Anand Swaminathan
@emswami.bsky.social
EM doc | Resuscitationist | Medical Educator | EMRAP Managing Editor
He/Him/His
Instagram: @EMSwami
He/Him/His
Instagram: @EMSwami
This is a great way to use LLMs in medicine. Simply letting the LLM do all the work will invariably lead to numerous issues but a "triple-threat" approach makes a lot of sense
@pulmcrit.bsky.social
emcrit.org/pulmcrit/tri...
@pulmcrit.bsky.social
emcrit.org/pulmcrit/tri...
September 1, 2025 at 7:20 PM
This is a great way to use LLMs in medicine. Simply letting the LLM do all the work will invariably lead to numerous issues but a "triple-threat" approach makes a lot of sense
@pulmcrit.bsky.social
emcrit.org/pulmcrit/tri...
@pulmcrit.bsky.social
emcrit.org/pulmcrit/tri...
Andexanet alfa increases VTE w/o offering improved clinical outcomes bit.ly/41oy4vm
-660 patients AA or 4FPCC
-No mortality benefit for andexanet
-9% increase in VTE (NNH = 11)
Not perfect data but mounting evidence that this massively expensive drug offers no benefit w/ incr complications
-660 patients AA or 4FPCC
-No mortality benefit for andexanet
-9% increase in VTE (NNH = 11)
Not perfect data but mounting evidence that this massively expensive drug offers no benefit w/ incr complications
August 26, 2025 at 2:31 PM
Andexanet alfa increases VTE w/o offering improved clinical outcomes bit.ly/41oy4vm
-660 patients AA or 4FPCC
-No mortality benefit for andexanet
-9% increase in VTE (NNH = 11)
Not perfect data but mounting evidence that this massively expensive drug offers no benefit w/ incr complications
-660 patients AA or 4FPCC
-No mortality benefit for andexanet
-9% increase in VTE (NNH = 11)
Not perfect data but mounting evidence that this massively expensive drug offers no benefit w/ incr complications
Occult VF in Cardiac Arrest: 5.3% of patients with cardiac arrest showed VF on echo but ECG w/ PEA/asystole
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
July 1, 2025 at 5:44 PM
Occult VF in Cardiac Arrest: 5.3% of patients with cardiac arrest showed VF on echo but ECG w/ PEA/asystole
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
Study does not show improved outcomes but not powered to do so
Strong argument for intra-arrest echo as it can dramatically change management
#EMIMCC
Ketamine in peds PSA (PMID: 40481829)
- Registry of 12,780 ED PSAs
-0.016% (2 patients) w/ critical events (1 suspected aspiration, 1 anaphylaxis)
-0.52% high-risk events
-7 laryngospasms
Bottom line: ketamine is exquisitely safe in peds PSA in the ED
- Registry of 12,780 ED PSAs
-0.016% (2 patients) w/ critical events (1 suspected aspiration, 1 anaphylaxis)
-0.52% high-risk events
-7 laryngospasms
Bottom line: ketamine is exquisitely safe in peds PSA in the ED
June 10, 2025 at 7:58 PM
Ketamine in peds PSA (PMID: 40481829)
- Registry of 12,780 ED PSAs
-0.016% (2 patients) w/ critical events (1 suspected aspiration, 1 anaphylaxis)
-0.52% high-risk events
-7 laryngospasms
Bottom line: ketamine is exquisitely safe in peds PSA in the ED
- Registry of 12,780 ED PSAs
-0.016% (2 patients) w/ critical events (1 suspected aspiration, 1 anaphylaxis)
-0.52% high-risk events
-7 laryngospasms
Bottom line: ketamine is exquisitely safe in peds PSA in the ED
February 26, 2025 at 6:18 PM
January 9, 2025 at 4:23 PM
Clinical Conundrum: Should We Always Treat Fever in Sepsis?: bit.ly/3BwUEbq
TL;DR: No. No incr mortality/morbidity + possible protective effects
#MedSky #EMIMCC
TL;DR: No. No incr mortality/morbidity + possible protective effects
#MedSky #EMIMCC
December 18, 2024 at 1:26 AM
Clinical Conundrum: Should We Always Treat Fever in Sepsis?: bit.ly/3BwUEbq
TL;DR: No. No incr mortality/morbidity + possible protective effects
#MedSky #EMIMCC
TL;DR: No. No incr mortality/morbidity + possible protective effects
#MedSky #EMIMCC
