josh farkas 💊
@pulmcrit.bsky.social
Pulm/crit attending at U. Vermont 🐄 Zentensivist 🧘♂️ trying to post more about medicine in order to distract myself from doomscrolling 🤦♂️ author of free online critical care textbook emcrit.org/ibcc/toc/ 📖 no conflicts of interest 💰
Pinned
josh farkas 💊
@pulmcrit.bsky.social
· Nov 28
PulmCrit: How to quickly create a useful professional account in BlueSky
I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it
emcrit.org
how to quickly set up a useful MedSky account!
🦋 Mix of basic & more advanced stuff (eg designing user-curated hashtag feeds)
🦋 Take a look & add any useful tips you have in the comments section
blog:
emcrit.org/pulmcrit/blu... #MedSky
🦋 Mix of basic & more advanced stuff (eg designing user-curated hashtag feeds)
🦋 Take a look & add any useful tips you have in the comments section
blog:
emcrit.org/pulmcrit/blu... #MedSky
“I have been using a combination of cap refill and MAP since the original ANDROMEDA SHOCK paper”
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
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
November 24, 2025 at 2:30 PM
“I have been using a combination of cap refill and MAP since the original ANDROMEDA SHOCK paper”
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
New study design:
Multiply a small & uncertain number with a big number and you get a big number
The final big number looks, well, really big
This grabs headlines & gets cited
It doesn’t clarify underlying uncertainty, so it doesn’t actually illuminate anything
Mathematically rigorous clickbait
Multiply a small & uncertain number with a big number and you get a big number
The final big number looks, well, really big
This grabs headlines & gets cited
It doesn’t clarify underlying uncertainty, so it doesn’t actually illuminate anything
Mathematically rigorous clickbait
November 23, 2025 at 2:27 PM
New study design:
Multiply a small & uncertain number with a big number and you get a big number
The final big number looks, well, really big
This grabs headlines & gets cited
It doesn’t clarify underlying uncertainty, so it doesn’t actually illuminate anything
Mathematically rigorous clickbait
Multiply a small & uncertain number with a big number and you get a big number
The final big number looks, well, really big
This grabs headlines & gets cited
It doesn’t clarify underlying uncertainty, so it doesn’t actually illuminate anything
Mathematically rigorous clickbait
ADQI/ICA guidelines finally scrapped the 48-hour mandatory albumin infusion before formally diagnosing HRS-AKI
I’ve argued against this for years (it delays tx for 3 days & you miss optimal window for intervention)
HRS-AKI carries a massive ~30% in-hospital mortality, its an emergency…
I’ve argued against this for years (it delays tx for 3 days & you miss optimal window for intervention)
HRS-AKI carries a massive ~30% in-hospital mortality, its an emergency…
a close up of a man 's face with a beard looking at the camera .
ALT: a close up of a man 's face with a beard looking at the camera .
media.tenor.com
November 23, 2025 at 2:02 PM
ADQI/ICA guidelines finally scrapped the 48-hour mandatory albumin infusion before formally diagnosing HRS-AKI
I’ve argued against this for years (it delays tx for 3 days & you miss optimal window for intervention)
HRS-AKI carries a massive ~30% in-hospital mortality, its an emergency…
I’ve argued against this for years (it delays tx for 3 days & you miss optimal window for intervention)
HRS-AKI carries a massive ~30% in-hospital mortality, its an emergency…
patients w/ hepatic encephalopathy sometimes develop a spontaneous portosystemic shunt (their body essentially creates a TIPS) that exacerbates encephalopathy
if they are healthy enough to tolerate closure (MELD <11), IR ligation of the shunt improves encephalopathy
this case👇 is extremely unusual
if they are healthy enough to tolerate closure (MELD <11), IR ligation of the shunt improves encephalopathy
this case👇 is extremely unusual
November 23, 2025 at 1:44 PM
patients w/ hepatic encephalopathy sometimes develop a spontaneous portosystemic shunt (their body essentially creates a TIPS) that exacerbates encephalopathy
if they are healthy enough to tolerate closure (MELD <11), IR ligation of the shunt improves encephalopathy
this case👇 is extremely unusual
if they are healthy enough to tolerate closure (MELD <11), IR ligation of the shunt improves encephalopathy
this case👇 is extremely unusual
a fancy nephrology guideline trying to describe how to titrate a norepi gtt is sending me 🤣
adjust q4hr??
