according to his prior predictions, Tesla should have had fully autonomous cars since… 2017, 2018, and 2019, plus a Mars Colony since 2024, so I do not think this a reason to be bearish on med school en.wikipedia.org/wiki/List_of... www.aol.com/articles/10-...

Tales From The Future@talesftf.bsky.social · last wk.

After a decade of fake FSD promises: Musk is claiming that “Optimus will beat top surgeons in 3 years”. Can’t stop, won’t stop. $TSLA $TSLAQ “Elon Musk calls medical school 'pointless,' says robots will beat any surgeon in 3 years — telling students to walk away” finance.yahoo.com/sectors/heal...

journal.chestnet.org/article/S001... POCUS has a lower diagnostic yield than CT post arrest but actually identifies the cause of arrest as often as CT (and much more quickly...)

Diagnostic Yield of CT Imaging and Point-of-Care Ultrasound After In-Hospital Cardiac Arrest

Our results show that among survivors of IHCA, CT imaging and POCUS frequently identified new pathologic features, including suspected arrest causes, with subsequent management changes in a substantia...

journal.chestnet.org

Point of care D dimer in space? I guess interesting from a research perspective but maybe not the most useful medical investigation to have on the ISS! theijf.org/brief/blood-...

Canadian device soon to test for blood clots in space

A made-in-Canada device that can detect blood clots in astronauts is expected to launch into orbit this fall, the Canadian Space Agency confirmed.

theijf.org

Fresh Blog: Is oseltamivir assassinating ICU patients? ☠️ The REMAP-CAP trial has concluded with >98% certainty that oseltamivir is killing patients. ☠️ This is an extraordinary claim that requires extraordinary evidence. #1/2... #EMIMCC

Important study of real-world use of rapid respiratory diagnostics. Encouragingly, pace INHALE, no signal to harm in the intervention group (indeed signal to benefit in those with panel-detectable organisms on culture).

Antibiotic Steward 🅱️C🆔🅿️🌟@absteward.bsky.social · 2mo ago

🆕💥🔴Multicenter retrospective study of ICU patients with pneumonia BIOFIRE® PN Panel implementation was associated with improved early antimicrobial de-escalation and appropriate therapy #idsky academic.oup.com/cid/article-...

Counterpoint: Treat fluids like the drugs they are, especially considering Give the right one for the right patient. Hyperkalemia? Avoid NS Hypochloremia? Give NS (Traumatic) brain injury? Give NS Hyperkalemia and fluid overload? Give furosemide Etc.

Segun Olusanya (He/Him)@drfreeze.bsky.social · 2mo ago

Yes Just give whatever crystalloid you have in your cupboard. Don’t give colloids.

Take home messages so far from #CCR26 1. Stop routine carbocisteine/HT saline nebs- no benefit & may be harmful 2. Stop prescribing oseltamivir in critically unwell flu- it probably kills patients 3. Don't use bicarb in ❤️ arrest or for 'all comers' with metab acidosis but may be useful in some circs

Fascinating results of SODa-BIC trial at #CCR26 - no difference in primary outcome of MAKE-30. Well done to the triallists- first double blind bicarb trial! Marlies Ostermann doing a great job of putting these results in context with previous and ongoing studies www.nejm.org/doi/full/10....

Yes Just give whatever crystalloid you have in your cupboard. Don’t give colloids.

Ben Millette@benmillette.bsky.social · 2mo ago

Interesting results from the FISSH trial at #CCR26 ! No difference in mortality overall but some signal for benefit for balanced crystalloid in patients with AKI, esp those with Stage 2 or 3 AKI Have we now had enough fluid trials comparing NS and balanced crystalloid? 🤔

Interesting results from the FISSH trial at #CCR26 ! No difference in mortality overall but some signal for benefit for balanced crystalloid in patients with AKI, esp those with Stage 2 or 3 AKI Have we now had enough fluid trials comparing NS and balanced crystalloid? 🤔

I will never understand the seeming widespread enthusiasm internationally for giving bicarb in cardiac arrest. I have almost never seen this in UK practice and there's little evidence to support it. Why is this a thing???

Paul Rudd Confused Reaction

Alt: Paul Rudd Confused Reaction

static.klipy.com

Critical Care Reviews@criticalcarereviews.com · 2mo ago

#CCR26 Ary Serpa Neto provides the editorial for the BIHCA trial. He reiterates the absence of evidence of bicarb and that we all use it (!) What should clinicians do tomorrow? Dr Serpa Neto: avoid routine use, but role as a rescue therapy / specific conditions not tested

Jaw-dropping results from REMAP-CAP- oseltamivir domain today. I believe this is the first randomised evidence for oseltamivir in the critically unwell. No evidence of benefit and 98% probability of harm 🤯🤯🤯 #CCR26

So is it finally dead yet, or do we need precision medicine to identify vitamin C responders? (This is sarcasm)

JAMA@jama.com · 2mo ago

📊 Research Summary: High-dose intravenous #VitaminC did not improve mortality or organ function in adults with severe burns and may increase risk of adverse outcomes, supporting the removal of vitamin C from acute burn protocols. #CCR26 @criticalcarereviews.com ja.ma/4v31fkv

Wow! MARCH trial results show no significant benefit for hypertonic saline and carbocisteine in ventilated ICU patients, and significant harm associated with both. Very well done to all of the investigators! www.nejm.org/doi/full/10.... #CCR26

Carbocisteine or Hypertonic Saline for Acute Respiratory Failure | NEJM

Mucoactive agents are widely used in patients with acute respiratory failure despite limited evidence of their effectiveness or safety. We conducted a multicenter, open-label, randomized trial with...

nejm.org

Interesting! This is at odds with the ICU ROX subgroup results...

NEJM.org@nejm.org · 2mo ago

Among patients who were unresponsive after cardiac arrest, conservative oxygen therapy did not increase 180-day survival with favorable function as compared with liberal oxygen therapy. Full LOGICAL trial results: https://nej.md/4x7TavY #CCR26 | @criticalcarereviews.com

41% of ventilated patients receive a mucoactive agent If you exclude (prescribed) NaCl 0.9%, it’s 27% of all ventilated patients pmc.ncbi.nlm.nih.gov/articles/PMC... MARCH will change practice whichever way it goes

#ccr26 is this week. Sadly can’t attend so will be following the live stream. Anyone got any interesting predictions to make? I’m expecting a surge of interest in bicarbonate… #emimcc #foamcc

💡 JAMA Insights: #POCUS by trained clinicians is a guideline-endorsed alternative to chest #radiography for #pneumonia diagnosis, offering higher sensitivity and specificity, immediate results, and no ionizing radiation. ja.ma/4xbZ9QI

Strong opinion of the day: there seems to be a trend for presenting slideshows online in 'normal view' (I.e. in editing mode) Please stop doing this!🙏🙏🙏 It's just awful

Seems open evidence is no longer available in Europe 😭 Anyone have suggestions for a suitable replacement- reliable and transparently-evidenced medical AI

Only just learned this great fact- the white crust on cheeses like brie and camembert is actually penicillium mold! Only produces trivial amount of penicillin so cross reactive allergies are very rare en.wikipedia.org/wiki/Penicil...

two pieces of cheese are sitting on a wooden table and the words food and wine are on the bottom

Alt: two pieces of cheese are sitting on a wooden table and the words food and wine are on the bottom

media.tenor.com

Fresh blog on the HI-PEITHO trial 😁 🔊 ~18 mg alteplase over 7 hrs is safe (no ICH, no difference in bleeding rates) 🔊 Alteplase reduces the risk of cardiopulmonary decompensation and poor functional outcomes #1/2 #EMIMCC

There are lots of ongoing studies The PRECARE study from Sydney suggested malposition 89% of the time pubmed.ncbi.nlm.nih.gov/40090608/m

#TEElovers @drfreeze.bsky.social @thinkingcc.bsky.social @load-dependent.eurosky.social any thoughts ? jamanetwork.com/journals/jam...

Transesophageal Echocardiography During CPR in Patients With Out-of-Hospital Cardiac Arrest

This randomized clinical trial tests whether the use of transesophageal echocardiography during cardiopulmonary resuscitation (CPR) increases the rates of sustained return of spontaneous circulation a...

jamanetwork.com

The plot thickens @pulmcrit.bsky.social

NEJM.org@nejm.org · 4mo ago

In patients with pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis led to a lower risk of a composite of major adverse outcomes than anticoagulation alone. Full HI-PEITHO trial results: nej.md/4uMu4lv #ACC26 | @accintouch.bsky.social

Any consultants who find their sympathy for resident doctors waning in the wake of the newly announced strike action would do well to read the conditions of their current student loan repayments. If you don't find it monstrously unjust, you don't understand it.

Ben Millette@benmillette.bsky.social · 5mo ago

The enormous unfairness in the current system is demonstrated by the modeling done by the IFS here. Many medical students have loans of £70-100k and won't actually start paying down their loans for many years ifs.org.uk/articles/how...

I wonder if it means that when PCT tells us the high NEWS2 is not sepsis, we think a bit harder. The need for more study into the outcome won’t identify this unless we have sufficient granularity (of clinical reason). “When the PCT is ⬇️, we find ⬆️ time is spent with the patient, with more DDxs”

This study is a real headscratcher. None of the other studies of PCT in ED have shown any benefit so my priors lean towards not believing it. But even so... www.thelancet.com/journals/lan...

Procalcitonin testing combined with NEWS2 evaluation compared with usual care based on NEWS2 for identification of sepsis and antibiotic initiation in the emergency department in England and Wales (PR...

Making a procalcitonin-guided algorithm available to clinicians in emergency departments did not change intravenous antibiotic initiation at 3 h in patients managed as suspected sepsis, but a decrease...

thelancet.com

Presented at #ISICEM: In a multicenter trial involving patients with acute hypoxemic respiratory failure, 28-day mortality with high-flow oxygen was not significantly different from that with standard oxygen. Full SOHO trial results: www.nejm.org/doi/full/10.... @isicem.bsky.social