REBEL Core Cast 132.0 - Recent Onset AF: bit.ly/4f0zRe4
- ED cardioversion safe in low risk (CHADS-VASC < 2 for men, < 3 for women) up to 48 hours from onset
- Restrict cardioversion to < 12 hours in high risk
- Electricity >>>>> Procainamide > Amiodarone
#MedSky #EMIMCC #FOAMed
- ED cardioversion safe in low risk (CHADS-VASC < 2 for men, < 3 for women) up to 48 hours from onset
- Restrict cardioversion to < 12 hours in high risk
- Electricity >>>>> Procainamide > Amiodarone
#MedSky #EMIMCC #FOAMed
December 4, 2024 at 8:02 PM
REBEL Core Cast 132.0 - Recent Onset AF: bit.ly/4f0zRe4
- ED cardioversion safe in low risk (CHADS-VASC < 2 for men, < 3 for women) up to 48 hours from onset
- Restrict cardioversion to < 12 hours in high risk
- Electricity >>>>> Procainamide > Amiodarone
#MedSky #EMIMCC #FOAMed
- ED cardioversion safe in low risk (CHADS-VASC < 2 for men, < 3 for women) up to 48 hours from onset
- Restrict cardioversion to < 12 hours in high risk
- Electricity >>>>> Procainamide > Amiodarone
#MedSky #EMIMCC #FOAMed
December 1, 2024 at 3:02 PM
November 28, 2024 at 4:39 PM
Give prophylactic abx post-tube thoracostomy in trauma
Best evidence (2022 SRMA bit.ly/4cHLCpE) shows decreased rates of empyema w/ abx particularly in patients with penetrating trauma
#MedSky
Insta Reel: bit.ly/3OoGtIh
Best evidence (2022 SRMA bit.ly/4cHLCpE) shows decreased rates of empyema w/ abx particularly in patients with penetrating trauma
#MedSky
Insta Reel: bit.ly/3OoGtIh
November 22, 2024 at 3:04 PM
Give prophylactic abx post-tube thoracostomy in trauma
Best evidence (2022 SRMA bit.ly/4cHLCpE) shows decreased rates of empyema w/ abx particularly in patients with penetrating trauma
#MedSky
Insta Reel: bit.ly/3OoGtIh
Best evidence (2022 SRMA bit.ly/4cHLCpE) shows decreased rates of empyema w/ abx particularly in patients with penetrating trauma
#MedSky
Insta Reel: bit.ly/3OoGtIh
Paralytic 1st RSI assoc w/ improved 1st pass success bit.ly/4eDjt2Y
Key is understanding onset of action of meds:
- Roc 1.2 mg/kg onset ~ 45-60 sec
- Ketamine ~ 30 sec
- Etomidate ~ 30 sec
Paralytic 1st aligns onset + reduces chance for apneic but not paralyzed
#MedSky
Key is understanding onset of action of meds:
- Roc 1.2 mg/kg onset ~ 45-60 sec
- Ketamine ~ 30 sec
- Etomidate ~ 30 sec
Paralytic 1st aligns onset + reduces chance for apneic but not paralyzed
#MedSky
November 20, 2024 at 4:39 PM
Paralytic 1st RSI assoc w/ improved 1st pass success bit.ly/4eDjt2Y
Key is understanding onset of action of meds:
- Roc 1.2 mg/kg onset ~ 45-60 sec
- Ketamine ~ 30 sec
- Etomidate ~ 30 sec
Paralytic 1st aligns onset + reduces chance for apneic but not paralyzed
#MedSky
Key is understanding onset of action of meds:
- Roc 1.2 mg/kg onset ~ 45-60 sec
- Ketamine ~ 30 sec
- Etomidate ~ 30 sec
Paralytic 1st aligns onset + reduces chance for apneic but not paralyzed
#MedSky
Flu season is here. Reminder that tamiflu (oseltamivir) is pretty worthless: bit.ly/3p2HFYD
High-quality SRMA shows:
No ⬇️ in 🏥 overall
No ⬇️ 🏥In older or at higher risk
⬆️In adverse events (nausea, vomiting)
Echoes what we've been saying for years bit.ly/3XetvR2
#MedSky
High-quality SRMA shows:
No ⬇️ in 🏥 overall
No ⬇️ 🏥In older or at higher risk
⬆️In adverse events (nausea, vomiting)
Echoes what we've been saying for years bit.ly/3XetvR2
#MedSky
November 19, 2024 at 8:41 PM
Flu season is here. Reminder that tamiflu (oseltamivir) is pretty worthless: bit.ly/3p2HFYD
High-quality SRMA shows:
No ⬇️ in 🏥 overall
No ⬇️ 🏥In older or at higher risk
⬆️In adverse events (nausea, vomiting)
Echoes what we've been saying for years bit.ly/3XetvR2
#MedSky
High-quality SRMA shows:
No ⬇️ in 🏥 overall
No ⬇️ 🏥In older or at higher risk
⬆️In adverse events (nausea, vomiting)
Echoes what we've been saying for years bit.ly/3XetvR2
#MedSky