the whole point of a NE gtt in HRS-AKI is immediate BP control
tell the ICU RN the target MAP and they will achieve it immediately... that's why NE gtts are great
(and peripheral IV is fine)
adjust q4hr??
the whole point of a NE gtt in HRS-AKI is immediate BP control
tell the ICU RN the target MAP and they will achieve it immediately... that's why NE gtts are great
(and peripheral IV is fine)
November 22, 2025 at 8:57 PM
a fancy nephrology guideline trying to describe how to titrate a norepi gtt is sending me 🤣
adjust q4hr??
the whole point of a NE gtt in HRS-AKI is immediate BP control
tell the ICU RN the target MAP and they will achieve it immediately... that's why NE gtts are great
(and peripheral IV is fine)
adjust q4hr??
the whole point of a NE gtt in HRS-AKI is immediate BP control
tell the ICU RN the target MAP and they will achieve it immediately... that's why NE gtts are great
(and peripheral IV is fine)
Ethical review of brain death in the context of familial objections or pregnancy.
This is largely intuitive and common sense, but it's useful to have a guideline if needed for reference. #EMIMCC
www.neurology.org/doi/pdf/10.1...
This is largely intuitive and common sense, but it's useful to have a guideline if needed for reference. #EMIMCC
www.neurology.org/doi/pdf/10.1...
Brain Death/Death by Neurologic Criteria Guidance on Communication, Objections, Pregnancy, and Public Trust | Neurology
This position statement provides updated member guidance from the American Academy
of Neurology (AAN) regarding (1) communication with surrogate decision makers about
brain death/death by neurologic c...
www.neurology.org
November 21, 2025 at 11:25 PM
Ethical review of brain death in the context of familial objections or pregnancy.
This is largely intuitive and common sense, but it's useful to have a guideline if needed for reference. #EMIMCC
www.neurology.org/doi/pdf/10.1...
This is largely intuitive and common sense, but it's useful to have a guideline if needed for reference. #EMIMCC
www.neurology.org/doi/pdf/10.1...
cosign: isotonic bicarb is great for the renal failure patient with hyperkalemia & acidemia
even if the kidneys take 24-48 hrs to start working, isotonic bicarb resus can often drop the K & improve pH enough to avoid needing dialysis (buys time for renal recovery)
even if the kidneys take 24-48 hrs to start working, isotonic bicarb resus can often drop the K & improve pH enough to avoid needing dialysis (buys time for renal recovery)
Fluids in HyperK
-Restore volume, incr kidney perfusion leading to incr urine output + K elimination
-0.9% saline: pH 5.5, big Cl load. Worsen acidosis leading incr serum K
-LR superior: small amount of K in it won’t raise serum K. Won’t contribute to acidosis
youtube.com/shorts/3G4yc...
#EMIMCC
-Restore volume, incr kidney perfusion leading to incr urine output + K elimination
-0.9% saline: pH 5.5, big Cl load. Worsen acidosis leading incr serum K
-LR superior: small amount of K in it won’t raise serum K. Won’t contribute to acidosis
youtube.com/shorts/3G4yc...
#EMIMCC
Fluids in Hyperkalemia #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
November 21, 2025 at 7:34 PM
cosign: isotonic bicarb is great for the renal failure patient with hyperkalemia & acidemia
even if the kidneys take 24-48 hrs to start working, isotonic bicarb resus can often drop the K & improve pH enough to avoid needing dialysis (buys time for renal recovery)
even if the kidneys take 24-48 hrs to start working, isotonic bicarb resus can often drop the K & improve pH enough to avoid needing dialysis (buys time for renal recovery)
this would be really easy to misdiagnose as Lofgren syndrome 2/2 sarcoidosis 😬 #PulmSky
#idboardreview Pt w/ R knee & b/l ankle joint pain x1wk: dx aseptic arthritis. 2 wks later, extensive erythema nodosum on legs & non-tender supraclavicular lymph node: biopsy caseating granuloma. Afb+ #IDsky #idmeded #meded
November 21, 2025 at 2:38 PM
this would be really easy to misdiagnose as Lofgren syndrome 2/2 sarcoidosis 😬 #PulmSky
According to the Trump admin, nursing isn’t a profession so they won’t qualify for student loans 🤬
We’re barely recovering from the last RN shortage and they want to create another one 😫
Literally zero patients survive the ICU without outstanding RN care.
www.newsweek.com/nursing-not-...
