One of the biggest areas in critical care echo is its role in haemodynamic phenotyping. This excellent talk from Prof Sam Orde highlights this. Join us in September in London at our course to learn more. The talk: lnkd.in/eUDCm5xe The course booking link: lnkd.in/e93iqdXd #echofirst #pocus

But Amgen keeps fighting for Avacopan Another ‘3rd party’ reanalysis suggests Avacopan might indeed be non-inferior but not superior www.medpagetoday.com/rheumatology...

New Avacopan Analysis Sent to FDA After Data Manipulation Allegations

Agency has been calling for the vasculitis drug to be pulled from the market since January

medpagetoday.com

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · last mo.

finally Health Canada wakes up recalls-rappels.canada.ca/en/alert-rec... Avacopan is dead -please stop using it, please stop anyone on it

Prone positioning improves oxygenation, reduces lung stress and strain, and lowers mortality when applied early for prolonged sessions in selected intubated patients with moderate-to-severe acute respiratory distress syndrome. zurl.co/ZjW6e

Drug-induced acute kidney injury has distinct recovery patterns, and normalization of serum creatinine may conceal persistent structural damage. zurl.co/g6xGO

Our latest blog is out: The Nothing-to-Lose Fallacy https://criticalcarereviews.com/2026/the-nothing-to-lose-fallacy

Critical illness changes antiseizure medication exposure, requiring tailored selection, dosing, and monitoring in intensive care. zurl.co/69LiK

Persistent tissue hypoperfusion combined with vasopressor dose improved risk stratification in early septic shock and identified a small subgroup with markedly increased 28-day mortality. zurl.co/Rkm1g

📝 JAMA Patient Page: #Cyclosporiasis is an infection of the small bowel caused by the #parasite Cyclospora cayetanensis, primarily acquired by ingesting #contaminated food or water—most often fresh produce with crevices, such as leafy #greens, #herbs, and #berries. 🔗 ja.ma/4b69SCM

A good death in intensive care "Increasingly, ICU is recognised not only as a place of rescue, but also as a place where compassion, dignity and comfort can be provided at the end of life." #AnSky #ICUSky #MedSky doi.org/10.1111/anae...

🆕 New REBEL EM Post Can #POCUS improve outcomes in shock resuscitation? ✅ ↓ Mortality ✅ ↓ Vasoactive days ✅ ↑ Lactate clearance 💥 Bedside ultrasound isn’t just diagnostic—it’s therapeutic. 🔗 https://loom.ly/083PigU 🧠 By Christopher Karnicki #FOAMed

13 years ago today, NASA's Cassini spacecraft captured this iconic view of Earth from Saturn's orbit 🪐 That tiny blue dot is us from nearly 900 million miles away!!

Vasoactive Management of Cardiogenic Shock in Severe Aortic Stenosis: A Phenotype-Based Approach CCR Journal Watch https://criticalcarereviews.com/latest-evidence/journal-watch

Unpopular ICU opinion: When a patient becomes apneic during a spontaneous breathing trial, we often declare that the patient failed the trial Maybe not. Maybe we failed the patient by stopping the trial too soon, before sedatives had worn off and the respiratory drive had a chance to return

Excellent read from @iwashyna.bsky.social voices.nejm.org/doi/full/10.... I still struggle with this, as a PGY29 #MedSky

🫀Norepi or Epi after Cardiac Arrest? 🤔Was there a lower rate of recurrent cardiac arrest when using one over the other? 📚This meta-analysis & systematic review sought to answer that! 👀Check out the full post by Drs. Elizabeth Smith & Dorian Alexander from UTHealth Houston (@uthoustonemres)

Septic shock extends beyond vasoplegia to involve microcirculatory, metabolic, endocrine, myocardial and neural disturbances that shape its presentation and response to treatment. zurl.co/X1mMh

