Daniel McClellan
@sunglassesdo.bsky.social
Intensivist in California, boarded in EM and CC. Doing primarily academic CTICU and community mixed ICU.
Reposted by Daniel McClellan
glad to see validation for using balanced crystalloid in DKA >10 years after I started pushing this (emcrit.org/pulmcrit/fou...)
But balanced crystalloid in DKA is so passe now
The next frontier is using KAcetate & KCitrate to avoid NAGMA
c'mon... let's get that published by 2035 😁
#EMIMCC
But balanced crystalloid in DKA is so passe now
The next frontier is using KAcetate & KCitrate to avoid NAGMA
c'mon... let's get that published by 2035 😁
#EMIMCC
Are you using 0.9% NaCl or balanced salt solutions such as Lactated Ringer's or Plasmalyte to resuscitate your patients with DKA? This paper suggests that we should be using the latter. 🎩 tip to the authors.
eddyjoemd.com/foamed
eddyjoemd.com/foamed
August 21, 2025 at 11:10 AM
glad to see validation for using balanced crystalloid in DKA >10 years after I started pushing this (emcrit.org/pulmcrit/fou...)
But balanced crystalloid in DKA is so passe now
The next frontier is using KAcetate & KCitrate to avoid NAGMA
c'mon... let's get that published by 2035 😁
#EMIMCC
But balanced crystalloid in DKA is so passe now
The next frontier is using KAcetate & KCitrate to avoid NAGMA
c'mon... let's get that published by 2035 😁
#EMIMCC
Reposted by Daniel McClellan
Very interesting physiological study of the hemodynamic effect of nitroprusside infusion in HFpEF vs HFrEF. I think this is equally relevant both for the interaction with EF seen with most heart failure therapies, as in the disparate effects seen with IABP in cardiogenic shock 🧵 #cardiosky #emimcc
Effects of Vasodilation in Heart Failure With Preserved or Reduced Ejection Fraction: Implications of Distinct Pathophysiologies on Response to Therapy
The purpose of this study was to compare hemodynamic responses to vasodilator therapy in patients with heart failure (HF) and preserved ejection fract…
www.sciencedirect.com
July 16, 2025 at 8:27 PM
Very interesting physiological study of the hemodynamic effect of nitroprusside infusion in HFpEF vs HFrEF. I think this is equally relevant both for the interaction with EF seen with most heart failure therapies, as in the disparate effects seen with IABP in cardiogenic shock 🧵 #cardiosky #emimcc
Reposted by Daniel McClellan
Cascade reporting involves the lab only reporting the most narrow-spectrum antibiotics that a pathogen is sensitive to (and intentionally HIDING the results for broader spectrum agents)
It's designed to push us towards choosing narrower antibiotics but it's a disaster... rantorial #1/7 #EMIMCC
It's designed to push us towards choosing narrower antibiotics but it's a disaster... rantorial #1/7 #EMIMCC
June 18, 2025 at 7:39 PM
Cascade reporting involves the lab only reporting the most narrow-spectrum antibiotics that a pathogen is sensitive to (and intentionally HIDING the results for broader spectrum agents)
It's designed to push us towards choosing narrower antibiotics but it's a disaster... rantorial #1/7 #EMIMCC
It's designed to push us towards choosing narrower antibiotics but it's a disaster... rantorial #1/7 #EMIMCC
Reposted by Daniel McClellan
If you induce someone w/ etomidate & rocuronium alone, unless you get another sedative on board SUPER fast the etomidate wears off and the patient will be intubated without sedation
