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@phlegmfighter 💯 Sometimes I ask for a consult hoping the added expertise will avoid expensive/invasive testing One of the best & most challenging parts of being an expert is using your knowledge to say nothing else is needed So the response of “order all the tests before I see them” hurts

@pulmtoilet Sounds like it’s time for an intubation vacation I try not to overthink it Pass an SBT=extubate* *unless there’s a compelling reason not to I also give one strike (⬇️mental status, marginal pass on SBT, other organ failure, etc) can have one but not all 3

What’s the highest temperature you’ve seen in clinical practice and what was the cause? #MedTwitter

🫀Live footage of what happens when epinephrine is given before defibrillation in VT/VF arrest

RT @aaeminfo: 💡 In their #AAEM24 talk, Drs. Winters & Lentz highlighted important articles from the 2023-2024 literature that pertains to t…

@reverendofdoubt I am a supporter of an in house night intensivist. I think about all the services we back up at night, much bigger impact than the walls of the ICU Ex: place a TV pacer on the cards patient no need to call in the cath lab, come to the ED and help stabilize a complex case etc.

@reverendofdoubt *if acute and making urine these may not need dialysis at all (aside from tox)

@RabbleRouseED @FGmoraDO No I haven’t seen it from inhaled or IV route, it doesn’t look like high doses were given either but will have to read more Have heard of really bad cases of neurotoxicity after inadvertent intrathecal TXA

@EMHighAK @TheShenger @drjgutt @sreeja_natesan @MikePallaci @ResusOne @davidcarr333 @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak @skobner @AaronLacyMD @MRamzyDO @reverendofdoubt Judgement call if needs to be controlled A-fib of 120/min often better than sinus of 60/min in terms of cardiac output (CO=HRxSV) Amio or ⚡️cardioversion if needing something Dont forget about digoxin Avoid negative inotropes like diltiazem and beta blockers if in shock

Fluid management in pancreatitis? Less seems to be better Our brief thoughts: Emily Straley @UVMEmergencyMed @aaeminfo @FGmoraDO @RabbleRouseED

RT @JAMA_current: A liberal transfusion strategy compared with a restrictive strategy resulted in a lower rate of unfavorable neurological…

RT @ResusPadawan: Acute Respiratory Distress Syndrome: Updates for Critical Care Transport @uwemcc @UWashEM @Airli…

📕Hyponatremia in textbooks Elegant algorithm and diagnostic testing leads to definitive diagnosis 🤷HypoNa in real life Diagnostic tests/history are conflicting & cause is uncertain Tx: Not sick: do nothing and see what happens Sick: do something and see what happens to Na

@IM_Crit_ I only currently use a high dose infusion rate of ketamine in refractory status epilepticus but wonder if in cases when propofol cannot be used (high TGs) and dex not effective maybe I should use higher doses ketamine instead of benzodiazepines? Would ❤️ more data to inform

@PulmCrit Only challenge with generalizability of this trial (haven’t read it in detail yet) is post cardiac surgery patient may receive amiodarone for a-fib prophylaxis looks like they did in about ~ 22% of this studied population

@reverendofdoubt Yea 💯 My decision making has evolved to if I’m really surprised the troponin is negative based on the story or ischemic ECG then admission/further risk stratification, otherwise discharge most everyone else with negative troponin(s)

The pathway from the paper👇