🥇What does performance under pressure in medicine look like? 🏃🏽‍♂️‍➡️What if we had the same tools as professional sports teams and elite athletes? 🧠 We've partnered with Arena Labs for data driven insights! 👀https://loom.ly/YvLC3F8 @Arena_Labs @MRamzyDO @Marco_propersi @EMSwami

Today's Paper of the Day is: Modulation of the Vasopressin System in Distributive and Cardiogenic Shock: Principles and Practical Applications criticalcarereviews.com/latest-evide... Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026

“The question is, are we happy to suppose that our grandchildren may never be able to see an elephant except in a picture book?” — David Attenborough

Spaces are filling up fast for this! Don’t miss out-outstanding faculty including: Prof Michel Slama Prof Sam Orde Prof Andre Denault Felipe Teran Hazem Lashin Alexa Bond All true experts in critical care ultrasound. VEXUS and reporting masterclasses included!

Segun Olusanya (He/Him)@drfreeze.bsky.social · 4mo ago

Bookings are now open for the 4th edition of the Barts/Nepean Advanced Critical Care Echo course with outstanding local/international faculty Covering material for advanced critical care echo, including content for BSE ACCE/EDEC/DDU/NBE examinations Book here! events.humanitix.com/bartsheart2026

Check our ADVOCATE discussion - we have done a couple of updates over time www.nephjc.com/news/advocate

Advocating for Patients with Vasculitis: A Steroid-Sparing Regimen with Avacopan — NephJC

This week, we will discuss the ADVOCATE trial. Avacopan is not just a flash in the pan? We hope so, having won the RheumMadness and offering a steroid free hope.

nephjc.com

And @nejm.org retracts ADVOCATE based on the FDA uncovering and 2 academic authors asking for article to be pulled. (Good on them!) www.nejm.org/doi/10.1056/... h/t @drjmluther.bsky.social #Avacopan #vasculitis

Retraction: Jayne DRW et al. Avacopan for the Treatment of ANCA-Associated Vasculitis, N Engl J Med 2021;384:599-609. | NEJM

The two academic authors of the article by Jayne et al., Avacopan for the Treatment of ANCA-Associated Vasculitis, N Engl J Med 2021;384:599-609,1 request retraction of the article because, accordi...

nejm.org

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · 2mo ago

With link this time www.medscape.com/viewarticle/...

“If mankind were to disappear, the world would regenerate back to the rich state of equilibrium that existed ten thousand years ago. If insects were to vanish, the environment would collapse into chaos.” — E.O. Wilson

Boom The European Medical Agency @ema.europa.eu pulls the approval for Tavneos aka Avacopan over trial shenanigans #Vasculitis cc @kidneyboy.bsky.social @brycebarr.bsky.social

Swapnil Hiremath 🍁🇨🇦@hswapnil.medsky.social · 4mo ago

more h/t @nephcrit.bsky.social www.fda.gov/drugs/drug-a... accusations of selectively re-adjudicating with an intent to p-hack #Avacopan #Tavneos

With link this time www.medscape.com/viewarticle/...

New Data Lead to Decision to Revoke Autoimmune Disease Drug

The EMA says the benefits of Tavneos no longer outweigh the risks for the treatment of active granulomatosis with polyangiitis.

medscape.com

Drowning prevention starts with you. Here are some water safety rules. ⬇️

Systemic vascular resistance is not a realiable measure of left ventriclar afterload. In this study, noradrenaline actually decreased left ventricular wall stress even though SVR increased. Higher heart rate and contractility leads to a smaller LV, lower wall stress. #emimcc #cccsky #cardiosky

Systemic vascular resistance: an unreliable index of left ventricular afterload. | Circulation

Systemic vascular resistance (SVR) is a frequently used clinical index of left ventricular afterload. However, SVR may not adequately assess left ventricular afterload (i.e., ventricular internal fibe...

ahajournals.org

Schrodinger's arrhythmia: atrial fibrillation/flutter (A. Fib/flutter)

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

youtube.com