We’re barely recovering from the last RN shortage and they want to create another one 😫
Literally zero patients survive the ICU without outstanding RN care.
www.newsweek.com/nursing-not-...
Nursing is no longer counted as a 'professional degree' by Trump admin
The Department of Education has excluded nursing as a "professional degree" program as it implements various changes to student loans.
www.newsweek.com
November 21, 2025 at 2:34 AM
According to the Trump admin, nursing isn’t a profession so they won’t qualify for student loans 🤬
We’re barely recovering from the last RN shortage and they want to create another one 😫
Literally zero patients survive the ICU without outstanding RN care.
www.newsweek.com/nursing-not-...
We’re barely recovering from the last RN shortage and they want to create another one 😫
Literally zero patients survive the ICU without outstanding RN care.
www.newsweek.com/nursing-not-...
Reposted by josh farkas 💊
Priorities in UGIB management: blood, ceftriaxone (if varices suspected), GI to bedside + consider intubation
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
Promotility Agents in UGIB #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
November 19, 2025 at 3:20 PM
Priorities in UGIB management: blood, ceftriaxone (if varices suspected), GI to bedside + consider intubation
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
Finer point: administration of metaclopramide + erythromycin
Promotility agents which help empty the stomach of blood, improve the view for endoscopist
youtube.com/shorts/ae98W...
#EMIMCC
Roon is launching a social media site for USA doctors only
Looks lame
The strength of MedTwitter has always been diversity (geographic & training - docs, RNs, PAs, pharmacists etc)
Further fractionating our community isn't the way forward
I think Bluesky is ideal; we just need more people here
Looks lame
The strength of MedTwitter has always been diversity (geographic & training - docs, RNs, PAs, pharmacists etc)
Further fractionating our community isn't the way forward
I think Bluesky is ideal; we just need more people here
November 19, 2025 at 4:46 PM
Roon is launching a social media site for USA doctors only
Looks lame
The strength of MedTwitter has always been diversity (geographic & training - docs, RNs, PAs, pharmacists etc)
Further fractionating our community isn't the way forward
I think Bluesky is ideal; we just need more people here
Looks lame
The strength of MedTwitter has always been diversity (geographic & training - docs, RNs, PAs, pharmacists etc)
Further fractionating our community isn't the way forward
I think Bluesky is ideal; we just need more people here
Finished updating the IBCC chapter on septic shock
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
November 19, 2025 at 2:01 PM
Finished updating the IBCC chapter on septic shock
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
Single-center RCT finds benefit from sepsis resus that targets perfusion index (Pi)
Intervention group: fix macrohemodynamics, then target Pi >1.4
I think they're right
Pi is similar to cap refill, but continuously displayed number on monitor 😍
pubmed.ncbi.nlm.nih.gov/41033063/ #EMIMCC
Intervention group: fix macrohemodynamics, then target Pi >1.4
I think they're right
Pi is similar to cap refill, but continuously displayed number on monitor 😍
pubmed.ncbi.nlm.nih.gov/41033063/ #EMIMCC
November 18, 2025 at 3:15 PM
Single-center RCT finds benefit from sepsis resus that targets perfusion index (Pi)
Intervention group: fix macrohemodynamics, then target Pi >1.4
I think they're right
Pi is similar to cap refill, but continuously displayed number on monitor 😍
pubmed.ncbi.nlm.nih.gov/41033063/ #EMIMCC
Intervention group: fix macrohemodynamics, then target Pi >1.4
I think they're right
Pi is similar to cap refill, but continuously displayed number on monitor 😍
pubmed.ncbi.nlm.nih.gov/41033063/ #EMIMCC
Contrast may cause anaphylacTOID reactions (not anaphyLAXIS)
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
Stop using steroids to pretreat CT contrast allergy
youtube.com/watch?v=h2Hv...
youtube.com/watch?v=h2Hv...
Steroids are OUT for CT contrast allergy
YouTube video by First10EM
youtube.com
November 18, 2025 at 1:51 PM
Contrast may cause anaphylacTOID reactions (not anaphyLAXIS)
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
Plea from an intensivist:
Don't use ACEi/ARB for management of HTN in patients who are tenuous or have limited prognosis (eg advanced malignancy). There are much safer anti-HTN tx's (amlodipine, nifedipine XR).
Educate patients that if they're too sick to eat they should to hold ACEi/ARB #EMIMCC
Don't use ACEi/ARB for management of HTN in patients who are tenuous or have limited prognosis (eg advanced malignancy). There are much safer anti-HTN tx's (amlodipine, nifedipine XR).
Educate patients that if they're too sick to eat they should to hold ACEi/ARB #EMIMCC
a cartoon of spongebob saying " i am on my knees please " with his mouth open
ALT: a cartoon of spongebob saying " i am on my knees please " with his mouth open
media.tenor.com
November 17, 2025 at 3:23 PM
Plea from an intensivist:
Don't use ACEi/ARB for management of HTN in patients who are tenuous or have limited prognosis (eg advanced malignancy). There are much safer anti-HTN tx's (amlodipine, nifedipine XR).
Educate patients that if they're too sick to eat they should to hold ACEi/ARB #EMIMCC
Don't use ACEi/ARB for management of HTN in patients who are tenuous or have limited prognosis (eg advanced malignancy). There are much safer anti-HTN tx's (amlodipine, nifedipine XR).
Educate patients that if they're too sick to eat they should to hold ACEi/ARB #EMIMCC
Reposted by josh farkas 💊
Individualized PEEP:
Can you estimate optimal PEEP in any BMI with the simple equation of BMI/3?
Maybe!
Our new paper comparing esophageal pressure base transpulmonary pressure estimates of optimal PEEP (tPP of 0 +\-2) vs BMI/3 in OR patients
www.sciencedirect.com/science/arti...
Can you estimate optimal PEEP in any BMI with the simple equation of BMI/3?
Maybe!
Our new paper comparing esophageal pressure base transpulmonary pressure estimates of optimal PEEP (tPP of 0 +\-2) vs BMI/3 in OR patients
www.sciencedirect.com/science/arti...
Identifying Optimal Positive End-Expiratory Pressure by Body Mass Index Does Not Account for Natural Physiologic Variability in Pleural Pressure
Mechanical ventilation and selecting optimal positive end-expiratory pressure (PEEP) in patients across a wide range of body mass indexes (BMI) is cha…
www.sciencedirect.com
November 13, 2025 at 7:41 PM
Individualized PEEP:
Can you estimate optimal PEEP in any BMI with the simple equation of BMI/3?
Maybe!
Our new paper comparing esophageal pressure base transpulmonary pressure estimates of optimal PEEP (tPP of 0 +\-2) vs BMI/3 in OR patients
www.sciencedirect.com/science/arti...
Can you estimate optimal PEEP in any BMI with the simple equation of BMI/3?
Maybe!
Our new paper comparing esophageal pressure base transpulmonary pressure estimates of optimal PEEP (tPP of 0 +\-2) vs BMI/3 in OR patients
www.sciencedirect.com/science/arti...
there's been LOTS of back-and-forth about vaso in sepsis
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
November 13, 2025 at 6:52 PM
there's been LOTS of back-and-forth about vaso in sepsis
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
(e.g., these two 2025 review articles reach totally different conclusions! Lajoye is correct IMHO)
TLDR: there is no simple answer; personalize tx 🌌
my current take on vaso in sepsis is here: emcrit.org/ibcc/shock/#... #EMIMCC
Fresh IBCC: POCIT (Point-of-care infrared thermography)
This is basically where POCUS was 1995-2005
Technology & evidence-basis are improving
Early adopters may be interested
IMHO anything bringing us to the bedside more & forcing us to engage w/ the exam is good
emcrit.org/ibcc/pocit/ #EMIMCC
This is basically where POCUS was 1995-2005
Technology & evidence-basis are improving
Early adopters may be interested
IMHO anything bringing us to the bedside more & forcing us to engage w/ the exam is good
emcrit.org/ibcc/pocit/ #EMIMCC
November 13, 2025 at 2:00 PM
Fresh IBCC: POCIT (Point-of-care infrared thermography)
This is basically where POCUS was 1995-2005
Technology & evidence-basis are improving
Early adopters may be interested
IMHO anything bringing us to the bedside more & forcing us to engage w/ the exam is good
emcrit.org/ibcc/pocit/ #EMIMCC
This is basically where POCUS was 1995-2005
Technology & evidence-basis are improving
Early adopters may be interested
IMHO anything bringing us to the bedside more & forcing us to engage w/ the exam is good
emcrit.org/ibcc/pocit/ #EMIMCC
this is an ID fellowship, so the answer isn’t sarcoidosis 😳
#IDboardreview 25 yo M w/ recent tattoo (2 wks ago) now presents with this non-pruritic non-tender rash? Diagnosis? #medEd #IDMedEd #idsky
November 13, 2025 at 12:01 AM
this is an ID fellowship, so the answer isn’t sarcoidosis 😳
Reposted by josh farkas 💊
1/ 👋 there #neurotwitter #neurosky #neurocritcare, as part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/ar...
November 12, 2025 at 9:01 PM
1/ 👋 there #neurotwitter #neurosky #neurocritcare, as part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/ar...
Reposted by josh farkas 💊
Nothing normal about “normal” saline
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
Nothing Normal About "Normal" Saline #criticalcare #emergencymedicine #resuscitation
YouTube video by EMSwami
youtube.com
November 12, 2025 at 2:33 PM
Nothing normal about “normal” saline
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
-0.9% NaCl: 154 mEq Na + 154 mEq Cl. pH ~ 5.6
-Human/animal data shows it's proinflammatory
-SALT-ED (PMID:29485926) + SMART (PMID:29485925) show incr kidney injury w/ 0.9% NaCl vs balanced solutions
-LR more physiologic
youtube.com/shorts/XcV7R...
#EMIMCC
IMHO the best strategy for occasional intubators (e.g., pulm/crit) is:
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
Hyperangulated videolaryngoscopy: stylet first until benefit of bougie is shown
"...the current challenge for the wider community of anaesthetists ... is not mastery of HAVL but access to devices, routine use, gaining familiarly and developing competence."
#AnSky
ttps://doi.org/10.1111/anae.70062
"...the current challenge for the wider community of anaesthetists ... is not mastery of HAVL but access to devices, routine use, gaining familiarly and developing competence."
#AnSky
ttps://doi.org/10.1111/anae.70062
November 10, 2025 at 1:27 PM
IMHO the best strategy for occasional intubators (e.g., pulm/crit) is:
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
-Preox with BiPAP (PREOXY trial)
-Paralyze with roc/ketamine
-Intubate with hyperangulated VL + rigid stylet
This has a very sharp learning curve
Fellows can do this ~50 times and provide reproducibly safe intubations #EMIMCC
I'm revising the IBCC septic shock chapter based on ANDROMEDA-SHOCK II
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
November 10, 2025 at 1:16 PM
I'm revising the IBCC septic shock chapter based on ANDROMEDA-SHOCK II
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
would love any feedback & critique on this
ANDROMEDA algorithm is nice, but it's too complicated for everyday use. We need something simpler.
& maybe it's time to push for IR thermography 😍
emcrit.org/ibcc/sepsis/... #EMIMCC
your daily reminder:
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
From @jama.com: Patients with #AFib who continued their usual caffeinated coffee intake after cardioversion experienced less recurrence of AF or atrial flutter compared to those who abstained from coffee and caffeine.
#AHA25 @ahascience.bsky.social
ja.ma/3XolIkd
#AHA25 @ahascience.bsky.social
ja.ma/3XolIkd
November 9, 2025 at 3:15 PM
your daily reminder:
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
☕️ coffee is great
☕️ caffeine-free diets for hospitalized patients are silly & cause misery due to caffeine withdrawal #EMIMCC
this is really excellent.
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
Our latest blog is out:
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
Faith, Evidence and the Stars: The ANDROMEDA‑SHOCK‑2 Trial
https://criticalcarereviews.com/blog/current
November 8, 2025 at 4:49 PM
this is really excellent.
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC
I was drafting a blog post on ANDROMEDA-SHOCK-2 but this really covers what I was going to say, so I don't have to now.
I am still working on a simplified, pragmatic approach to apply this at the bedside... stay tuned. #EMIMCC