Inhumane, ? causes PTSD
Use ketamine
During the K shortage I used a combo of roc/etomidate/midaz/fentanyl
#EMIMCC
Inhumane, ? causes PTSD
Use ketamine
During the K shortage I used a combo of roc/etomidate/midaz/fentanyl
#EMIMCC
June 17, 2025 at 2:09 AM
If you induce someone w/ etomidate & rocuronium alone, unless you get another sedative on board SUPER fast the etomidate wears off and the patient will be intubated without sedation
Inhumane, ? causes PTSD
Use ketamine
During the K shortage I used a combo of roc/etomidate/midaz/fentanyl
#EMIMCC
Inhumane, ? causes PTSD
Use ketamine
During the K shortage I used a combo of roc/etomidate/midaz/fentanyl
#EMIMCC
Reposted by Daniel McClellan
ZODIAC trial: For ischemic stroke patients who are awaiting thrombectomy, flat positioning reduced the risk of neuroworsening or death
Premature termination but seems reasonable
Statistically robust results
Best available evidence; should change practice
pubmed.ncbi.nlm.nih.gov/40465238/ #EMIMCC
Premature termination but seems reasonable
Statistically robust results
Best available evidence; should change practice
pubmed.ncbi.nlm.nih.gov/40465238/ #EMIMCC
June 9, 2025 at 4:33 PM
ZODIAC trial: For ischemic stroke patients who are awaiting thrombectomy, flat positioning reduced the risk of neuroworsening or death
Premature termination but seems reasonable
Statistically robust results
Best available evidence; should change practice
pubmed.ncbi.nlm.nih.gov/40465238/ #EMIMCC
Premature termination but seems reasonable
Statistically robust results
Best available evidence; should change practice
pubmed.ncbi.nlm.nih.gov/40465238/ #EMIMCC
Reposted by Daniel McClellan
Fresh OPTPRESS MC-RCT shows increased mortality from targeting MAP 80-85 in septic shock vs. MAP 65-70
Protocol used early vasopressin on top of NE
Be careful of blindly protocoled vaso+NE combo
Both are potent vasoconstrictors. They can incr MAP while causing harm
link: zurl.co/SEeIz #EMIMCC
Protocol used early vasopressin on top of NE
Be careful of blindly protocoled vaso+NE combo
Both are potent vasoconstrictors. They can incr MAP while causing harm
link: zurl.co/SEeIz #EMIMCC
May 30, 2025 at 12:06 PM
Fresh OPTPRESS MC-RCT shows increased mortality from targeting MAP 80-85 in septic shock vs. MAP 65-70
Protocol used early vasopressin on top of NE
Be careful of blindly protocoled vaso+NE combo
Both are potent vasoconstrictors. They can incr MAP while causing harm
link: zurl.co/SEeIz #EMIMCC
Protocol used early vasopressin on top of NE
Be careful of blindly protocoled vaso+NE combo
Both are potent vasoconstrictors. They can incr MAP while causing harm
link: zurl.co/SEeIz #EMIMCC
Reposted by Daniel McClellan
⚡️Procainamide vs Amiodarone for Stable V-Tach?
💥Still a hot debate 🔄
Check out the full breakdown of the PROCAMIO Trial:
👉 t.co/4bDc2ETjxv
Don’t miss the REBEL Review OnePager! 📄✅
💙 Like | 🔁 Repost | ➕Follow
#FOAMed #medsky
@emswami.bsky.social @marco-propersi.bsky.social @mramzydo.bsky.social
💥Still a hot debate 🔄
Check out the full breakdown of the PROCAMIO Trial:
👉 t.co/4bDc2ETjxv
Don’t miss the REBEL Review OnePager! 📄✅
💙 Like | 🔁 Repost | ➕Follow
#FOAMed #medsky
@emswami.bsky.social @marco-propersi.bsky.social @mramzydo.bsky.social
April 24, 2025 at 7:21 PM
⚡️Procainamide vs Amiodarone for Stable V-Tach?
