@neelregmi.bsky.social
Reposted
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Silva et al: Safety of Peripherally Administered 23.4% Sodium Chloride
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Safety of Peripherally Administered 23.4% Sodium Chloride
Neurocritical Care - For patients with increased intracranial pressure, prompt initiation of hyperosmolar therapy with 23.4% sodium chloride may minimize permanent neurological damage and prevent...
link.springer.com
October 28, 2025 at 5:38 PM
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Reposted
Suction Assisted Laryngoscopy for Airway Decontamination (SALAD) solves the challenge of the soiled airway by maintaining continuous suctioning during airway securing attempts.
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus
youtube.com/shorts/vpvmy...
#EMIMCC
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus
youtube.com/shorts/vpvmy...
#EMIMCC
SALAD Technique #emergencymedicine #criticalcare #intubation
YouTube video by EMSwami
youtube.com
October 6, 2025 at 11:07 PM
Suction Assisted Laryngoscopy for Airway Decontamination (SALAD) solves the challenge of the soiled airway by maintaining continuous suctioning during airway securing attempts.
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus
youtube.com/shorts/vpvmy...
#EMIMCC
1) Overhand grip of suction
2) Lead w/ suction catheter
3) Park suction in esophagus
youtube.com/shorts/vpvmy...
#EMIMCC
Reposted
IV insulin is a backbone tx in hyperK
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose
youtube.com/shorts/Sz9Zy...
#EMIMCC
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose
youtube.com/shorts/Sz9Zy...
#EMIMCC
Reduced Dose Insulin in HyperK #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
October 1, 2025 at 1:51 PM
IV insulin is a backbone tx in hyperK
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose
youtube.com/shorts/Sz9Zy...
#EMIMCC
Standard: 10 units IVP w/ dextrose
2021 meta(PMID: 33993515) looked at 10 units vs < 10 units
No difference in reduction in serum K.
Reduced risk of hypoglycemic + severe hypoglycemic events w/ reduced insulin dose
youtube.com/shorts/Sz9Zy...
#EMIMCC
Reposted
"consensus" guideline on the management of DKA & HHS
with ZERO input from:
- anyone in emergency medicine
- anyone in critical care
- anyone in hospital medicine
the guidelines (published in 2024) contain many antiquated practices and big errors... 🧵#1/3 #EMIMCC
pubmed.ncbi.nlm.nih.gov/39052901/
with ZERO input from:
- anyone in emergency medicine
- anyone in critical care
- anyone in hospital medicine
the guidelines (published in 2024) contain many antiquated practices and big errors... 🧵#1/3 #EMIMCC
pubmed.ncbi.nlm.nih.gov/39052901/
September 28, 2025 at 9:37 PM
"consensus" guideline on the management of DKA & HHS
with ZERO input from:
- anyone in emergency medicine
- anyone in critical care
- anyone in hospital medicine
the guidelines (published in 2024) contain many antiquated practices and big errors... 🧵#1/3 #EMIMCC
pubmed.ncbi.nlm.nih.gov/39052901/
with ZERO input from:
- anyone in emergency medicine
- anyone in critical care
- anyone in hospital medicine
the guidelines (published in 2024) contain many antiquated practices and big errors... 🧵#1/3 #EMIMCC
pubmed.ncbi.nlm.nih.gov/39052901/
Reposted
cosign this 😁
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
Time to Ditch Andexanet Alfa?
-ANNEXA-1: No mortality benefit, incr VTE
-Real world data: Rech 2025 (PMID:40700941) no improved outcomes, 9% incr VTE w/ andexanet alfa (NNH = 11)
Mounting evidence that andexanet offers no benefit while increasing complications
youtube.com/shorts/7DGcv...
#EMIMCC
-ANNEXA-1: No mortality benefit, incr VTE
-Real world data: Rech 2025 (PMID:40700941) no improved outcomes, 9% incr VTE w/ andexanet alfa (NNH = 11)
Mounting evidence that andexanet offers no benefit while increasing complications
youtube.com/shorts/7DGcv...
#EMIMCC
Andexanet Alfa + Thrombembolism #emergencymedicine #criticalcare
YouTube video by EMSwami
youtube.com
September 17, 2025 at 2:11 PM
cosign this 😁
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
four-factor PCC had clotting factors & *also* endogenous anticoagulants (protein C & S, antithrombin III)
that’s why PCC doesn’t cause as much thrombosis: it’s rebuilding the coagulation cascade rather than purely functioning as a pro-thrombotic
(& Adnexanet alfa price is insane)
Reposted
when to start anticoagulation after ischemic stroke 2/2 AF?
balancing risk of recurrent stroke vs. hemorrhagic transformation
CATALYST: new meta-analysis of RCTs showing earlier initiation of DOAC reduces stroke w/o causing bleeds
I defer this to stroke neurologists, but good to know #EMIMCC
balancing risk of recurrent stroke vs. hemorrhagic transformation
CATALYST: new meta-analysis of RCTs showing earlier initiation of DOAC reduces stroke w/o causing bleeds
I defer this to stroke neurologists, but good to know #EMIMCC
August 7, 2025 at 4:16 PM
when to start anticoagulation after ischemic stroke 2/2 AF?
balancing risk of recurrent stroke vs. hemorrhagic transformation
CATALYST: new meta-analysis of RCTs showing earlier initiation of DOAC reduces stroke w/o causing bleeds
I defer this to stroke neurologists, but good to know #EMIMCC
balancing risk of recurrent stroke vs. hemorrhagic transformation
CATALYST: new meta-analysis of RCTs showing earlier initiation of DOAC reduces stroke w/o causing bleeds
I defer this to stroke neurologists, but good to know #EMIMCC
Reposted
A2B trial (dexmed vs. clonidine vs. propofol):
😴 Dexmed & propofol both great (no winner)
😴 Select based on patient specifics
🤔 Why does everyone love *multimodal* analgesia, yet expect a *single* sedative to be the holy grail? Many patients need multimodal sedation.
#EMIMCC #MultimodalSedation
😴 Dexmed & propofol both great (no winner)
😴 Select based on patient specifics
🤔 Why does everyone love *multimodal* analgesia, yet expect a *single* sedative to be the holy grail? Many patients need multimodal sedation.
#EMIMCC #MultimodalSedation
July 2, 2025 at 12:38 PM
A2B trial (dexmed vs. clonidine vs. propofol):
😴 Dexmed & propofol both great (no winner)
😴 Select based on patient specifics
🤔 Why does everyone love *multimodal* analgesia, yet expect a *single* sedative to be the holy grail? Many patients need multimodal sedation.
#EMIMCC #MultimodalSedation
😴 Dexmed & propofol both great (no winner)
😴 Select based on patient specifics
🤔 Why does everyone love *multimodal* analgesia, yet expect a *single* sedative to be the holy grail? Many patients need multimodal sedation.
#EMIMCC #MultimodalSedation
Reposted
🌟 ABX Pearl of the Day: ertapenem hypoalbuminemia
❓ Q: My ICU patient with hypoalbuminemia has ESBL E. coli pyelonephritis, resistant to PO abx. He improved (afeb, WBC WNL, off pressors) after 3d of meropenem. Should I avoid narrowing to ertapenem?
#IDsky #medsky #meded #pharmsky #skyRX #AMSsky
❓ Q: My ICU patient with hypoalbuminemia has ESBL E. coli pyelonephritis, resistant to PO abx. He improved (afeb, WBC WNL, off pressors) after 3d of meropenem. Should I avoid narrowing to ertapenem?
#IDsky #medsky #meded #pharmsky #skyRX #AMSsky
July 2, 2025 at 3:23 PM
Reposted
Occult VF in Cardiac Arrest: 5.3% of patients with cardiac arrest showed VF on echo but ECG w/ PEA/asystole
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
July 1, 2025 at 5:44 PM
Occult VF in Cardiac Arrest: 5.3% of patients with cardiac arrest showed VF on echo but ECG w/ PEA/asystole
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
Reposted
your daily reminder that ertapemen works poorly among patients w/ albumin <2.5 mg/dL
albumin tightly binds ertapenem. albumin functions like a antibiotic depot, allowing once-daily dosing
daily ertapenem is great for less sick *outpatients*
for sick ICU pts with alb <2.5 choose meropenem #EMIMCC
albumin tightly binds ertapenem. albumin functions like a antibiotic depot, allowing once-daily dosing
daily ertapenem is great for less sick *outpatients*
for sick ICU pts with alb <2.5 choose meropenem #EMIMCC
Among 100 patients with persistent MSSA bacteraemia who were treated with ertapenem combination therapy, those with hypoalbuminemia (<2.5g/dL) had a significantly longer time to negative blood cultures.
doi.org/10.1093/jac/...
#IDSky
doi.org/10.1093/jac/...
#IDSky
May 31, 2025 at 2:04 PM
your daily reminder that ertapemen works poorly among patients w/ albumin <2.5 mg/dL
albumin tightly binds ertapenem. albumin functions like a antibiotic depot, allowing once-daily dosing
daily ertapenem is great for less sick *outpatients*
for sick ICU pts with alb <2.5 choose meropenem #EMIMCC
albumin tightly binds ertapenem. albumin functions like a antibiotic depot, allowing once-daily dosing
daily ertapenem is great for less sick *outpatients*
for sick ICU pts with alb <2.5 choose meropenem #EMIMCC
Reposted
for an intubated asthmatic whose bronchospasm won't break:
high-dose ketamine is good, but it should be given with an anticholinergic.
why give glycopyrrolate?
🤤reduces secretions from ketamine
👊it causes bronchodilation!
so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC
high-dose ketamine is good, but it should be given with an anticholinergic.
why give glycopyrrolate?
🤤reduces secretions from ketamine
👊it causes bronchodilation!
so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC
May 31, 2025 at 12:04 PM
for an intubated asthmatic whose bronchospasm won't break:
high-dose ketamine is good, but it should be given with an anticholinergic.
why give glycopyrrolate?
🤤reduces secretions from ketamine
👊it causes bronchodilation!
so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC
high-dose ketamine is good, but it should be given with an anticholinergic.
why give glycopyrrolate?
