commonly methylene blue and/or cyanokit get used in your personal refractory shock algorithm?
I got more familiar with them during fellowship but my previous training institution hardly ever used it at all. Still defining this aspect of my practice.
#Medsky
#Criticalcare
I got more familiar with them during fellowship but my previous training institution hardly ever used it at all. Still defining this aspect of my practice.
#Medsky
#Criticalcare
One of my favorite @criticalcaretime.bsky.social infographics: Comparison of vasodilator scavengers.
When to choose
🟦 Methylene Blue
🟥 Hydroxocobalamin (Cyanokit)
For more discussion you can read here:
onepagericu.com/blog/mini-le...
When to choose
🟦 Methylene Blue
🟥 Hydroxocobalamin (Cyanokit)
For more discussion you can read here:
onepagericu.com/blog/mini-le...
December 1, 2024 at 12:30 PM
Crit care docs, how commonly methylene blue and/or cyanokit get used in your personal refractory shock algorithm?
I got more familiar with them during fellowship but my previous training institution hardly ever used it at all. Still defining this aspect of my practice.
#Medsky
#Criticalcare
I got more familiar with them during fellowship but my previous training institution hardly ever used it at all. Still defining this aspect of my practice.
#Medsky
#Criticalcare
Reposted
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
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 9:57 AM
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/
Reposted
One thing is to acknowledge the great intra- and interindividual variation in dose response with noradrenaline. Fixed thresholds for adding vaso or other adjuncts like at 0.25 μg/kg/min makes no physiological sense at all.
November 30, 2024 at 2:39 PM
One thing is to acknowledge the great intra- and interindividual variation in dose response with noradrenaline. Fixed thresholds for adding vaso or other adjuncts like at 0.25 μg/kg/min makes no physiological sense at all.
Reposted
For anyone interested in learning more about angiography, check out my introductory guide!
You’ll find a lot of nice annotated diagrams like this one.
intuitivecardiology.notion.site/angiography
You’ll find a lot of nice annotated diagrams like this one.
intuitivecardiology.notion.site/angiography
November 25, 2024 at 12:12 AM
For anyone interested in learning more about angiography, check out my introductory guide!
You’ll find a lot of nice annotated diagrams like this one.
intuitivecardiology.notion.site/angiography
You’ll find a lot of nice annotated diagrams like this one.
intuitivecardiology.notion.site/angiography
Reposted
A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc
At the back of Revision Notes In Intensive Care Medicine there is a list of 59 key papers relating to intensive care medicine published between 1998 and 2015 (the book was published in 2016).
I'd like to keep my revision up to date. Are there any equivalent lists of key papers from 2016 to now?
I'd like to keep my revision up to date. Are there any equivalent lists of key papers from 2016 to now?
November 27, 2024 at 5:16 AM
A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc
Reposted
the Hospitalists and Resuscitationist workshop 2025 early bird pricing ends in a week, see photo to see who will be teaching--dream list imo. plz scroll to bottom area to see all the topics covered!
thinkingcriticalcare.com/2024/06/05/h...
thinkingcriticalcare.com/2024/06/05/h...
November 24, 2024 at 11:34 PM
the Hospitalists and Resuscitationist workshop 2025 early bird pricing ends in a week, see photo to see who will be teaching--dream list imo. plz scroll to bottom area to see all the topics covered!
thinkingcriticalcare.com/2024/06/05/h...
thinkingcriticalcare.com/2024/06/05/h...
Reposted
I’d love to hear from the rest of #pocusky and #emimcc. Do you use curvilinear probes for procedures?
I can’t recommend a microconvex enough. It’s invaluable for drains as it’s footprints so small so you can rotate it as you like and still have room for a cannula between the ribs. It’s also a game changer for CVCs as you can master the supraclav fossa view.
youtu.be/piaYfmTfXMc
youtu.be/piaYfmTfXMc
Central Line Academy: Introduction
YouTube video by InterAnest
youtu.be
November 24, 2024 at 7:11 PM
Reposted
We lack oral options for most MDR-GNB among current or upcoming antibiotics, so ambulatory care for these patients will relay largely on #OPAT.
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
November 17, 2024 at 11:33 AM
We lack oral options for most MDR-GNB among current or upcoming antibiotics, so ambulatory care for these patients will relay largely on #OPAT.
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
The good news: most new agents are stable to be administered via infusion bags or elastomeric pumps 👉 www.mdpi.com/1999-4923/15...
#AMSsky #IDsky
Reposted
Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. (That's it?!?!? - seems low)... 342 ICUs. Free article.
#emimcc #FOAMed
pubmed.ncbi.nlm.nih.gov/39529908/
#emimcc #FOAMed
pubmed.ncbi.nlm.nih.gov/39529908/
Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes - PubMed
Septic shock requiring three vasopressors is associated with exceptionally high mortality. Knowledge of patients at highest risk of mortality in this population may inform management and expectations ...
pubmed.ncbi.nlm.nih.gov
November 16, 2024 at 8:27 PM
Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. (That's it?!?!? - seems low)... 342 ICUs. Free article.
