Among patients with acute ischemic #stroke due to non–large vessel occlusion, #tenecteplase administered 4.5 to 24 hours after symptom onset increased excellent outcomes but raised the risk of intracranial #hemorrhage. #ISC26 📽️ Watch the video & read the full study: bit.ly/4kgH1yQ

Daily Pearl: Type B lactic acidosis should be considered in patients receiving high doses of beta 2 agonists (albuterol) which can cause a dramatic non-hypoxic rise in lactate. Source: CPS - November 26, 2025 VMR with Sharmin & Rahul - SOB, cough, malaise

CANADA NEWS: University of Toronto Family Medicine Chair and basic income advocate Dr. Danielle Martin has been nominated to replace former Deputy PM Chrystia Freeland in upcoming Toronto by-election (University-Rosedale) The healthcare case for guaranteed income security is overwhelming.

In the phase 3 CORE-TIMI 72a and CORE2-TIMI 72b trials involving patients with severe hypertriglyceridemia, olezarsen led to a significantly greater reduction in the triglyceride level and in acute pancreatitis events than placebo. Full results and Research Summary: nej.md/491XG5V #MedSky

When managing patients with ischemic #stroke, can we please adopt a single BP target? Currently, BP should be <185/110 mmHg prior to thrombolysis & <180/105 after, which feels unnecessarily complicated. Wouldn't it be simpler to use one target, such as <180/100 mmHg, for both?

I'd consider watching this if it counted as CPD points. #medsky #FOAMed #GIbleed #EmergencyMedicine #IfInDoubtScopeIt

PBFluids▶️PISCES showed a striking cardiovascular benefit with fish oil in hemodialysis. Lovaza closely matches the trial’s ethyl-ester formulation, is FDA regulated, EHR friendly, and offers a practical option while we wait for the exact formulation pbfluids.com/2026/01/why-...

“Africans want to solve Africa’s problems, not satisfy the curiosity of the funders.” www.theguardian.com/world/2026/j... @dennisrenmd.bsky.social @kaymd.bsky.social

Tirzepatide significantly improves cardiometabolic risk in obese patients with obstructive sleep apnea, targeting both weight and apnea metrics. by Malhotra A, Grunstein R (...) Bednarik J et 9 al. in Nat Med #MedSky 👉 get more here 📖 read the article:

If they learned how to use #POCUS, why can't we? www.independent.co.uk/space/nasa-a...

hi, intesivist here. we dont use sepsis screens. sepsis screens use us.

#foamcc #emimcc

Revisiting "How to Figure Out the Length of Antibiotic Therapy", and how it came to be. Sobering that my greatest claim to writing fame is now over 15 years old, implying a subsequent lack of inspiration. 🤷‍♂️ #IDsky #medsky paulsaxmd.substack.com/p/the-story-...

I had the pleasure of interviewing Noah Wyle on the Skeptics' Guide to Emergency Medicine. Consider listening & sharing the SGEM episode. thesgem.com/2025/05/sgem... #MedSky

Daily Pearl: Severe hypomagnesemia can independently cause both hypokalemia (by affecting the ROMK channel in the kidneys) and hypocalcemia (by inducing PTH resistance). Long-term PPI use can lead to profound hypomagnesemia. Source: CPS - Episode 431: The Clinical Unknown Series

🦠 Tamiflu: Worth It? 📉 Reduces flu symptoms by <1 day 🤢 Nausea, vomiting, headaches common 🚫 No reduction in death or hospitalization in mild cases So… treat everyone? Maybe not. 📖 Read more: https://wp.me/pdrP8b-5sK 👥 @emswami @marco_propersi @mramzydo #FOAMed

Daily Pearl: In aspiration PNA, elderly patients may present with atypical signs of infection, such as functional decline, confusion, or tachypnea, in the absence of fever due to immunosenescence.