💥Still a hot debate 🔄
Check out the full breakdown of the PROCAMIO Trial:
👉 t.co/4bDc2ETjxv
Don’t miss the REBEL Review OnePager! 📄✅
💙 Like | 🔁 Repost | ➕Follow
#FOAMed #medsky
@emswami.bsky.social @marco-propersi.bsky.social @mramzydo.bsky.social
💥Still a hot debate 🔄
Check out the full breakdown of the PROCAMIO Trial:
👉 t.co/4bDc2ETjxv
Don’t miss the REBEL Review OnePager! 📄✅
💙 Like | 🔁 Repost | ➕Follow
#FOAMed #medsky
@emswami.bsky.social @marco-propersi.bsky.social @mramzydo.bsky.social
Reposted by Daniel McClellan
More patients who received the Watchman 2.5 device compared with the Amulet occluder device for left atrial appendage occlusion experienced high-risk device-related thrombi, according to a study published in #JACCCEP.
Read more: bit.ly/4idcC1O
#cvEP #CardioSky #MedSky @jaccjournals.bsky.social
Read more: bit.ly/4idcC1O
#cvEP #CardioSky #MedSky @jaccjournals.bsky.social
April 14, 2025 at 8:15 PM
More patients who received the Watchman 2.5 device compared with the Amulet occluder device for left atrial appendage occlusion experienced high-risk device-related thrombi, according to a study published in #JACCCEP.
Read more: bit.ly/4idcC1O
#cvEP #CardioSky #MedSky @jaccjournals.bsky.social
Read more: bit.ly/4idcC1O
#cvEP #CardioSky #MedSky @jaccjournals.bsky.social
Reposted by Daniel McClellan
Is the Renal Protective Effect of Montelukast on Vancomycin due to its Anti-allergic Mechanism?
✅ Just Accepted
#IDSky
✅ Just Accepted
#IDSky
Is the Renal Protective Effect of Montelukast on Vancomycin due to its Anti-allergic Mechanism?
Research has shown that montelukast (a leukotriene receptor antagonist) can alleviate vancomycin associated acute kidney injury (AKI).
doi.org
April 11, 2025 at 2:44 PM
Is the Renal Protective Effect of Montelukast on Vancomycin due to its Anti-allergic Mechanism?
✅ Just Accepted
#IDSky
✅ Just Accepted
#IDSky
Reposted by Daniel McClellan
Let's talk about using carbapenem antibiotics in patients with valproic acid (VPA) poisoning
/1🧵
/1🧵
April 10, 2025 at 6:50 PM
Let's talk about using carbapenem antibiotics in patients with valproic acid (VPA) poisoning
/1🧵
/1🧵
Reposted by Daniel McClellan
is contrast nephropathy in the room with us right now?
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
April 10, 2025 at 11:46 PM
is contrast nephropathy in the room with us right now?
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
another article showing that contrast nephropathy isn’t a thing
I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️
https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC
For those of you who do stellate ganglion blocks for VT storm, how does your hospital handle privileges/credentialing for that procedure? Our admin is apparently unsure what proof of competency they should require.
#emimcc #cardiosky
#emimcc #cardiosky
March 30, 2025 at 10:16 PM
For those of you who do stellate ganglion blocks for VT storm, how does your hospital handle privileges/credentialing for that procedure? Our admin is apparently unsure what proof of competency they should require.
#emimcc #cardiosky
#emimcc #cardiosky
Reposted by Daniel McClellan
📣 New original research! 📣
Can delaying reperfusion to first unload the LV be cardioprotective after MI? This study tried to answer that question.
🔥 1st use of intra-aortic entrainment pumping🔥
📌LV unloading -> ⬇️28 day infarct size
🔗 bit.ly/3DmFBCd
Can delaying reperfusion to first unload the LV be cardioprotective after MI? This study tried to answer that question.
🔥 1st use of intra-aortic entrainment pumping🔥
📌LV unloading -> ⬇️28 day infarct size
🔗 bit.ly/3DmFBCd
March 21, 2025 at 6:57 PM
📣 New original research! 📣
Can delaying reperfusion to first unload the LV be cardioprotective after MI? This study tried to answer that question.
🔥 1st use of intra-aortic entrainment pumping🔥
📌LV unloading -> ⬇️28 day infarct size
🔗 bit.ly/3DmFBCd
Can delaying reperfusion to first unload the LV be cardioprotective after MI? This study tried to answer that question.