#emimcc #FOAMed
pubmed.ncbi.nlm.nih.gov/39529908/
#emimcc #FOAMed
pubmed.ncbi.nlm.nih.gov/39529908/
Reposted
Very nice overview of the current state of affairs in cardiogenic shock (published this week in @TheLancet):
November 17, 2024 at 2:27 AM
Very nice overview of the current state of affairs in cardiogenic shock (published this week in @TheLancet):
Reposted
one cause of hypernatremia in ICU = recovery from AKI!
[1] urea *accumulates* while kidney is failing…
[2] kidney recovers➡️ clearance of accumulated urea obligates the excretion of H2O
(similar to using oral urea to tx hypoNa)
so hypernatremia can be a sign of renal recovery 🤯
#EMIMCC #nephsky
[1] urea *accumulates* while kidney is failing…
[2] kidney recovers➡️ clearance of accumulated urea obligates the excretion of H2O
(similar to using oral urea to tx hypoNa)
so hypernatremia can be a sign of renal recovery 🤯
#EMIMCC #nephsky
November 16, 2024 at 4:57 PM
Reposted
#TLM24 #LiverSky #IDsky
MTE #3: HCV and Coinfections with Other Types of Viral Hepatitis
➡️ Management of HBsAg+ persons prior to HCV DAA
Reminders :
- HBsAg+ ❌ simplified Tx
- HBV reactivation = 24% if HBsAg+ and ALT ⬆️ 9%
- Risk of HBV DNA ⬆️ isolated anti-HBc is low (1.4%) & ALT ⬆️ ~0%.
MTE #3: HCV and Coinfections with Other Types of Viral Hepatitis
➡️ Management of HBsAg+ persons prior to HCV DAA
Reminders :
- HBsAg+ ❌ simplified Tx
- HBV reactivation = 24% if HBsAg+ and ALT ⬆️ 9%
- Risk of HBV DNA ⬆️ isolated anti-HBc is low (1.4%) & ALT ⬆️ ~0%.
November 17, 2024 at 12:55 AM
Reposted
Should you avoid IV iron in an iron deficient pt who was recently transfused?
Many fear iron overload, as 1U RBC transfusion contains ~200mg iron (primarily within RBCs). Is this a problem?
1/X #medsky #ansky #emimcc #hemesky #irondeficiency
Many fear iron overload, as 1U RBC transfusion contains ~200mg iron (primarily within RBCs). Is this a problem?
1/X #medsky #ansky #emimcc #hemesky #irondeficiency
November 15, 2024 at 9:32 PM
Should you avoid IV iron in an iron deficient pt who was recently transfused?
Many fear iron overload, as 1U RBC transfusion contains ~200mg iron (primarily within RBCs). Is this a problem?
1/X #medsky #ansky #emimcc #hemesky #irondeficiency
Many fear iron overload, as 1U RBC transfusion contains ~200mg iron (primarily within RBCs). Is this a problem?
1/X #medsky #ansky #emimcc #hemesky #irondeficiency
Reposted
I just heard a phrase I never want to hear again - “homeopathically vaccinated for tetanus”.
#IDSky
#vaccinate
#IDSky
#vaccinate
November 14, 2024 at 5:44 AM
I just heard a phrase I never want to hear again - “homeopathically vaccinated for tetanus”.
#IDSky
#vaccinate
#IDSky
#vaccinate
Reposted
Sometimes, when on call, I get consults for labs signaling a lower-than-normal creatinine.... If 2 am when this happens, I tend to be dismissive
However, here is a nice overview of ⬇️ creatinine causes
#NephSky #MedSky
🔗 karger.com/bpu/article/...
However, here is a nice overview of ⬇️ creatinine causes
#NephSky #MedSky
🔗 karger.com/bpu/article/...
November 14, 2024 at 2:00 AM
Sometimes, when on call, I get consults for labs signaling a lower-than-normal creatinine.... If 2 am when this happens, I tend to be dismissive
However, here is a nice overview of ⬇️ creatinine causes
#NephSky #MedSky
🔗 karger.com/bpu/article/...
However, here is a nice overview of ⬇️ creatinine causes
#NephSky #MedSky
🔗 karger.com/bpu/article/...
Reposted
📢 The @ASCO released updated living guidelines for treating stage IV #NSCLC with driver alterations! ascopubs.org/doi/10.1200/....
This is no easy feat, but it was an honor to work alongside exceptional experts dedicated to providing the most up-to-date, evidence-based guidance.
#LCSM #LCAM
This is no easy feat, but it was an honor to work alongside exceptional experts dedicated to providing the most up-to-date, evidence-based guidance.
#LCSM #LCAM
November 13, 2024 at 2:04 PM
📢 The @ASCO released updated living guidelines for treating stage IV #NSCLC with driver alterations! ascopubs.org/doi/10.1200/....
This is no easy feat, but it was an honor to work alongside exceptional experts dedicated to providing the most up-to-date, evidence-based guidance.
#LCSM #LCAM
This is no easy feat, but it was an honor to work alongside exceptional experts dedicated to providing the most up-to-date, evidence-based guidance.
#LCSM #LCAM