Lethal Quadrad of Trauma: Hypothermia, Coagulopathy, Acidosis + HypoCa - HypoCa common in major trauma -Aggressive, prophylactic supplementation is key -Standard: 1 gm CaCl w/ 1st 2 units (don’t wait for level). Give another 1 gm CaCl w/ every additional 4 units youtube.com/shorts/43m17... #EMIMCC

Lethal Quadrad - HypoCa in Trauma #emergencymedicine #criticalcare

YouTube video by EMSwami

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Procainamide vs Amio in Stable VT -PROCAMIO (27354046) RCT comparing 2 agents -Amio: 32% more likely cause major adverse event(NNH = 3) -Procainamide 30% more likely convert patient(NNT = 3) but, only 67% conversion rate -Electricity 1st still best approach youtube.com/shorts/W9Kwe... #EMIMCC

Procainamide vs Amiodarone in Stable VT #emergencymedicine #criticalcare

YouTube video by EMSwami

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Phenobarbital a game changer in EtOH w/d -Option 1: No benzos given. Load 10 mg/kg over 30 min + wait 30 min for effect -Option 2: post-escalating BZD. Give phenobarbital 130 mg IV q15 until adequate sedation achieved -Early phenobarbital use can avoid intubation youtube.com/shorts/IMcT7... #EMIMCC

Phenobarbital in EtOH Withdrawal #emergencymedicine #criticalcare

YouTube video by EMSwami

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Haloperidol is a Fantastic Multi-Tasker -Sedation of the agitated patient -Potent antiemetic particularly in gastroparesis (PMID 28320545) + CHS (PMID: 33160719) -Excellent in migraines (PMID 27510942) -Refractory sickle cell disease pain + chronic abdominal pain youtube.com/shorts/A5Ju5... #EMIMCC

Haloperidol is Great #emergencymedicine

YouTube video by EMSwami

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Beta blockade in sepsis? -Early, tachycardia compensatory mechanism to increase CO + perfusion -Persistent tachycardia after resus may indicate exaggerated sympathetic response that can cause cardiac dysfunction youtube.com/shorts/nLmSy... #EMIMCC

Esmolol in Sepsis #emergencymedicine #criticalcare

YouTube video by EMSwami

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what is your best pearl, or most useful reference, about interpreting a complete blood count with differential? The blood count is one of the most commonly ordered tests in clinical medicine, but its subtleties are woefully overlooked. #EMIMCC

Inception: We Need To Go Deeper Meme with Leonardo DiCaprio

ALT: Inception: We Need To Go Deeper Meme with Leonardo DiCaprio

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ED Cardioversion of recent onset AF safe + effective in selected groups: -On AC > 3 weeks regardless of onset -Low risk by structured tool (CHADS-VASC) < 48 hours from onset -High-risk + presents < 12 hours from onset Low risk CHADS-VASC < 2 (men) < 3 (women) youtube.com/shorts/Xdpbk... #EMIMCC

Which Recen-Onset AF Patients Can Get ED Cardioversion? #emergencymedicine

YouTube video by EMSwami

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We worry a lot about “too much Keppra” but in status epilepticus the greater risk may be underdosing the initial load. Neuropsychiatric adverse effects are largely linked to ongoing maintenance therapy, not a single appropriately dosed loading dose #emimcc #FOAMed #EMsky #RxSky

Jim Lake Jr: Why Isn't It Working?

ALT: Jim Lake Jr: Why Isn't It Working?

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Agree with this All formulae for corrected calcium are imperfect Just measure ionized calcium pubmed.ncbi.nlm.nih.gov/42035248/ #EMIMCC

Albumin-adjusted ("corrected") calcium should no longer be reported: a position statement from the Joint IOF Working Group and IFCC Committee on Bone Metabolism and EFLM Committee on CKD - PubMed

Albumin-adjusted ("corrected") calcium should no longer be reported: a position statement from the Joint IOF Working Group and IFCC Committee on Bone Metabolism and EFLM Committee on CKD

pubmed.ncbi.nlm.nih.gov

This dogma must stop being taught to clinicians and be put out to pasture as a relic of a bygone era in scientific literature. I love this 😍 What other dogmas should we retire? #idsky #microsky #EMIMCC