🤤reduces secretions from ketamine
👊it causes bronchodilation!
so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC
Reposted
did you think that labetalol is a single drug?
nope
it’s actually a mixture of FOUR different drugs
RS, RR, SS, and SR-labetalol
and this is clinically relevant!
lets discuss why…
🧵 #1/3 #EMIMCC
nope
it’s actually a mixture of FOUR different drugs
RS, RR, SS, and SR-labetalol
and this is clinically relevant!
lets discuss why…
🧵 #1/3 #EMIMCC
May 11, 2025 at 4:45 PM
did you think that labetalol is a single drug?
nope
it’s actually a mixture of FOUR different drugs
RS, RR, SS, and SR-labetalol
and this is clinically relevant!
lets discuss why…
🧵 #1/3 #EMIMCC
nope
it’s actually a mixture of FOUR different drugs
RS, RR, SS, and SR-labetalol
and this is clinically relevant!
lets discuss why…
🧵 #1/3 #EMIMCC
Reposted
I was skeptical about percutaneous mechanical aspiration for tricuspid valve endocarditis, but it apparently can work.
Look at this picture of a vegetation that was fished out of a patient I was involved with. Only after removal was he able to achieve negative blood cultures.👇 #EMIMCC
Look at this picture of a vegetation that was fished out of a patient I was involved with. Only after removal was he able to achieve negative blood cultures.👇 #EMIMCC
May 8, 2025 at 1:56 AM
I was skeptical about percutaneous mechanical aspiration for tricuspid valve endocarditis, but it apparently can work.
Look at this picture of a vegetation that was fished out of a patient I was involved with. Only after removal was he able to achieve negative blood cultures.👇 #EMIMCC
Look at this picture of a vegetation that was fished out of a patient I was involved with. Only after removal was he able to achieve negative blood cultures.👇 #EMIMCC
Reposted
Pharmacokinetics of drug removal during plasma exchange (PLEX):
You have a complex patient on several meds and you’re about to remove all the albumin in their body - how much does this affect medication levels? 🧵 #1/4 #EMIMCC
You have a complex patient on several meds and you’re about to remove all the albumin in their body - how much does this affect medication levels? 🧵 #1/4 #EMIMCC
a cartoon of spongebob holding a pencil and writing on a piece of paper
ALT: a cartoon of spongebob holding a pencil and writing on a piece of paper
media.tenor.com
May 9, 2025 at 1:33 PM
Pharmacokinetics of drug removal during plasma exchange (PLEX):
You have a complex patient on several meds and you’re about to remove all the albumin in their body - how much does this affect medication levels? 🧵 #1/4 #EMIMCC
You have a complex patient on several meds and you’re about to remove all the albumin in their body - how much does this affect medication levels? 🧵 #1/4 #EMIMCC
Reposted
happy Pi day to all who celebrate 🥳
March 14, 2025 at 8:19 PM
happy Pi day to all who celebrate 🥳
Reposted
Working link www.nejm.org/doi/full/10....
Abelacimab versus Rivaroxaban in Patients with Atrial Fibrillation | NEJM
Abelacimab is a fully human monoclonal antibody that binds to the inactive form of factor XI and blocks its activation. The safety of abelacimab as compared with a direct oral anticoagulant in pati...
www.nejm.org
January 23, 2025 at 7:01 PM
Working link www.nejm.org/doi/full/10....
Reposted
December 12, 2024 at 6:43 PM
Reposted
Fresh blog: the ADAPT and SCREEN trials are full of sound & fury, signifying little
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
PulmCrit: ADAPT and SCREEN trials are full of sound and fury, signifying little
I think ICU docs may have developed a bit of an RCT problem; not an addiction, but perhaps a dependency. It all started off fine at first. RCTs are the
emcrit.org
December 13, 2024 at 6:28 PM
Fresh blog: the ADAPT and SCREEN trials are full of sound & fury, signifying little
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
🤷♂️ Sepsis screens & procal-based ABX duration are highly context-dependent interventions. Effects will vary depending on baseline usual care.
🤷♂️ They lack generalizability.
emcrit.org/pulmcrit/ada... #EMIMCC
Reposted
CXR findings of pulmonary edema 🫁 Cr. #keyrad
#radsky
#radiology
@laurengroner.bsky.social
@danielvargasmd.bsky.social
@mmestas.bsky.social
@drfurkanufuk.bsky.social
@pulmpeeps.bsky.social
#radsky
#radiology
@laurengroner.bsky.social
@danielvargasmd.bsky.social
@mmestas.bsky.social
@drfurkanufuk.bsky.social
@pulmpeeps.bsky.social
December 13, 2024 at 12:32 AM
CXR findings of pulmonary edema 🫁 Cr. #keyrad
#radsky
#radiology
@laurengroner.bsky.social
@danielvargasmd.bsky.social
@mmestas.bsky.social
@drfurkanufuk.bsky.social
@pulmpeeps.bsky.social
#radsky
#radiology
@laurengroner.bsky.social
@danielvargasmd.bsky.social
@mmestas.bsky.social
@drfurkanufuk.bsky.social
@pulmpeeps.bsky.social
Reposted
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: