Haney Mallemat
@CriticalCareNow
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Critical Care, Emergency Medicine, Ultrasound, Echocardiography & education. No financial disclosures. Tweets are not medical advice
South of the Garden
Joined November 2010
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Last Seen Profiles
Pinned Tweet
ResusX is a 3-day resuscitation experience in Philly (w/ a virtual option). Starts 9/18/24
There are also 4 pre-conference workshops to choose from
Come to the main conference, or just the workshops, or come for it all!
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Enjoy this new series called UltraRounds.
Let me know if this video was helpful.
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The crashing patient on the ventilator is scary and every second counts. You need a stepwise algorithm to stabilize this patient that works fast. This is important if you are a nurse, respiratory therapist, NP, PA, or doctor.
#FOAmed
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Don’t like wasting time looking for veins in a code. Don’ place central lines during codes.
The IO is the fastest way to vascular access. Technically a central line & any medication can go through including blood.
Are you using the IO for your critically-ill patients?
#FOAMED
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Welcome back to UltraRounds...it's the SubXiphoid View!
#EmergencyMedicine
#Resuscitation
#POCUS
#Echo
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Today's
#Top10Tuesday
are some best practices that I've observed for the critically-ill COVID patients. These are all the results of participating and listening to webinars with some of the brightest and cutting edge experts out there
What are your thoughts about these?
#FOAMed
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No disrespect to any of my physician colleagues, but can we temporarily rename today to “National Healthcare Worker’s Day”. Everyone in healthcare could use a great big “thank you” right now.
(…Doctors, we’ll celebrate our own thing in 2021…I’ll even buy the cake)
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What’s the fastest central access? Nope, it’s not a central line.
IOs are awesome & underutilized in healthcare. You can push anything through them. It’s my go to access in a code.
How many are using them? Are using the tibia or the humerus?
#Tips4NewDocs
#Tipsfornewdocs
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Do you know the difference between peak & plateau pressures?
Peak pressure represent all the forces during inspiration & is a measure of stiffness (chest wall, ungs,etc) & resistance of flow (ET tube,bronchi,etc).You need to perform an inspiratory hold for the plateau pressure
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Trying some new content today, this is a new series called “Top 10 Tuesday”. Each week I’ll cover a new topic
For the first Top 10 Tuesday let’s talk about Acute respiratory distress syndrome (ARDS)
Please let me know in the comments whether or not you like this content format.
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Stop ordering so many ABGs (in non-mechanically ventilated patients)
This is a
#TipsForNewDocs
but others might want to listen
I realize this is controversial so let it rip in the comments.Interested to hear yr thoughts
#FOAmcc
#FOAmed
#CriticalCare
#emergencymedicine
#icu
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How to fix auto-PEEP.
Do you like the series? Let me know in the comments
#RespiratoryTherapist
#PEEP
#EmergencyMedicine
#CriticalCare
#Autopeep
#Resuscitation
#MechanicalVentilation
#RespiratoryFailure
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What agents do you use to intubate your sick patients? What dose? This
#CritBits
is all about that.
What do YOU use and WHY?
Please like & subscribe on YouTube so you’ll never miss these videos!
#FOAMed
#FOAMcc
#criticalcare
#intensivecare
#ICU
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Do you intubate patients? How do you predict and prevent post-Intubation hypotension?
Post-intubation hypotension occurs in 25% and cardiac arrest in 3%… so we need to be able to identify which patients are at risk and prepare for it.
#CritBits
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How do you evaluate the patient with undifferentiated shock? Are you using ultrasound? If so, what’s your protocol? Please share this with someone who uses ultrasound to assess their hypotensive patients
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Subclavian ultrasound? Is this the line we should all be using?
Are you using ultrasound for your subclavians? Are you placing subclavians? Let me know in comments below
#CriticalCare
#Resuscitation
#CentralLine
#EmergencyMedicine
#Sepsis
#Vasopressors
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There has never been a better time to post this brilliant tweet by
@meganranney
.
We are now (and will be for the foreseeable future) working long-hours and are at maximum capacity. Please remember to maintain your humanity and decency during these trying times.
#FOAMed
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Introducing a BRAND NEW weekly series called
#WhatsTheDX
. I did a version of this a few years ago, but I’m completely updating the format to make it more interactive, much more educational, & hopefully a little more fun.
Please reply with your answers...answer tomorrow
#FOAMed
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Patients w/ life-threatening asthma are challenging. Every second counts and many things must be done quickly & early. Remember:
Summary:
1. Don’t intubate
2. Epinephrine IM, then IV
3. BPAP
4. If you intubate, avoid too fast of a rate
Watch the video:
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Do you want to be a true resuscitation master? Then you have to know about the right ventricle!
The RV is often overlooked but is so vital for resuscitation. Watch this brand new
#CritBits
for more.
@msiuba
@iceman_ex
@ThinkingCC
@bmiesemer
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This arrived today, thanks to
@airwaycam
Let me tell you it was put to work right out of the box. We used for one of the many awake prone patients on our service.
Thank you for what you do Rich, just one of the ways you have positively impacted my life and those of my patients
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#IttyBittyCritBits
(a simple thought as you're walking in to your shift) NTG drip in severe decompensated heart failure. The recommended starting dose is 5mcg/min and titrate from there...but this is not enough (see post below). Inspired by a post started by
@EM_RESUS
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#CritBits15
: Intubating the Physiologically Difficult Airway,Part I: Identifying the riskiest patient
Risk factors for post-intubation hypotension/cardiac arrest
1.Hypotension
2.Hypoxemia
3.Acidosis
4.Obesity
5.Increased illness scores (e.g., Apache)
Consider Shock Index: HR/SPB
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Stop drowning patients with maintenance fluids
Fluid is a drug and we have to be careful how we give. Too much can cause organ edema and injury.
Watch the video and then tell me what are your thoughts on maintenance fluids.
#FOAmcc
#FOAmed
#Tipsfornewdocs
#Tips4NewDocs
#icu
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Are you down with (Ab)Normal saline?
It’s not physiologic and can cause harm. Yet it’s still the standard in many places.
What are your thoughts on using abnormal saline?
#CriticalCare
#InternalMedicine
#emergencymedicine
#icu
#foamed
#FOAMcc
#resuscitation
#Tips4NewDocs
#ICU
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How to approach the crashing patients on the vent. Part I
You need a quick and simple algorithm to troubleshoot when your vented patients crash
Do you use this mnemonic? Do you something else? Hit me up at the comments, I love to hear from you
#FOAmcc
#foamed
#resuscitation
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Are you nervous when pregnant patients presents acutely ill? These patients are scary because you are caring for 2 patients. Also, pregnant patients undergo so physiologic changes during pregnancy & have little reserve when critical illness occurs. Remember mnemonic T.O.L.D.
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How many of you are using ultrasound for your subclavian catheter placement?
Check out the video discussion on CriticalCareNow by
@HarmanSGill
&
@mdmdtyler
for more on this
#FOAMED
#FOAMCC
#CriticalCare
#EmergencyMedicine
#Hypotension
#Vasopressors
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Don’t Let Mechanically Ventilated Patients Get SILI (Self-Induced-Lung-Injury). Yes, it's a thing & it might be leading to lung injury in the COVID patients
Is this the reason that pts are getting worse on the ventilator & transitioning from L to H type? Please comment below
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@queenofironyRN
At first I beloved that people did not understand the virus…now, months later, after all the public warning, I’m left speechless
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Push dose pressors for hypotension by
@FoozFlower
💉Rapid correction of BP
💉Label & use caution
💉If in doubt, consult your pharmacist
Are you using them? Reply meh, yay or nay
#EmergencyMedicine
#Hypotension
#CriticalCare
#Shock
#FOAMED
#FOAMCC
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Are you using Hi-flow for your COVID patients? Interested to hear your thoughts on how you are managing and if you are proning awake as well. Please let me know.
Here's a little summary of how hi-flow works.
#FOAMed
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#CritBits
Episode 13: Ultrasound Hacks for Cardiac Arrest. Doing ultrasound is good but it distracts from other things; remember these 5 tips:
1. Turn machine on before rhythm check
2. Let the most experienced person scan
3. Countdown rhythm check
4. Use PSLX
5. Just take clips
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CriticalCareNow is a
#FOAMed
resource from over 30 educators in Resuscitation. Daily content w/ specific themes that mixes audio, video, & images
More content coming, including a video-series called “the iV League”, launching tonight 5pmEST
Please enjoy
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Remember…there’s more than just Vancomycin
Here’s a list of the commonly used antibiotics for MRSA. This is not complete but these are the most commonly used ones.
The bottom line is there’s more than one way to kill MRSA
#Sepsis
#CriticalCare
#EmergencyMedicine
#foamed
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A broken heart on Valentine’s Day can lead to shock, it can actually can happen any day of the year.
This Valentine’s Day I threw together this quick sketch about the 4 classes of shock. It’s not a fancy valentines gift, but I made it just for you.
Happy Valentine’s Day
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#CritBits
Episode 6: End-Tidal CO2 Intro to the waveform (plus some outtakes). Please submit your
#CritBitThis
for your chance for a FREE
#ResusX
t-shirt
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Fever with HIV? This chart from
@The_EMDaily
helps sort out the bugs to consider based on CD4. The post is here
#FOAMed
#FOAMid
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Part II: Stop ordering so many ABGs. Do you really need that gas?
#TipsForNewDocs
Let me know if this is what you do (or don’t do) in your practice
#CriticalCare
#emergencymedicine
#FOAmed
#FOAmcc
#internalmedicine
#IntensiveCare
#doctor
#ResusX
#icu
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Not types of shock are obvious when you first evaluate patients. But you have to figure it out fast…because mortality increases by the second.
.
Ultrasound is a the perfect way to rapidly and non-invasively evaluate the patient in shock.
#foamed
#IttyBittyCritBit
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Someone asked me on plane home to describe
#SMACC19
.Well, that’s difficult to do if you’ve never been,but upon reflection it’s a conference that celebrates medicine, humanism, education, failure, innovation & community. Thanks for 6 amazing years.Looking forward to next journey.
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A pulse check during cardiac arrest is like using a rotary phone in 2020? What’s a rotary phone?
This post from CriticalCareNow by Jeff Pepin will help with at least one of those questions.
#foamed
#foamcc
#cardiacarrest
#acls
#criticalcare
#icu
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How do you treat auto peep?
I’m re-launching CritBits soon, but before I do a few throwbacks to a video series I used to do
In this series, I break down pathophysiology to the most basic form to help better teach concepts.
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#CritBits
Episode 21: Ultrasound for Undifferentiated Shock
Assess Tank,Pump,Pipes using any one of many u/s protocols. My go to is HIMAP by
@emcrit
&
@bretpnelson
(w/ some modifications)
H-HEART
I-Intravascular Assessment
M-Morrison's (FAST)
A-Aorta
P-Pulmonary
#FOAMed
#FOAMcc
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I miss lecturing…so let’s do one live. I’ll be live streaming “Respiratory Failure Made Simple” on 5/22 at 5PM EST. 25 minutes followed by Q&A
Light refreshments will be served
Who is coming? I need a headcount to order sandwiches ;)
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Any educators here using TikTok? I know this sounds crazy, but it’s an under utilized
#meded
platform
I’m not talking about doctors & nurses being silly on TikTok, I’m talking about legit education
I’ve been posting for a few days (as
@criticalcarenow
) see video here
Thoughts?
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#CritBits
Episode 10: End-Tidal for cardiac output including assessing a fluid bolus. Did you know a 5% increase in end-tidal w/ a passive leg raise suggests fluid responsiveness?
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#IttyBittyCritBits
Use The Bougie More. I’d also be interested to hear your practices and how you teach trainees
#CritBits
#intensivecare
#emergencymedicine
#criticalcare
#criticalcarenurse
#prehospital
#intensivecareunit
#resuscitation
#ventilator
#ventilation
#FOAMed
#FOAMcc
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Resuscitate BEFORE You Intubate.
A new post by
@BabakBehgam
from CriticalCareNow
This post discusses the Shock Index which is vastly underutilized as a predictor for post-intubation crash.
#intensivecare
#Criticalcare
#emergencymedicine
#foamed
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Welcome back to UltraRounds. Today we're reviewing up the Parasternal Short Axis View today
Share with someone who you think would learn from this!
#Echo
#FOAM
#FOAMED
#EmergencyMedicine
#CriticalCare
#Resuscitation
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Respiratory failure is a common presentation. Here’s an easy strategy to approach it.
Here is the rule of 2’s, a very simple approach to the patient with respiratory failure. We’ll deep dive this a little more in upcoming
#CritBits
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Are you ready to play
#WhatsTheDx
?
Last week we had a ton of people play, so I’m doing another giveaway this week to my Twitter friends.
61M post-CVA admitted and receives ECHO for workup. Clip shown.
#WhatsTheDx
and what cardiac view is this. You need both answers to win!
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Tachypnea leads to less time for expiration & more breath stacking. Have you ever tried ketamine in the life-threatened asthmatic?
What medications do you use in the severe asthmatic? Do you use ketamine? What doses? Please share your experiences below
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Yesterday I live streamed “Mechanical Ventilation Made Easy”
I talked about a simple approach to understanding vents and discussed the modes that you probably work with on a daily basis.
