Profile avatar
pulmcrit.bsky.social
pulm/crit attending at U. Vermont 🐄 zentensivist 🧘‍♂️ FOAMite 🌊 diuresis jedi 💦 ECG nerd 🤓 resuscitationist 💉 no COI 💰
791 posts 7,276 followers 303 following
Regular Contributor
Active Commenter
Posts 24 Comments 26

It means the era for following medical congress on Twitter is likely over. If you want to see the full picture you need to be watching Bluesky www.linkedin.com/pulse/platfo...

submitted 1 hour ago • 1 comment

Assessing fluid responsiveness in spontaneously breathing MV patients is tough, so this work on SIGH35 by Messina et al. is really 👌 ▪️ Apply a 35cm H20 ‘sigh breath’ for 4 secs and measure the change in pulse pressure from baseline to nadir Simples. 1/ ccforum.biomedcentral.com/articles/10....

submitted 1 day ago • 1 comment

I was skeptical about percutaneous mechanical aspiration for tricuspid valve endocarditis, but it apparently can work. Look at this picture of a vegetation that was fished out of a patient I was involved with. Only after removal was he able to achieve negative blood cultures.👇 #EMIMCC

submitted 12 hours ago • 10 comments

I'm updating the IBCC chapter on opioid use disorder. Any pearls/pitfalls or recent review articles? Would be especially interested to hear about methadone initiation & management of fentanyl-xylazine withdrawal 🙏

submitted 1 day ago • 0 comments

nocturnal alpha-2 agonists FTW 🥳 the MENDING RCT shows benefit from PO guanfacine 2 mg QHS in delirium (unpublished, data online here https://clinicaltrials.gov/study/NCT04742673?cond=delirium&term=guanfacine&rank=2&tab=results) logistically an oral medication seems more feasible #EMIMCC

submitted 1 day ago • 1 comment

PO meds are so hot right now (PO=IV) but in critically ill patients (esp with enteral feeding tubes), the pharmacology gets tricky & data is often scant when the patient starts vomiting... do we redose everything? IMHO the default route for live-saving meds in ICU should still be IV #EMIMCC

submitted 2 days ago • 3 comments

Agree with all of these. Thankfully @apccmpd.bsky.social and @accpchest.bsky.social have established footholds here.

submitted 2 days ago • 0 comments

I think it is evident that we have already brought the conversation to BlueSky! In an environment plagued by scientific misinformation, do medical organisations/journals have a moral imperative to remain, to provide a source of truth & reason? Or should they just.. leave? Let's discuss. #AnSky

submitted 3 days ago • 5 comments

🆕🔥Updated systematic review & meta-analysis (+REMAP CAP) 30 RCTs,N=7519 Corticosteroids probably 🔽 short-term mortality 🔽the need for invasive mechanical ventilation & likely 🔽duration of ICU stay in adult pts hospitalised with non viral CAP #idsky #EMIMCC link.springer.com/article/10.1...

submitted 2 days ago • 1 comment

#Breakpoints and #Communicable pods join forces to unpack oh, only the BIGGEST Staph aureus trial in history, with the principal investigators... 🍇 📖 📊 🤓 It's big, its practice-changing, and its available now wherever you get your podcasts 😉 @sidpharm.bsky.social @cmicomms.bsky.social #IDsky

submitted 3 days ago • 1 comment

ICU Small Bowel Obstruction (SBO) Refresher: If you don't manage patients with SBO, this brief post is not for you. The risk of SBO is highest following colorectal, oncologic gynecological, or pediatric surgery. I see 1-2 SBO cases per month & recently reviewed the literature:

submitted 3 days ago • 1 comment

giving FFP to a patient with cirrhosis will make the INR look better but is unlikely to actually help the patient clot. INR reflects clinical coagulation for patients on warfarin, but not in cirrhosis/DIC. (https://emcrit.org/ibcc/cirrhosis/#coagulation_management_in_cirrhosis:_active_hemorrhage)

submitted 4 days ago • 2 comments

bucket list: write a one word note. “heparin” nothing more. I probably need to be more a more senior attending before I can get away with this.

submitted 4 days ago • 10 comments

Pharmacists- any book recommendations for textbooks on ICU/hospital pharmacology? I’m finishing up Critical Care Pharmacotherapy 2e by Erstad and it’s a banger, but I’d like to read a couple more books if more good ones are out there?

submitted 6 days ago • 2 comments

cutting medicaid would be harmful for EVERYONE some hospitals & clinics would close lack of preventative care would cause unnecessary emergencies, worsening ED congestion surviving hospitals would be forced to cut services people are selfish so we need to explain how these cuts hurt EVERYONE

submitted 6 days ago • 0 comments

1/ Hi 👋 #medtwitter #neurotwitter #neurocritcare #FOAMed #meded today, as your #SoMeAmbassador for @neurocritcarej we will be breaking down an oldie but goodie @neurocriticalcarej paper! link.springer.com/ar... Jump to 11/ for info on the paper

submitted 7 days ago • 1 comment

Knee dislocation high risk for popliteal injuries -Always do full vascular assessment post-reduction -ABI < 1.0 = CTA -Some dislocations reduce spont. If suspicious story/extensive swelling, do full vascular assessment youtube.com/shorts/2Z9wT... #EMIMCC #MedSky

submitted 7 days ago • 0 comments

what steroid is the fairest of them all? for PNA/sepsis, hydrocortisone might be the best (least CNS penetration, so least deleriogenic 🤡) mineralocorticoid activity may cause fluid retention & hypoK, but it's easy to follow lytes & diurese as needed discussion: emcrit.org/ibcc/adrenal... #EMIMCC

submitted 8 days ago • 1 comment

I'm expanding & updating the pharmacology section of the IBCC any drugs or pharmacology-related issues you would like to see explored in greater depth? 💊

submitted 9 days ago • 1 comment

What Rhea says! Repost or quote repost to expand our community #AnSky #MedSky

submitted 10 days ago • 1 comment

ABG can largely be replaced by VBG pH: VBG ~ 0.03 units lower than ABG PCO2: VBG 6-10 mm Hg higher than ABG HCO3: VBG 1-2 mmol lower than ABG Under most circumstances, these differences won’t affect management making ABG unnecessary youtube.com/shorts/zGfQ7... #EMIMCC #MedSky

submitted 10 days ago • 3 comments

MidaKet for procedural sedation 😁 This is my go-to strategy for procedural sedation in sick, non-intubated patients. Start with a mildly obtunding dose of midazolam, then add a moderate dose of ketamine. Results in dissociative anesthesia & good resp/cardiovascular stability. 🧵 1/6 #EMIMCC

submitted 10 days ago • 2 comments

So a clip with me on Last Week Tonight with John Oliver talking about indirect costs

submitted 10 days ago • 10 comments

Does dexmedetomidine help prevent delirium in patients who have undergone cardiac surgery? This meta-analysis says it does. 🎩 tip to the authors. eddyjoemd.com/foamed

submitted 11 days ago • 0 comments