We dive into the subtle art of placing, understanding, and interpreting the PA (Swan Ganz) catheter, on a new lesson at icu101.com.
#emimcc #medsky
#emimcc #medsky
November 10, 2025 at 8:12 PM
We dive into the subtle art of placing, understanding, and interpreting the PA (Swan Ganz) catheter, on a new lesson at icu101.com.
#emimcc #medsky
#emimcc #medsky
Permissive Hypercapnia
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
Mechanical Vent in Asthma #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
November 10, 2025 at 3:00 PM
Permissive Hypercapnia
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
-Allows CO2 to rise to avoid breath stacking (pH will stay low too)
-Settings: RR 8-10, I:E ratio w/ long expiratory time
-As meds kick in, will relieve bronchospasm which means less expiratory time needed + can start to blow off CO2
youtube.com/shorts/Xblf7...
#EMIMCC
IMHO the best strategy for occasional intubators (e.g., pulm/crit) is:
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
Hyperangulated videolaryngoscopy: stylet first until benefit of bougie is shown
"...the current challenge for the wider community of anaesthetists ... is not mastery of HAVL but access to devices, routine use, gaining familiarly and developing competence."
#AnSky
ttps://doi.org/10.1111/anae.70062
"...the current challenge for the wider community of anaesthetists ... is not mastery of HAVL but access to devices, routine use, gaining familiarly and developing competence."
#AnSky
ttps://doi.org/10.1111/anae.70062
November 10, 2025 at 1:27 PM
IMHO the best strategy for occasional intubators (e.g., pulm/crit) is:
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
I'm revising the IBCC septic shock chapter based on ANDROMEDA-SHOCK II
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
November 10, 2025 at 1:16 PM
I'm revising the IBCC septic shock chapter based on ANDROMEDA-SHOCK II
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
"CRT, like a star, is not the destination but a guide for the journey". AS-2 it's not just a trial, it's a manifesto, an act of faith #EMIMCC #Andromeda #AndromedaShock2 #Sepsis
criticalcarereviews.com/blog/current
criticalcarereviews.com/blog/current
Faith, Evidence and the Stars
The most up-to-date critical care website in the world.
criticalcarereviews.com
November 9, 2025 at 9:02 PM
"CRT, like a star, is not the destination but a guide for the journey". AS-2 it's not just a trial, it's a manifesto, an act of faith #EMIMCC #Andromeda #AndromedaShock2 #Sepsis
criticalcarereviews.com/blog/current
criticalcarereviews.com/blog/current
Fascinating paper suggesting the assumption that there is a sigmoid dose response relationship and threshold effect ( "all-or-nothing") for loop diuretics rests on repeated misinterpretation of original studies from the 70s and 80s. #nephsky #cardiosky #emimcc academic.oup.com/ehjcvp/artic...
What are the pharmacodynamics of loop diuretics?
A recent editorial was entitled ‘Loop diuretics in heart failure: few facts and lots of prejudice’.1 I would argue that we have forgotten or distorted some
academic.oup.com
November 9, 2025 at 6:40 PM
Fascinating paper suggesting the assumption that there is a sigmoid dose response relationship and threshold effect ( "all-or-nothing") for loop diuretics rests on repeated misinterpretation of original studies from the 70s and 80s. #nephsky #cardiosky #emimcc academic.oup.com/ehjcvp/artic...
your daily reminder:
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
From @jama.com: Patients with #AFib who continued their usual caffeinated coffee intake after cardioversion experienced less recurrence of AF or atrial flutter compared to those who abstained from coffee and caffeine.
#AHA25 @ahascience.bsky.social
ja.ma/3XolIkd
#AHA25 @ahascience.bsky.social
ja.ma/3XolIkd
November 9, 2025 at 3:15 PM
your daily reminder:
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
Hypokalemia caused by loop diuretics, I wonder if chloride loss and ensuing metabolic alkalosis is more important than potassium loss itself? #cardiosky #nephsky #emimcc
November 9, 2025 at 2:44 PM
Hypokalemia caused by loop diuretics, I wonder if chloride loss and ensuing metabolic alkalosis is more important than potassium loss itself? #cardiosky #nephsky #emimcc
Reupping this question as I’m seeing the same, often because it is assumed to be better tolerated hemodynamically (myth?). #cardiosky #emimcc #kidneysky
Bolus or infusion of iv furosemide?
I’ve always felt that twice a day bolus is more effective but am seeing increasing use of infusions in patients under cardiology and acute medicine.
I’ve always felt that twice a day bolus is more effective but am seeing increasing use of infusions in patients under cardiology and acute medicine.
November 8, 2025 at 4:53 PM
Reupping this question as I’m seeing the same, often because it is assumed to be better tolerated hemodynamically (myth?). #cardiosky #emimcc #kidneysky
this is really excellent.
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
Our latest blog is out:
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
November 8, 2025 at 4:49 PM
this is really excellent.
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
The management of paediatric fever among Australian ED clinicians
doi.org/10.1111/1742...
#OpenAccess
@shane-george.bsky.social
@drsimoncraig.bsky.social
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
doi.org/10.1111/1742...
#OpenAccess
@shane-george.bsky.social
@drsimoncraig.bsky.social
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
November 8, 2025 at 2:08 AM
The management of paediatric fever among Australian ED clinicians
doi.org/10.1111/1742...
#OpenAccess
@shane-george.bsky.social
@drsimoncraig.bsky.social
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
doi.org/10.1111/1742...
#OpenAccess
@shane-george.bsky.social
@drsimoncraig.bsky.social
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
FAST in Hypotensive Trauma
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
FAST in Hypotensive Trauma #emergencymedicine #criticalcare #trauma #fast
YouTube video by EMSwami
youtube.com
November 7, 2025 at 10:35 PM
FAST in Hypotensive Trauma
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
-Start w/ lung/cardiac windows first
-RUQ (+) - changes next destination for management but no immediate intervention
-Lung (+) (ie PTX) or cardiac (+) (ie tamponade) - immediate intervention (thoracostomy/thoracotomy)
youtube.com/shorts/LKmmo...
#EMIMCC
#Dengue Simplified Severity Score
doi.org/10.1111/1742...
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
doi.org/10.1111/1742...
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
November 7, 2025 at 8:18 PM
#Dengue Simplified Severity Score
doi.org/10.1111/1742...
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
doi.org/10.1111/1742...
@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM
November 7, 2025 at 7:23 AM
The misconception that antibiotic allergy assessment is solely the domain of allergists has led to complacency in clinical practice, yet verifying allergy histories should be a core competency for all physicians, particularly infectious diseases. #IDsky #EMIMCC
🆕🔥State-of-the-Art Review with 🌟s @trubianojason.bsky.social : Antibiotic Allergy—A Multidisciplinary Approach to Delabeling #idsky
url: academic.oup.com/cid/article/...
url: academic.oup.com/cid/article/...
November 6, 2025 at 8:58 PM
Pharm bros! My boss today wouldn't give meropenem to a patient with a history of (non-anaphylactic) penicillin allergy. Is there any evidence to support this?
@alaurx.bsky.social @sarajpharmd.bsky.social
#emimcc
@alaurx.bsky.social @sarajpharmd.bsky.social
#emimcc
November 6, 2025 at 7:35 PM
Pharm bros! My boss today wouldn't give meropenem to a patient with a history of (non-anaphylactic) penicillin allergy. Is there any evidence to support this?
@alaurx.bsky.social @sarajpharmd.bsky.social
#emimcc
@alaurx.bsky.social @sarajpharmd.bsky.social
#emimcc
A prev healthy man in his 50s arrives by EMS with a GCS of 9. It started an hour ago with him screaming ”I can’t breathe” and then having a seizure. He flails with only his left arm on the stretcher. Looks sick so he gets an artline quickly - 95/55. #POCUS gets the diagnosis. Scary stuff. #EMIMCC
November 6, 2025 at 6:51 PM
Incr safe apneic time important in improving 1st pass success
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
Safe Apneic Time #emergencymedicine #criticalcare #intubation #airway
YouTube video by EMSwami
youtube.com
November 5, 2025 at 3:03 PM
Incr safe apneic time important in improving 1st pass success
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
-Preox w/ NIV: Incr PaO2, recruit alveoli
-Oxygenate + intubate in Bed Up, Head Elevated
-Apneic O2 w/ flush rate NC
-Use rocuronium instead of succinylcholine (up to 45 sec more safe apneic time)
youtube.com/shorts/-3MFR...
#EMIMCC
November 5, 2025 at 1:39 PM