Matthew Snowsill
@mattsnowsill.bsky.social
🏥 London EM Consultant
🚑 ACCESS London Retrieval Consultant
🚁 Former London HEMS
🧑🎓 QMUL Resus MSc grad
🚑 Founder & Lead: PHEMfeedback.bsky.social 💚
🤔 #ResusSky #MedSky #MedTwitter #FOAMed #POCUS #PHEM #HumanFactors #PrehospitalFeedback #Resus #emimcc
🚑 ACCESS London Retrieval Consultant
🚁 Former London HEMS
🧑🎓 QMUL Resus MSc grad
🚑 Founder & Lead: PHEMfeedback.bsky.social 💚
🤔 #ResusSky #MedSky #MedTwitter #FOAMed #POCUS #PHEM #HumanFactors #PrehospitalFeedback #Resus #emimcc
Pinned
The magic of that movement in the old place for me was the exposure to #resuscitation communities, concepts and people
I have made this feed for those with similar passions
bsky.app/profile/did:...
#medsky #emergencymedicine #criticalcare #anaesthesia #prehospital #retrieval #pocus #echofirst
I have made this feed for those with similar passions
bsky.app/profile/did:...
#medsky #emergencymedicine #criticalcare #anaesthesia #prehospital #retrieval #pocus #echofirst
Reposted by Matthew Snowsill
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
Reposted by Matthew Snowsill
"One intangible advantage of capillary refill time is that performing it brings the clinician back to the bedside to reassess the patient. This act may be itself the holy grail of early sepsis management."
great piece on #sepsis
great piece on #sepsis
💬 Editorial: While capillary refill time shows promise for early #SepticShock management, integrating it into broader, multimodal resuscitation strategies remains key to improving outcomes.
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
#LIVES2025 @esicm.bsky.social
ja.ma/4hAs5u7
October 29, 2025 at 2:32 PM
"One intangible advantage of capillary refill time is that performing it brings the clinician back to the bedside to reassess the patient. This act may be itself the holy grail of early sepsis management."
great piece on #sepsis
great piece on #sepsis
Reposted by Matthew Snowsill
I would normally not have batted an eye at this paper
But it’s by Robert Hahn, and is a nice overview of everything we know about fluid redistribution in the critically unwell- including gel phase, some glycocalyx stuff, 3 compartment models, and albumin escape rates
#foamed
But it’s by Robert Hahn, and is a nice overview of everything we know about fluid redistribution in the critically unwell- including gel phase, some glycocalyx stuff, 3 compartment models, and albumin escape rates
#foamed
Where does the fluid go?
💦 morphological changes/damage by fluid overload
🛌 fluid distribution in anesthesia
3️⃣ extracellular fluid compartments
💧 physiology, manipulation & max filling of slow-exchange fluid space
🔥 inflammation, capillary leakage & lymphatic flow 💦
🥚 albumin
🔓 rdcu.be/eLnfi
💦 morphological changes/damage by fluid overload
🛌 fluid distribution in anesthesia
3️⃣ extracellular fluid compartments
💧 physiology, manipulation & max filling of slow-exchange fluid space
🔥 inflammation, capillary leakage & lymphatic flow 💦
🥚 albumin
🔓 rdcu.be/eLnfi
October 18, 2025 at 5:12 PM
I would normally not have batted an eye at this paper
But it’s by Robert Hahn, and is a nice overview of everything we know about fluid redistribution in the critically unwell- including gel phase, some glycocalyx stuff, 3 compartment models, and albumin escape rates
#foamed
But it’s by Robert Hahn, and is a nice overview of everything we know about fluid redistribution in the critically unwell- including gel phase, some glycocalyx stuff, 3 compartment models, and albumin escape rates
#foamed
actacc.org/education/meet…
Webinar by the WITCA (Women in Cardiothoracic Anaesthesia) group
For those who might be interested 😊#emimccc#medskyky
Webinar by the WITCA (Women in Cardiothoracic Anaesthesia) group
For those who might be interested 😊#emimccc#medskyky
https://actacc.org/education/meet…
October 13, 2025 at 1:26 PM
actacc.org/education/meet…
Webinar by the WITCA (Women in Cardiothoracic Anaesthesia) group
For those who might be interested 😊#emimccc#medskyky
Webinar by the WITCA (Women in Cardiothoracic Anaesthesia) group
For those who might be interested 😊#emimccc#medskyky
Reposted by Matthew Snowsill
normal mentation *doesn't* indicate adequate systemic perfusion
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
Sad Sad Bean GIF
ALT: Sad Sad Bean GIF
media.tenor.com
October 8, 2025 at 9:05 PM
normal mentation *doesn't* indicate adequate systemic perfusion
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
especially in cardiogenic shock, people can mentate well despite terrible CO & systemic perfusion
poor mentation is sometimes an early sign of *septic* shock, but often a very late indicator of other shock states #EMIMCC
Reposted by Matthew Snowsill
v1.108 is rolling out today 🚚
Now live, at long last: Bookmarks, aka Saved Posts. For all those posts you'll definitely plan to come back to!
Update the app and give it a try. The button is right down there 👇
Now live, at long last: Bookmarks, aka Saved Posts. For all those posts you'll definitely plan to come back to!
Update the app and give it a try. The button is right down there 👇
September 8, 2025 at 6:24 PM
v1.108 is rolling out today 🚚
Now live, at long last: Bookmarks, aka Saved Posts. For all those posts you'll definitely plan to come back to!
Update the app and give it a try. The button is right down there 👇
Now live, at long last: Bookmarks, aka Saved Posts. For all those posts you'll definitely plan to come back to!
Update the app and give it a try. The button is right down there 👇
x.com/ACCESS_Londo...
For those near London interested in #resus, #emimcc
Maternal critical care transfers is the theme of this Clinical Development Day (in person only).
Sorry it's a link to the other place....
For those near London interested in #resus, #emimcc
Maternal critical care transfers is the theme of this Clinical Development Day (in person only).
Sorry it's a link to the other place....
x.com
August 28, 2025 at 4:40 PM
x.com/ACCESS_Londo...
For those near London interested in #resus, #emimcc
Maternal critical care transfers is the theme of this Clinical Development Day (in person only).
Sorry it's a link to the other place....
For those near London interested in #resus, #emimcc
Maternal critical care transfers is the theme of this Clinical Development Day (in person only).
Sorry it's a link to the other place....
Reposted by Matthew Snowsill
Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
onlinelibrary.wiley.com
June 3, 2025 at 12:03 PM
Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
@emajournal.bsky.social
Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service
onlinelibrary.wiley.com/share/author...
Reposted by Matthew Snowsill
minor updates to the antiemetic chapter
🤢 inhaled isopropyl alcohol pads are safe, fast, and underutilized
🤢 ondansetron is often a front-line drug due to favorable safety profile
🤢 olanzapine is a highly effective, broad-spectrum agent that is underutilized
(emcrit.org/ibcc/antieme...) #EMIMCC
🤢 inhaled isopropyl alcohol pads are safe, fast, and underutilized
🤢 ondansetron is often a front-line drug due to favorable safety profile
🤢 olanzapine is a highly effective, broad-spectrum agent that is underutilized
(emcrit.org/ibcc/antieme...) #EMIMCC
May 26, 2025 at 12:25 PM
minor updates to the antiemetic chapter
🤢 inhaled isopropyl alcohol pads are safe, fast, and underutilized
🤢 ondansetron is often a front-line drug due to favorable safety profile
🤢 olanzapine is a highly effective, broad-spectrum agent that is underutilized
(emcrit.org/ibcc/antieme...) #EMIMCC
🤢 inhaled isopropyl alcohol pads are safe, fast, and underutilized
🤢 ondansetron is often a front-line drug due to favorable safety profile
🤢 olanzapine is a highly effective, broad-spectrum agent that is underutilized
(emcrit.org/ibcc/antieme...) #EMIMCC
Reposted by Matthew Snowsill
My take on sepsis, circulation management in septic shock, peripheral noradrenaline
#EmergencyMedicine #EM #Sepsis #MedSky #EMedSky #MedEd #EMSky
#EmergencyMedicine #EM #Sepsis #MedSky #EMedSky #MedEd #EMSky
UK EM Field Notes #8
My take on sepsis, circulation management in septic shock, peripheral noradrenaline
open.substack.com
May 21, 2025 at 8:39 AM
Reposted by Matthew Snowsill
Sad news:
Another giant in Critical Care, Professor Rinaldo Bellomo, passed away this morning. He was born in Reggio Emilia, Italy & emigrated to Australia in the 1980s receiving his medical degree from Monash Medical School in Melbourne
He completed fellowships in nephrology,
Another giant in Critical Care, Professor Rinaldo Bellomo, passed away this morning. He was born in Reggio Emilia, Italy & emigrated to Australia in the 1980s receiving his medical degree from Monash Medical School in Melbourne
He completed fellowships in nephrology,
May 7, 2025 at 12:54 AM
Sad news:
Another giant in Critical Care, Professor Rinaldo Bellomo, passed away this morning. He was born in Reggio Emilia, Italy & emigrated to Australia in the 1980s receiving his medical degree from Monash Medical School in Melbourne
He completed fellowships in nephrology,
Another giant in Critical Care, Professor Rinaldo Bellomo, passed away this morning. He was born in Reggio Emilia, Italy & emigrated to Australia in the 1980s receiving his medical degree from Monash Medical School in Melbourne
He completed fellowships in nephrology,
Reposted by Matthew Snowsill
I work with the best team! Love this battle of the inotrope education: milrinone vs dobutamine.
Blue 🔵 or 🔴?
Blue 🔵 or 🔴?
May 2, 2025 at 2:18 AM
I work with the best team! Love this battle of the inotrope education: milrinone vs dobutamine.
Blue 🔵 or 🔴?
Blue 🔵 or 🔴?
Reposted by Matthew Snowsill
🚨 New: Best Practice Guidelines with the National Poisons Information Service (NPIS) - Management of Patients with Suspected but Unidentified Poisoning in the Emergency Department.
⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...
⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...
April 21, 2025 at 7:55 PM
🚨 New: Best Practice Guidelines with the National Poisons Information Service (NPIS) - Management of Patients with Suspected but Unidentified Poisoning in the Emergency Department.
⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...
⬇️ Download it 🔄 share it ▶️ practice it. 🔗 Link: rcem.ac.uk/clinical-...
Reposted by Matthew Snowsill
Relationship between ⌚ spent in A&E & odds of 30-day, post-discharge, all-cause mortality:
Compared with patients who spent 2h in A&E, the odds of post-discharge death were:
🕒 1.1 x ☝️ if spent 3h
🕕 1.6 x ☝️ if spent 6h
🕘 1.9 x ☝️ if spent 9h &
🕛 2.1 x ☝️ if spent 12h
#EMedsky
🔗 shorturl.at/Tvw9e
Compared with patients who spent 2h in A&E, the odds of post-discharge death were:
🕒 1.1 x ☝️ if spent 3h
🕕 1.6 x ☝️ if spent 6h
🕘 1.9 x ☝️ if spent 9h &
🕛 2.1 x ☝️ if spent 12h
#EMedsky
🔗 shorturl.at/Tvw9e
Association between time spent in emergency care and 30-day post-discharge mortality, England - Office for National Statistics
Relationship between time spent in A&E and the odds of 30-day, post-discharge, all-cause mortality, controlling for other factors.
shorturl.at
January 17, 2025 at 4:51 PM
Relationship between ⌚ spent in A&E & odds of 30-day, post-discharge, all-cause mortality:
Compared with patients who spent 2h in A&E, the odds of post-discharge death were:
🕒 1.1 x ☝️ if spent 3h
🕕 1.6 x ☝️ if spent 6h
🕘 1.9 x ☝️ if spent 9h &
🕛 2.1 x ☝️ if spent 12h
#EMedsky
🔗 shorturl.at/Tvw9e
Compared with patients who spent 2h in A&E, the odds of post-discharge death were:
🕒 1.1 x ☝️ if spent 3h
🕕 1.6 x ☝️ if spent 6h
🕘 1.9 x ☝️ if spent 9h &
🕛 2.1 x ☝️ if spent 12h
#EMedsky
🔗 shorturl.at/Tvw9e
Reposted by Matthew Snowsill
The Barts/London prehospital experience has just been published
www.resuscitationjournal.com/article/S030...
Excellent work by my friends and colleagues.
www.resuscitationjournal.com/article/S030...
Excellent work by my friends and colleagues.
Sub30: Feasibility study of a pre-hospital extracorporeal membrane oxygenation (ECMO) in patients with refractory out-of-hospital cardiac arrest in London, United Kingdom
Out-of-hospital cardiac arrest (OHCA) carries a significantly poor prognosis with fewer than one in ten patients (∼9%) surviving to hospital discharge with some evidence suggesting that survival rates may even be decreasing to 7.8 %1–2 Survival is inversely correlated to the time taken to restore a spontaneous circulation, and cardiac arrests refractory to initial resuscitation attempts lead to very low neurologically intact survival rates.3 Extracorporeal cardiopulmonary resuscitation (ECPR) describes the implementation of extra-corporeal membrane oxygenation (ECMO) during ongoing resuscitation and is emerging as a treatment to improve outcomes for patients in refractory cardiac arrest.
www.resuscitationjournal.com
December 8, 2024 at 10:55 AM
The Barts/London prehospital experience has just been published
www.resuscitationjournal.com/article/S030...
Excellent work by my friends and colleagues.
www.resuscitationjournal.com/article/S030...
Excellent work by my friends and colleagues.
Reposted by Matthew Snowsill
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 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
December 3, 2024 at 6:15 PM
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 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
Beautifully articulated as always
It's not just about rate of patients seen. *Emergency* Medicine needs time and space to train, reflect, innovate, discuss and enjoy the unique challenges it faces. These aspects are still work and service. They've been devalued but they're more important than ever
It's not just about rate of patients seen. *Emergency* Medicine needs time and space to train, reflect, innovate, discuss and enjoy the unique challenges it faces. These aspects are still work and service. They've been devalued but they're more important than ever
December 1, 2024 at 10:35 AM
Beautifully articulated as always
It's not just about rate of patients seen. *Emergency* Medicine needs time and space to train, reflect, innovate, discuss and enjoy the unique challenges it faces. These aspects are still work and service. They've been devalued but they're more important than ever
It's not just about rate of patients seen. *Emergency* Medicine needs time and space to train, reflect, innovate, discuss and enjoy the unique challenges it faces. These aspects are still work and service. They've been devalued but they're more important than ever
Reposted by Matthew Snowsill
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
(🧵1/11)
#emimcc #critcare #pulmsky #medsky
a man in a blue shirt and tie is standing in front of a bulletin board with papers on it .
ALT: a man in a blue shirt and tie is standing in front of a bulletin board with papers on it .
media.tenor.com
December 1, 2024 at 2:15 AM
Reposted by Matthew Snowsill
I built and lead a HIU programme and if your unit hasn’t got one, you need one - benefits the patient, benefits the unit, benefits the finances, and can be extremely interesting work
Thank you for sharing this with us, Dr Linda Dykes. The full study can be found here: www.redcross.org.uk/about-us/new...
Understanding frequent attendance at A&E| British Red Cross
Health inequalities and deprivation 'key factors' behind repeat A&E visits in Dorset, says new Red Cross report
www.redcross.org.uk
November 25, 2024 at 11:51 PM
I built and lead a HIU programme and if your unit hasn’t got one, you need one - benefits the patient, benefits the unit, benefits the finances, and can be extremely interesting work
Reposted by Matthew Snowsill
Interesting article. A lot of what we label as refractory VF isn’t refractory at all. It’s actually recurrent.
Is there a way in which we could change defibrillation strategies or antiarrhythmic drug administration to better address this?
academic.oup.com/eurheartj/ad...
Is there a way in which we could change defibrillation strategies or antiarrhythmic drug administration to better address this?
academic.oup.com/eurheartj/ad...
Defibrillation and refractory ventricular fibrillation
Of patients with out-of-hospital cardiac arrest (OHCA) presenting in ventricular fibrillation (VF), the majority require multiple shocks.1 Guidelines recom
academic.oup.com
November 28, 2024 at 7:05 PM
Interesting article. A lot of what we label as refractory VF isn’t refractory at all. It’s actually recurrent.
Is there a way in which we could change defibrillation strategies or antiarrhythmic drug administration to better address this?
academic.oup.com/eurheartj/ad...
Is there a way in which we could change defibrillation strategies or antiarrhythmic drug administration to better address this?
academic.oup.com/eurheartj/ad...
Reposted by Matthew Snowsill
Face mask ventilation vs high-flow nasal oxygenation
Comparison of end-tidal oxygen concentration and the lowest SpO2 after tracheal intubation between parturients.
#AnSky #MedSky
https://buff.ly/4fMvK6u
Comparison of end-tidal oxygen concentration and the lowest SpO2 after tracheal intubation between parturients.
#AnSky #MedSky
https://buff.ly/4fMvK6u
November 28, 2024 at 1:29 PM
Face mask ventilation vs high-flow nasal oxygenation
Comparison of end-tidal oxygen concentration and the lowest SpO2 after tracheal intubation between parturients.
#AnSky #MedSky
https://buff.ly/4fMvK6u
Comparison of end-tidal oxygen concentration and the lowest SpO2 after tracheal intubation between parturients.
#AnSky #MedSky
https://buff.ly/4fMvK6u
Reposted by Matthew Snowsill
Look forward to the East Anglian Air Ambulance RAID annual conference this Friday…the theme being ‘Innovations in Pre-Hospital Resuscitation’.
November 27, 2024 at 9:48 PM
Look forward to the East Anglian Air Ambulance RAID annual conference this Friday…the theme being ‘Innovations in Pre-Hospital Resuscitation’.
Reposted by Matthew Snowsill
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....
Nipped back to the other place briefly. 8 bot followers waiting for me, not much else since I came across. Not really missing it loads but will check in from time to time while the communities build here.
November 26, 2024 at 7:41 PM
Nipped back to the other place briefly. 8 bot followers waiting for me, not much else since I came across. Not really missing it loads but will check in from time to time while the communities build here.