Antibiotic Steward 🅱️C🆔🅿️🌟@absteward.bsky.social · 3mo ago

Static vs. cidal: it’s not complex; it’s simply incorrect @bradspellberg.bsky.social et Al Honored to be part of this amazing group who challenges dogmas and debunk ID myths #idsky #microsky journals.asm.org/doi/10.1128/...

everyone learns about TCA overdose in med school, but not bupropion XR overdose time to level up bupropion XR overdose is increasingly common & VERY dangerous ongoing drug absorption creates a "toxin bomb" wherein patients look OK initially, but deteriorate later on... (#1/2) #EMIMCC

CS:GO Bomb Defuse Timer Countdown Animation

ALT: CS:GO Bomb Defuse Timer Countdown Animation

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Propofol in RSI -Unlike ketamine + etomidate, propofol has intrinsic HD effects (vasodilation + cardiac depression) -If using in patients w/ even slight HD compromise, be careful w/ dosing -Can use reduced bolus dose or titrate in small aliquots youtube.com/shorts/p3aji... #EMIMCC

Propofol in RSI #emergencymedicine #criticalcare #intubation #resuscitation

YouTube video by EMSwami

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Cool study - an amp of sodium bicarbonate (50 ml 8.4%) raises sodium similar to a boils of 3% - as expected of course! pubmed.ncbi.nlm.nih.gov/41937305/ @pulmcrit.bsky.social @kidneyboy.bsky.social #nephsky #emimcc

Comparison of 8.4% Sodium Bicarbonate vs. 3% Sodium Chloride in Severe Hyponatremia: A Retrospective Cohort Study - PubMed

This study found that a single 50 mL dose of HTB more often resulted in obtainment of guideline-recommended post-intervention serum sodium goal concentrations than a 100 mL HTS dose. Additional studies...

pubmed.ncbi.nlm.nih.gov

medicine of the PITT: status epilepticus in pregnancy if you're using levetiracetam as your go-to antiseizure med (as most folks are), then the treatment is essentially the same as usual add Mg, but Mg prevents sz recurrence (rather than lysing active sz) #1/2 #EMIMCC

a man with a stethoscope around his neck is sitting in front of a sign that says " only time will tell "

ALT: a man with a stethoscope around his neck is sitting in front of a sign that says " only time will tell "

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Myth: Ketamine increases ICP in TBI ➡️worse outcomes -Myth originates from low quality data -Recent data shows ICP unchanged + CPP unchanged or slight incr -Ketamine advantages: more HD stable + physiologically may be beneficial -Bottom line: safe to use in TBI youtube.com/shorts/deykT... #EMIMCC

Ketamine in TBI #emergencymedicine #criticalcare #trauma #intubation

YouTube video by EMSwami

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is there a reason that we don't use more IV glycopyrrolate for status asthmaticus? admittedly minimal direct evidentiary support, but makes sense & indirect evidence seems more benign than various alternative treatments (eg intubation, ECMO, extracorporeal CO2 removal). #EMIMCC

Orthostatics worthless in assessing volume status -50% > 65 + 44% teens orthostatic at baseline(PMID 9109468, 12006955) -Perform poorly in known volume loss(PMID 8198307) -Useless in assessing those w/ fluid depletion from vomiting, diarrhea (PMID 10086438) youtube.com/shorts/Dvq5R... #EMIMCC

Orthostatics Are Useless in Assessing Volume Status #emergencymedicine

YouTube video by EMSwami

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Surviving Sepsis 2026 is here & it's even more loony tunes than I was expecting. They're promoting pre-hospital ABX & preemptive broad-spectrum IV antibiotics for intubated patients. This insane fever dream is an antimicrobial stewardship nightmare. Embarrassment for SCCM. #EMIMCC

kudos to ACEP for calling out the Surviving Sepsis Campaign 2026 guidelines and not joining in this madness. ACEP is great at making evidence-based policies that actually *help* provide better patient care. When ACEP is politely burning your guideline, you’re in trouble. #EMIMCC

One point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working: Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number! #emimcc #cccsky

