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Simone Gherardi

@drghem.bsky.social

EM doc based in Italy. Here for FOAMed and EM&CC community "Zebras are not unicorns" #FOAMed #Meu #EMIMCC

77 Posts50 Follower86 Folgt
Simone Gherardi@drghem.bsky.social · 2mo ago

Doesn't seem like the population in which many bicarb lover or anyone would think about giving it in cardiac arrest (after the first dose of pressor). Even if I understand why the authors decided to give it early here, the trial doesn't adress properly the issue of bicard during arrest #EMIMCC

JAMA@jama.com · 2mo ago

📊 Research Summary: Sodium bicarbonate did not improve sustained return of spontaneous circulation or survival in adults with in-hospital cardiac arrest, supporting guidelines against its routine use. #CCR26 @criticalcarereviews.com ja.ma/43stWv0

JAMA Research Summary on Sodium Bicarbonate for In-Hospital Cardiac Arrest. A visual shows icons of a patient with a heart, a syringe, and vials. A clinical trial on 913 adults (median 73) found no significant improvement in sustained spontaneous circulation (39% with bicarb vs 37% with placebo) or survival outcomes.
josh farkas 💊@pulmcrit.bsky.social · 8mo ago

first: combination inhaled epo + nitric simultaneously (I know its expensive, put it on my tab) epi gtt for MAP > 85 to improve cardiovascular reserve if the clot flies off then: 50 mg tPA (very little data on IR for clot in transit)

Justin Morgenstern @first10em.bsky.social · 8mo ago

Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2) #FOAMed

Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2)

As far as I can tell, despite talking about the paper widely at conferences, I never included a write up of the original ANDROMEDA-SHOCK trial on First10EM. (Hernández 2019) (There is a massive file of all the topics I want to cover, and would cover if this was a job rather than a hobby. I assume it just got lost in there.) As a reminder, that trial showed that clinical management of septic shock patients based on capillary refill time was not statistically different from management guided by trending lactates, although there was some optimism because the point estimate for all cause mortality was actually 9% better.

first10em.com

josh farkas 💊@pulmcrit.bsky.social · 9mo ago

PPS - Bottom line is that if your critically unwell patient needs a CT scan you should just get the scan - Contrast-induced nephropathy is a myth emcrit.org/ibcc/contrast/ - Contrast allergy now just requires a dose of antihistamine - Radiation risks are minimal (especially for older adults)

kermit the frog is wearing a black hoodie and kermit the frog is wearing a black hood .

ALT: kermit the frog is wearing a black hoodie and kermit the frog is wearing a black hood .

media.tenor.com

josh farkas 💊@pulmcrit.bsky.social · 9mo ago

DBP and pulse pressure are somewhat redundant. I added pulse pressure but they will generally trend in opposite directions provided the MAP is held in a somewhat fixed position around 70mm I guess the evaluation of congestion is kinda assumed... also I wanted to de-emphasize the whole fluids thing

@IM_Crit_@imcrit.bsky.social · 9mo ago

ICU Snapshots: Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU

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@IM_Crit_@imcrit.bsky.social · 11mo ago

ICU Practice - Return to Basics: When you prepare for the "average" intubation (no cardiac arrest, no active emesis), how do you pre-oxygenate the patient? Oxygen mask/nasal cannula? Non-invasive ventilation?

Simone Gherardi@drghem.bsky.social · last yr.

Those "softer" skills usually given for granted or misunderstood, "you have or you dont". In many place where I've trained or worked one spokes about leading as an abstraction and something you don't create or striving for #EMIMCC @emcases.bsky.social emergencymedicinecases.com/leadership-e...

Leading: Building Teams, Trust and Purpose in Emergency Medicine

Dr. Thom Mayer, Dr. Carolyn Snider, Dr. Howard Ovens, Dr. Anton Helman discuss: Leading is about action, not designation. We are all leaders. Being consistent, kind, and honest. How vulnerability is p...

emergencymedicinecases.com

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

It's entirely possible that bronchodilation is due to the anticholinergic and ketamine isn't doing anything. Regardless, I've used this combination (high dose ketamine + IV scheduled glycopyrrolate) and like the study shows it seems to work well. Pending further data this seems reasonable.🤷‍♂️

Simone Gherardi@drghem.bsky.social · last yr.

Mmmmm love ketamine but always I ve always been skeptical on super powerfull bronchodilatatory properties #EMIMCC

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

for an intubated asthmatic whose bronchospasm won't break: high-dose ketamine is good, but it should be given with an anticholinergic. why give glycopyrrolate? 🤤reduces secretions from ketamine 👊it causes bronchodilation! so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC