What is something in your consult/progress note that someone else would almost immediately recognize as being only from you? I'll start: -"Avoid avoidable nephrotoxins" -"low threshold for methylene blue" An RN pointed out some of my note quirks and it made me curious. #emimcc #medsky #icusky

Circa 2020. Just intern me learning real quick what kind of EM-ICU doc I would someday become.

Thanh Neville, MD, MSHS@thanh-neville.bsky.social · 2w ago

I agree with @drsandman11.medsky.social: If you didn't look like this & doing everything you can to prevent people from dying during the pandemic, maybe think twice before judging Dr. Fauci.

My daughter just texted me about my new (and 1st) @nejm.org #Voices column: ‘From my pre med friend: “it’s things like that, that make me rly excited to go into this profession”’ And I am going to be smiling all day I would love your thoughts voices.nejm.org/doi/full/10....

Why I Choose the Hospital in July

House staff have a lot to learn, and July is a great time to teach them.

voices.nejm.org

The Paramedic Academic is now live. A new space for evidence-informed commentary on #paramedicine, emergency systems, regional #health and equity. The Paramedic Academic promises to provide less jargon, no paywalls and the occasional strong opinion. www.paramedic-academic.com

An absolute gem of a video for first year residents, early trainees and even seasoned docs with some potentially bad habits.

CriticalCareNow@criticalcarenow.bsky.social · last mo.

The best consults I've received all have one thing in common: clarity. Three communication habits that have served me well in both the emergency department and the ICU: Don't apologize for calling. Be courteous, but remember the consult exists because the patient needs expertise. Lead with the cl

Having had a few cases like this recently. Dutiful vent management and interventions like APRV can be immensely satisfying.

@IM_Crit_@imcrit.bsky.social · 12mo ago

ICU Snapshots: 60 yo pt, multiple medical problems (including morbid obesity; BMI 50), admitted to the ICU w ARDS in setting of sepsis. Intubated 08/14 (with 👇CXR), improved w VC-CMVs the next day but the same night became very hypoxic, had to be placed on FiO2 100% / PEEP 12

Proud to share the published results of an international collaboration assessing the outcomes of various ED-ICU care models. (I read 2000 abstracts so you didn't have to) 📉Lower ICU admission rate 📉Shorter hospital LOS (0.5d) 📈Longer ICU LOS (0.5d) 🙅No difference 28d mortality rdcu.be/fqNAI #EMIMCC

It's a bit fun when your workplace abilities to switch day/night shifts become a Spanish vacation super power -- easily taking on the Ibiza nightclubs till the early hours. Jet lag? Never heard of it. Sleeping during the day? Ez-pz. "Unhealthy" amounts of caffeine? Seems homeostatic to me.

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

Sorry, I am extremely skeptical that the language model underlying OpenEvidence is trained on an exclusively biomedical corpus – all the available evidence suggests it is RAG on a third-party foundation model.

Steven Ilko 🏥 🚁💨@zentensivistilko.bsky.social · 2mo ago

If we can't get studies to answer even "basic questions" (like ICU fluids). No way can an LLM use subsets of the lit to answer more complex questions. TL;DR- OpenEvidence is pitching itself to healthcare organizations and physicians as the answer to thinking. #emimcc www.nytimes.com/2026/06/08/b...

If we can't get studies to answer even "basic questions" (like ICU fluids). No way can an LLM use subsets of the lit to answer more complex questions. TL;DR- OpenEvidence is pitching itself to healthcare organizations and physicians as the answer to thinking. #emimcc www.nytimes.com/2026/06/08/b...

Have a Thorny Medical Question? Your Doctor May Be Using A.I. for That.

nytimes.com

OG Coca-Cola is effectively human draino and you won't be able to convince me otherwise at this point. #emimcc #medsky Anyone else have a favorite case report so far this year? www.cureus.com/articles/424...

Massive Fecaloma Dissolved by Coca-Cola: A Case Report

Fecalomas are hardened masses of fecal material that are a rare complication of chronic constipation and require surgical resection when conservative measures fail. Recent reports suggest that Coca-Co...

cureus.com

Anyone have any experience with medetomidine withdrawal, and spotting it from fentanyl withdrawal? I am thinking about it in a guy with maybe the worst opioid withdrawal I've ever seen. Otherworldly severe. #emimcc

Donald Trump promised the war in Iran would end with unconditional surrender. But he never said which country would do the surrendering.

That's the power of PEEP! Excellent proof of concept.

British Journal of Anaesthesia@bjajournals.bsky.social · 3mo ago

Flexible #bronchoscopy is the gold standard for tracheal #intubation in patients with difficult airways but sedation and GA frequently cause upper airway obstruction. High-flow nasal oxygenation can improve glottic view. https://www.bjanaesthesia.org/article/S0007-0912(24)00577-4/fulltext

Over on LinkedIn, Dr Jorge Salluh shared a very thoughtful post on how his journal, Crit Care Science, thinks about single center studies I’m sharing it here:

If I have a spill in my kitchen. And you provide me with 5 different ways to categorize and stratify my spill. But then tell me I'm to use my own judgement on how I clean it. You've done nothing. You've created a distinction without a difference. Waste of time, energy and money.

JAMA@jama.com · 3mo ago

Med News: A new framework for defining and diagnosing #obesity has sparked debate among experts. Find out more about how it could affect patient care:

A trial is negative because the wrong patients were included (even after half a dozen of negative trials). Results of positive trials can always be extended to the whole population

For anyone paying attention... Of course this is the solution. The tech is sold to admin as a way to allow me to see more patients in less time. Not for my wellness, nor the benefit of the patient. But for higher productivity. Their $$ benefit. My liability. Checks out.

brookswalsh@brookswalsh.bsky.social · 3mo ago

Problem: Medical AI scribe hallucinates Solution: Attestation turns these into *physician* errors. "The auditor recommended that the province implement IT controls in the systems to enforce an attestation from doctors, to confirm they reviewed the notes." www.cbc.ca/news/canada/...

EM workrooms are just neurodivergent people trading medical stories to relate to each other.

More poorly designed "AI Trials" with even worse reporting. The frequency with which ppl are using AI to alter care/decision making is rising. AI queries can be a helpful part of the conversation to generate questions... But I'm seeing cases of people using AI as the sole mode of decision making.

brookswalsh@brookswalsh.bsky.social · 3mo ago

As Dr @kmpanthagani.bsky.social points out, the AI did not obtain the history. It used the history obtained by the ER doc. And getting that history is the *highest*-level cognitive task ER doctors perform. youcanknowthings.substack.com/p/did-ai-rea...

Anyone else using music as an anxiolytic for patients either on the vent or for "routine procedure" (excluding low frequency high risk, and procedures while in extremis) #emimcc #icusky #emsky Did dissociated laryngoscopy and intubation and it seemed to keep the room and the patient cool 😎

Interested in the major trials in critical care? We have summarised and critiqued 250 of the most important randomised controlled trials stretching back over the past 25 years. https://criticalcarereviews.com/collections/foundational-trials

ACS (but not the kind I usually worry about now I'm in the micu more) is a serious and sometimes delayed/missed diagnosis. Know about it. Have a plan.

CriticalCareNow@criticalcarenow.bsky.social · 4mo ago

Suspected abdominal compartment syndrome. You're at the bedside — do you optimize sedation and start continuous NMB before calling surgery? What does that checklist actually look like in your unit? Comment and share your approach.

Also, AI can't pass medical exams.

David Harvey@topladave.bsky.social · 5mo ago

AI can pass medical exams, but still fail real patients. www.sciencealert.com/ai-chatbots-...

Man in his 60s presented w/ syncope and bilateral knee soreness. No swelling, nor SOB. Progressive hypoxia, diaphoresis and hypotension. Eventually intubated but DNR. Get the admission call for "ACS- new RBBB, elevated trop in shock". Performed POCUS and CT-Angio. Worst RV failure I've ever seen.

Another study showing how we treat women differently. More research is needed to find causes and direct our efforts towards more equitable care. We still have work to do.

EMA Journal@emajournal.bsky.social · 4mo ago

Differences in time to analgesia based on biological sex for patients with abdominal pain #OpenAccess doi.org/10.1111/1742... @wileyhealth.bsky.social #MedSky #EMSky #EMedSky #emimcc #ACEM

Was on call for a small hospital. Finished work for the morning, went home and then to the gym to swim/rehab. Did not keep an extra set of scrubs in the car, so had to go in as is. RN got me a pair of scrub bottoms. Anyone else have fun "just got called into work from doing something else" story?

Stop waiting, start liberating By identifying candidates with reversed insults and successful SBTs, we can bypass the ICU bottleneck safely. It’s the next logical step for Emergency Medicine. Comment to discuss.

Assessment of Congestion in Heart Failure Using VExUS: Current Evidence, Limitations and Clinical Perspectives CCR Journal Watch https://criticalcarereviews.com/latest-evidence/journal-watch