Justin Morgenstern @first10em.bsky.social · 5mo ago

Norepinephrine isn't work - now what?? A #FOAMed guide to the assessment and management of refractory shock

Sux Contraindications -Bumps K by ~ 0.5 mEq: Problem if ESRD/CKD + unknown K -Exaggerated incr K in malignant hyperthermia, motor neuron disease, muscular dystrophy, GBS -While these situations are uncommon, adds to cognitive load in high stress scenario youtube.com/shorts/kD2IK... #EMIMCC

Succinycholine Contraindications #emergencymedicine #criticalcare

YouTube video by EMSwami

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Safe to give 3% hypertonic saline through a peripheral IV bit.ly/49t5GcI Retrospective study w/ 216 administrations of 3% by PIV + only 8 minor complications Bottom line: don’t delay 3% hypertonic administration for placement of a central line youtube.com/shorts/M5AyB... #EMIMCC

Hypertonic Saline Via Peripheral IV #emergencymedicine #criticalcare

YouTube video by EMSwami

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The end of the road for rivaroxaban? Shows how important direct comparative trials among drugs within the same pharmacologic class are. #emimcc #cardiosky www.nejm.org/doi/full/10....

Here's a DOAC–CYP interaction workaround. If DOAC is needed w/ CYP3A4 concerns, consider edoxaban. It’s <4% metabolized by CYP3A4 unlike apixaban, rivaroxaban & dabigatran (20-50%). Caveat..avoid if CrCl>95 mL/min...renal clearance is too efficient, reducing efficacy👇 #emimcc #medsky #hemesky #Rxsky

a woman is holding a cup of coffee and saying crisis averted .

ALT: a woman is holding a cup of coffee and saying crisis averted .

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Steroids in Asthma Exacerbations -Short course of steroids reduce ED revisits/admissions -Anti-inflammatory reduce bronchial inflammation + bronchospasm -Also upregulate beta receptors in lung incr sensitivity to inhaled beta agonists (effect kicks in in minutes) youtube.com/shorts/PopLV... #EMIMCC

Steroids in Asthma #emergencymedicine

YouTube video by EMSwami

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Finally the Hyponatremia Intervention Trial is published and it is a big disappointment pbfluids.com/2026/03/fina...

Finally. The Hyponatremia Intervention Trial is published

The Hyponatremia Interventional Trial (HIT) has been published in NEJM Evidence. The results were unveiled at the Late-Breaking and High-Impact Clinical Trials session at ASN Kidney Week 2024 in Sa…

pbfluids.com

New JAMA review attempts to equate pulmonary congestion with systemic congestion ("volume overload") This is sloppy & often wrong Pts w/ LV failure often have pulmonary congestion w/o systemic congestion Pts w/ RV failure usually have systemic congestion w/ dry lungs CVP isn't PCWP #EMIMCC

For #PharmacyAwarenessMonth, I’m highlighting the role of EM pharmacists in cardiac arrest, traumas & intubations…one of many ways #pharmacists make a difference each day! Optimize #meds, ↓errors, improve lifesaving care timing. Proud to stand with dedicated pharmacists☺️💪🔥 #pharmacy #Rxsky #EMsky

Happy Pharm Awareness Month #PAM2026 to my incredible pharmacy colleagues in Canada & around the🌏! Proud to be a pharmacist alongside such dedicated colleagues. The work we do isn’t always easy but it matters...every💉💊, every💬, every🤒we help. Grateful to be in this with all of you 🙏 #pharmsky #RxSky

a man wearing glasses is praying with the words thank you behind him

ALT: a man wearing glasses is praying with the words thank you behind him

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🔥Just published 🔥 TAPER-V RCT In this RCT of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to a standard 2-week pulse regimen in patients a first episode or first recurrence of CDI Vanco for 10d is obsolete! #IDSky #EMIMCC jamanetwork.com/journals/jam...

Initial Vancomycin Taper for the Prevention of Recurrent C difficile Infection

This randomized clinical trial tested whether a 4-week pulse and taper vancomycin regimen was superior to a 2-week pulse regimen for preventing recurrence among patients with a first episode or first ...

jamanetwork.com