Like and subscribe to the channel if you enjoyed it.
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We’re turning back to waveform capnography. Here are a few examples for you to work through. Watch video before looking at pic!
Do you have some awesome capnography waveforms? Send them to me; if I feature them, I’ll mail you a FREE gift!
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Lactated ringers is awesome…but not always:
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A Very Cool Tool for Central Lines a video from CriticalCareNow
This little thing is the most underused part of the central line kit.
#CriticalCare
#Foamed
#EmergencyMedicine
#EmergencyMedicineResident
#CentralLine
#TraumaSurgeon
#TipsForNewDocs
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ICYMI
#CritBits
Episode 5: Win fame & fortune by knowing peak & plateau pressures (maybe a slight exaggeration)
Please like / subscribe on YouTube so you’ll never miss any content!
#intensivecare
#intensivecareunit
#resuscitation
#FOAMed
#FOAMcc
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Not all diuretic strategies are the same. Learn how to become a diuretic ninja
A new post from Sharad Patel at
#CriticalCareNow
#emergencymedicine
#criticalcare
#nephrology
#volumeoverload
#foamed
#foamcc
#internalmedicine
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The crashing patient on the ventilator is scary and every second counts. You need a stepwise algorithm to stabilize this patient that works fast.
#FOAMed
1
21
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How well do you know end tidal CO2 waveforms? Check this out for some essential pattern recognition
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3 things to do on your next code
Codes can be chaotic, noisy, and disorganized. Having good leader ship and protocols during a code are the keys to success.
Got other tips? Let’s go!
#tipsfornewdocs
#CRITICALCARE
#EmergencyMedicine
#Resuscitation
#Acls
#foamed
#foamcc
#icu
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Part II of respiratory failure made simple. Type I respiratory failure is a failure to oxygenate. There’s two things to do.
Watch this
#CritBits
to learn more
Don’t forget to like and subscribe if you enjoyed the video!
#FOAMed
#FOAMcc
#criticalcare
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This
#TopTenTuesday
focuses on identifying, preparing, & acting on Critically ill patients that you are intubating.
Do you have tip for intubating the critically ill patient? Please leave them in the comments below
#Foamcc
#FOAmed
Cards 1-4
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What’s a
#zentensivist
? It’s as simple as just watching, waiting, and avoiding the temptation to do something just for the sake of doing it.
Ht to
@msiuba
@PulmCrit
3
23
77
Haven’t had to give adenosine in several years. I tend to start with beta blockade unless I’m sure LVEF is >45%
Is it time to ditch Adenosine and start giving IV Diltiazem first for SVT?
@DocWillisMD
argues for a CCB-first approach, and the data look promising.
#AAEM23
@aaeminfo
@AAEMRSA
@CriticalCareNow
@smuramed
@HeySteveMD
@MRamzyDO
@DEZ_EM_Pharm
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Are you using dexmedetomidine?
This is a remarkable drug with many indications
Are you using it for your patients? What’s your experience? Love reading your opinions, thoughts, and experience!
#Tipsfornewdocs
#criticalcare
#emergencymedicine
#intensivecare
#foamed
#FOAmcc
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Differentiating Peak & Plateau Pressures
New post from our newest editor Komal Parikh
#CriticalCare
#EmergencyMedicine
#RespiratoryTherapist
#Ventilation
#CrashingPatient
#Resuscitation
#PeakPressure
#PlateauPressure
#FOAMED
#FOAMCC
#internalmedicine
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ICYMI
#CritBits
Episode 6: understanding the squiggly lines, an introduction to end-tidal CO2
Please like and subscribe on YouTube so you’ll never miss any content!
#FOAMed
#FOAMcc
#criticalcare
#intensivecare
#ICU
#resuscitation
#resuscitationist
0
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Pre-Oxygenate like a pro by
@HeySteveMD
Infographic by
@SharleenY
#Foamed
#resuscitation
#criticalcare
#EmergencyMedicine
#RespiratoryTherapist
#RespiratoryFailure
#anesthesia
#oxygenation
#rsi
#intubation
#ards
#foam
#foamcc
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A great podcast w/
@gattinon
and
@sergio_zanotti
regarding
#COVID
, the lungs and mechanical ventilation. Hear about the L and H type directly from the man who coined the terms.
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ICYMI CritBits Ep1: auto-PEEP
A MUST know if you manage ventilated pts.
Normally ventilated patient ➡️ expiratory waveform returns to baseline.
With asthma / COPD, waveform doesn’t come back to baseline, discussed in the next
#CritBits
Watch ➡️
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