🔥 1st use of intra-aortic entrainment pumping🔥
📌LV unloading -> ⬇️28 day infarct size
🔗 bit.ly/3DmFBCd
Reposted by Daniel McClellan
Prof Xavier Monnet addresses the HD effects of prone positioning.
Great take homes about the risk of the waterfall effect and the use of Trendelenburg position in the prone patient to predict fluid responsiveness.
Linked paper below
#ISICEM25
#EMIMCC
ccforum.biomedcentral.com/articles/10....
Great take homes about the risk of the waterfall effect and the use of Trendelenburg position in the prone patient to predict fluid responsiveness.
Linked paper below
#ISICEM25
#EMIMCC
ccforum.biomedcentral.com/articles/10....
March 18, 2025 at 5:54 PM
Prof Xavier Monnet addresses the HD effects of prone positioning.
Great take homes about the risk of the waterfall effect and the use of Trendelenburg position in the prone patient to predict fluid responsiveness.
Linked paper below
#ISICEM25
#EMIMCC
ccforum.biomedcentral.com/articles/10....
Great take homes about the risk of the waterfall effect and the use of Trendelenburg position in the prone patient to predict fluid responsiveness.
Linked paper below
#ISICEM25
#EMIMCC
ccforum.biomedcentral.com/articles/10....
Reposted by Daniel McClellan
They're going to destroy the Department of Veterans Affairs, specifically the VA healthcare system. Firing this many employees will render it effectively unusable by increasing patient wait times to the point of uselessness.
VA plans to lay off as many as 83,000 employees this year
A leaked memo released Tuesday called for VA to slash its workforce to 2019 levels that were in place before millions of veterans became newly eligible for care.
www.govexec.com
March 5, 2025 at 3:18 PM
They're going to destroy the Department of Veterans Affairs, specifically the VA healthcare system. Firing this many employees will render it effectively unusable by increasing patient wait times to the point of uselessness.
Reposted by Daniel McClellan
Our old friend @zentensivist.bsky.social gives us a masterclass in the advanced tricks of PA catheter placement icuscenarios.com/lightning-ro...
#medsky #emimcc
#medsky #emimcc
Lightning rounds 50: Mastering PA catheter placement with Matt Siuba – Critical Care Scenarios
icuscenarios.com
March 5, 2025 at 2:59 PM
Our old friend @zentensivist.bsky.social gives us a masterclass in the advanced tricks of PA catheter placement icuscenarios.com/lightning-ro...
#medsky #emimcc
#medsky #emimcc
Reposted by Daniel McClellan
Just so you know, up to 60,000 children go blind from measles every year
March 4, 2025 at 6:42 PM
Just so you know, up to 60,000 children go blind from measles every year
Reposted by Daniel McClellan
EMCrit 395 - Stellate Ganglion Block - Not Whether, but When? Refractory V.Fib and Electrical Storm--Here is a vital technique to have in your arsenal. A discussion with @POCUSaurusRex.
[#FOAMed for a bit]
emcrit.org/395
[#FOAMed for a bit]
emcrit.org/395
February 23, 2025 at 11:43 PM
EMCrit 395 - Stellate Ganglion Block - Not Whether, but When? Refractory V.Fib and Electrical Storm--Here is a vital technique to have in your arsenal. A discussion with @POCUSaurusRex.
[#FOAMed for a bit]
emcrit.org/395
[#FOAMed for a bit]
emcrit.org/395
Reposted by Daniel McClellan
For all my ECG nerds friends:
What to consider when you see one or more PVCs:
medicusofhouston.com
NEVER a tariff on MY classes!
#ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM
What to consider when you see one or more PVCs:
medicusofhouston.com
NEVER a tariff on MY classes!
#ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM
February 14, 2025 at 10:43 PM
For all my ECG nerds friends:
What to consider when you see one or more PVCs:
medicusofhouston.com
NEVER a tariff on MY classes!
#ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM
What to consider when you see one or more PVCs:
medicusofhouston.com
NEVER a tariff on MY classes!
#ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM
Reposted by Daniel McClellan
California Department of Water Resources Statement.
January 28, 2025 at 6:47 AM
California Department of Water Resources Statement.
Reposted by Daniel McClellan
Trump is attempting to unilaterally freeze trillions of dollars in federal spending that’s been duly appropriated by Congress. This is completely insane and illegal. He’s seizing unlawful control over the constitutional spending power? Five alarm fire www.washingtonpost.com/business/202...
White House pauses all federal grants, sparking confusion
The Trump administration has put a hold on all federal financial grants and loans, affecting tens of billions of dollars in payments.
www.washingtonpost.com
January 28, 2025 at 3:25 AM
Trump is attempting to unilaterally freeze trillions of dollars in federal spending that’s been duly appropriated by Congress. This is completely insane and illegal. He’s seizing unlawful control over the constitutional spending power? Five alarm fire www.washingtonpost.com/business/202...
These concerns greatly frustrate me, since we have a good amount of objective data that benzos are more likely to cause over sedation and lead to intubation.
(Edited 2:51 PM via @skeetsapp.com)
(Edited 2:51 PM via @skeetsapp.com)
January 26, 2025 at 10:51 PM
These concerns greatly frustrate me, since we have a good amount of objective data that benzos are more likely to cause over sedation and lead to intubation.
(Edited 2:51 PM via @skeetsapp.com)
(Edited 2:51 PM via @skeetsapp.com)
Reposted by Daniel McClellan
PO droxidopa to wean off vasopressor infusions (instead of midodrine):
the mechanism of conversion to norepi *inside* neurons is beautiful. this may restore normal functioning of the sympathetic nervous system
no robust data yet
thoughts? criticism? experiences? #EMIMCC @ajwpharm.bsky.social
the mechanism of conversion to norepi *inside* neurons is beautiful. this may restore normal functioning of the sympathetic nervous system
no robust data yet
thoughts? criticism? experiences? #EMIMCC @ajwpharm.bsky.social
January 23, 2025 at 2:16 PM
PO droxidopa to wean off vasopressor infusions (instead of midodrine):
the mechanism of conversion to norepi *inside* neurons is beautiful. this may restore normal functioning of the sympathetic nervous system
no robust data yet
thoughts? criticism? experiences? #EMIMCC @ajwpharm.bsky.social
the mechanism of conversion to norepi *inside* neurons is beautiful. this may restore normal functioning of the sympathetic nervous system
no robust data yet
thoughts? criticism? experiences? #EMIMCC @ajwpharm.bsky.social
Reposted by Daniel McClellan
Trump has revoked an executive order — signed in 1965 by LBJ — that required federal contractors to refrain from employment discrimination and take affirmative action to ensure equal opportunity "based on race, color, religion, and national origin." www.axios.com/2025/01/22/t...
Trump rolls back bedrock 1960s-era civil rights measure
The move abolishes decades of government practices on diversity and equal opportunity.
www.axios.com
January 22, 2025 at 9:10 PM
Trump has revoked an executive order — signed in 1965 by LBJ — that required federal contractors to refrain from employment discrimination and take affirmative action to ensure equal opportunity "based on race, color, religion, and national origin." www.axios.com/2025/01/22/t...
Reposted by Daniel McClellan
NIH appears to have canceled/postponed all of its study sections—the independent review panels that approve federal grants for health research.
Such grants fund the work/salaries of 300k people at more than 2,500 institutions
Such grants fund the work/salaries of 300k people at more than 2,500 institutions
All NIH study sections canceled indefinitely. This will halt science and devastate research budgets in universities.
January 22, 2025 at 9:27 PM
NIH appears to have canceled/postponed all of its study sections—the independent review panels that approve federal grants for health research.
Such grants fund the work/salaries of 300k people at more than 2,500 institutions
Such grants fund the work/salaries of 300k people at more than 2,500 institutions