Kwame gives us the skinny on practicing medicine abroad. How do you do it right? Who pays? How do you get started? icuscenarios.com/lightning-ro... #medsky #emimcc

Anyone in medical (including APPs) education using AI in assignments? I don’t mean using it to grade or create assignments or content, but having students do something with AI? #MedEd

Confused about steroids in the ICU? This week on the podcast, we talk to David Janz about who needs them, which ones to use, and which dose. icuscenarios.com/lightning-ro...

DOPES Mnemonic: structured approach to deal with hypoxia in the ventilated patient Displacement, Obstruction, Patient factors (ie PE, PTX), Equipment Issues, Stacked Breaths. Address all of these factors in parallel youtube.com/shorts/rwumW... #EMIMCC

DOPES in Crashing Vent #criticalcare #emergencymedicine

YouTube video by EMSwami

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Remembering the most likely mediator of reduced mortality in the original EGDT therapy was the presence of the CI in the intervention arm, the regular attendance of an interested and informed clinician (and skilled ICU nurse) likely has a bigger impact than any single drug or intervention.

Jack Iwashyna@iwashyna.bsky.social · 10mo ago

"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

Just updated the IBCC chapter on cholecystitis & cholangitis. These patients are often initially triaged to the ICU. Understanding these diseases can help us direct patients to interventions they need. Let’s talk about four pearls 😁 chapter: emcrit.org/ibcc/biliary... #EMIMCC

a woman in a pearl costume says pearls

ALT: a woman in a pearl costume says pearls

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A man in his 50s seeks the ED for the umpteenth time since his abdo pain started a few years ago. He says that it’s his gallbladder, surgery has been denied because of diffuse pain and normal blood tests. Today CRP 9, Leukocytes 11. #POCUS He got his operation the next day. #EMIMCC

Point-of-care ultrasound is being used by an increasing number of nurse practitioners, but its utility is not limited to the ICU, nor even to Acute Care. journals.lww.com/jaanp/abstra...

Expanding the horizon: The case for point-of-care... : Journal of the American Association of Nurse Practitioners

enhanced diagnostic accuracy, faster decision-making, and improved patient satisfaction. With growing access to affordable handheld devices and expanding educational opportunities, POCUS is becoming i...

journals.lww.com

rapidly pushing IV calcium may cause: 😦 vasodilation, bradycardia, hypotension 😦 nausea/vomiting, flushing if patients are conscious, this can make them feel horrible if the patient is obtunded & not intubated, emesis can be a big problem whenever possible, give IV Ca slowly #EMIMCC

a man wearing sunglasses and a green shirt with breaking bobby bones on the bottom

ALT: a man wearing sunglasses and a green shirt with breaking bobby bones on the bottom

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The other thing to remember is that patients in HFNC typically benefit more from “flow” than FiO2. So wean the FiO2 before the flow.

@IM_Crit_@imcrit.bsky.social · last yr.

Another thing I hear often in the ICU is this: The patient is on high-flow nasal cannula (HFNC) (or high-flow oxymask) When I specifically ask "how many liters?", often the answer is: 6 or 7 l/min HFNC is a respiratory support system delivering heated-humidified O2 @

And remember, ST is often compensatory. Don’t slow it down blindly.

REBEL EM@rebel-em.bsky.social · last yr.

🫀 Sinus tachycardia = a sign, not a diagnosis. Don’t just treat the rate—find the cause. Use this 8-point checklist & skip reflexive beta blockers. 🎧 REBEL Core Cast 137: https://wp.me/pdrP8b-5nI #EMIMCC #FOAMed #MedEd #MedSky

“But WHY did they fail?” All too often I get, “they failed SBT” from someone who also wasn’t there, and that’s that. Do it again and see for yourself. Often you can get them off the vent after all.

josh farkas 💊@pulmcrit.bsky.social · last yr.

great thread on SBTs 💨 if someone “failed” for unclear reasons before your shift, repeat the SBT with direct observation 💨 look for treatable causes of SBT failure -but- 💨 for most patients, repeating multiple SBTs daily doesn’t help more: emcrit.org/ibcc/extubat... #EMIMCC

Big news for lung ultrasound #POCUS

@IM_Crit_@imcrit.bsky.social · last yr.

This is the summary of the recommendations: 1. Lung ultrasound versus chest x-ray to diagnose CAP For adults with suspected CAP, we suggest lung US is an acceptable diagnostic alternative to CXR in medical centers where appropriate clinical expertise exists

I sadly see this not rarely. Especially with overworked interns. They run out of time and rather than admit this, and risk being perceived as failing, they lie. And they ALWAYS get caught.

Anand Swaminathan@emswami.bsky.social · last yr.

Advice for New Trainees #5: Never Lie. It’s not worth to tell what may seem like a small lie to cover up for something you forgot to check or do. Better to simply say, “I don’t know or I didn’t check. Let me find out and I’ll get back to you.” youtube.com/shorts/x6L6G... #EMIMCC

I’ll add to this, communicate when you want to be called. Don’t just start NE with a MAP goal>65, add, “call me if you get to X.” This prevents you getting busy and checking back to find that they’re almost maxed.

Anand Swaminathan@emswami.bsky.social · last yr.

Advice for New Trainees #3: Communicate If you want something done, not enough to just order it Best approach: put orders in, find nurse + discuss Gives nurse opportunity to share observations, clarify orders, catch errors + creates a shared mental model youtube.com/shorts/nLh20... #EMIMCC

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

Advice for New Trainees #2: Listen to your nurses Don’t mistake your short time as a doctor as equivalent clinically to their years and decades of experience If a nurse asks you to reevaluate a patient, GO TO THE BEDSIDE AND RE-EVALUTE THE PATIENT, EVERY TIME. youtube.com/shorts/c0o5F... #EMIMCC

Advice for Interns 2: Listen to The Nurses #emergencymedicine #internship #residents

YouTube video by EMSwami

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Might we be correcting hyponatremia too slowly? May our patients be suffering because we're too fearful of the risk of central pontine myelinolysis? Here's data that may challenge our regular approach. Hat tip to the authors. eddyjoemd.com/foamed

Interesting. Had never thought of this before. How many other things in medicine to we get wrong because if assumptions?

Lars Mølgaard Saxhaug@load-dependent.eurosky.social · last yr.

The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc

This is what we were waiting for. A direct comparison between apixaban and rivaroxaban for the treatment of acute VTE. Apixaban reduces bleeding risk in the first 3 months by >50%! Practice changing investigator-initiated RCT. #ISTH2025

New lesson in the POCUS course: Abdominal ultrasound! #medsky #emimcc #POCUS

Mottling is one of this signs that gets me real worried.

Eddy Joe Gutierrez@eddyjoemd.bsky.social · last yr.

When a patient presents with mottling among their constellation of signs, symptoms, and labs, there is a look that team members give each other that we've all seen. It's not a positive look. Here is some data reinforcing our intuition. 🎩 tip to the authors. eddyjoemd.com/foamed

beta-blocker in sepsis trials continue to mystify me you have patients on reasonable doses of pressor (0.5 mcg/kg/min norepi equivalent) with an average MAP ~80 (mean diastolic BP ~60!) you're worried about catecholamine toxicity instead of reducing the pressors you add a beta-blocker😳 #EMIMCC

Don’t be distracted by the obvious pleural yuck…

@IM_Crit_@imcrit.bsky.social · last yr.

ICU Snapshots: If you have a sharp eye, what is the worse finding here 👇?

My students know well of my disdain for the d-diner…

Will Preston@willpreston.bsky.social · last yr.

No, no. Wells is the scientist’s name, you’re referring to Wells’ monster. #emimcc

No, no. Wells is the scientist’s name, you’re referring to Wells’ monster. #emimcc

Anyone ever done peer review for Optum InterQual? I was approached about doing some reviews but not sure what to make of it. Sounds good, they send you material in your area of expertise and you review it for accuracy. I’ve done similar work before but never heard of this particular company.

Carolina Maciel on critical care EEG icuscenarios.com/episode-86-e... #medsky #emimcc

Basilar artery occlusion accounts for ≈10% of nontraumatic causes of coma Unconscious without a good explanation? CT head WITH ANGIOGRAPHY is a must❗️ www.sciencedirect.com/science/arti... #EMIMCC

Systematic combined noncontrast CT–CT angiography in the management of unexplained nontraumatic coma

Nontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis.The aim of this prospectiv…

sciencedirect.com