Guidance: Be comfortable with short-term eGFR swings. Act only on *sustained* changes. Otherwise you are treating biological variability, not disease. *And always correlate with the clinical picture *

Statistically significant does not mean clinically significant. In the latest Stats, Stat! animated video from 𝘕𝘌𝘑𝘔 𝘌𝘷𝘪𝘥𝘦𝘯𝘤𝘦, Nigam and colleagues explain the minimal clinically important difference. Watch “How the Minimal Clinically Important Difference Works”: youtu.be/rStW1rBjURc #MedSky

❄️ Winter is coming… and so are the pneumonia admits. CURB-65, PSI/PORT, SMART-COP — they’re not answering the same question. One guides admit vs discharge, another predicts mortality, and one spots who’s about to crash. New on @REBEL_EM 👉 https://loom.ly/pUrda8w

Daily Pearl: Postpartum heart failure is not always peripartum cardiomyopathy. Also consider thyrotoxicosis, as pregnancy can trigger or unmask Graves disease.

🦠 Tamiflu: Worth It? 📉 Reduces flu symptoms by <1 day 🤢 Nausea, vomiting, headaches common 🚫 No reduction in death or hospitalization in mild cases So… treat everyone? Maybe not. 📖 Read more: https://wp.me/pdrP8b-5sK 👥 @emswami @marco_propersi @mramzydo #FOAMed

Early IV→oral switch works—and safer. In the pragmatic COPAT RCT (5 hospitals), early oral therapy cut adverse events vs IV-only (3.2% vs 6.5%; HR 0.24) with equivalent efficacy. #AntimicrobialStewardship academic.oup.com/cid/advance-...

Scary 👻 47, F, admitted for ischemic stroke. S protein deficiency. Previous anterior MI. On Warfarin, INR 1.2 #FOAMed #POCUS #POCUSky #MedSky #EMIMCC

Leave-it-floxacin. Check out this week’s KASIC pearl to learn how to Pick Your Poison: Legionella Pneumonia kymdro.org/kasic/?p=8753 #IDsky #AntimicrobialResistance #antimicrobialstewardship #rxsky #pharmacy #FOAMed #NPs #PAs

The planned hepatitis B birth-dose trial in Guinea-Bissau raises serious ethical concerns. Withholding a proven, life-saving vaccine from newborns to answer speculative questions is an absence of equipoise with real downstream harms for trust in vaccines. bktitanji.substack.com/p/how-unethi...

Daily Pearl: New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.

RFK Jr. should have paid more attention to the comics in 1968.

This also makes the renal outcomes of tirzepatide even *more* impressive IMHO. That it was so effective at lowering the rate of poor renal outcomes & with less SGLT2i usage has me thinking it's just flat out the superior drug for diabetics at high risk for CVD and CKD.

Don't go to bed yet! SURPASS CVOT data is officially published! I already wrote about it in my blog however there are a couple interesting nuggets in the appendix worth commenting on especially because they may have been confounders! CC: @hswapnil.medsky.social @mikejohansenmd.medsky.social

Vapes, pouches, heated tobacco, shisha, cigarettes: nicotine in all forms is toxic to the heart & blood vessels Experts call for Europe-wide action to stem new wave of youth addiction https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf1010/8377624 #EHJ #Nicotine

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In the latest episode of Beyond Journal Club from @coreimpodcast.bsky.social and NEJM Group, we walk through the BALANCE trial and use it as a lens for treatment guidance. nej.md/3XNgajK

End of an era, you will not be missed

It took us a while to recognize euglycemic diabetic ketoacidosis (euDKA) in patients treated with Na-glucose cotransporter-2 inhibitors. It seems that we may have to be on the lookout for euDKA in patients treated with glucagon-like peptide-1 receptor agonists (#Ozempic #Zepbound)

Patient admitted for respiratory failure, mucus plug on right main bronchus. Found unconscious while waiting for bronchoscopy, no SpO2 variation. Scanning right lung this is what I see. #POCUS #MedEd #FOAMED

All you need to know about antibiotics in 🇺🇸 EDs/wards/ICUs #Medsky #idsky #emimcc

NLR needs to be interpreted in clinical context look at NLR for the next thousand evals you do & it will start making sense short version: NLR 1-3: normal NLR ~8-12: moderate stress (most ICU patients, eg DKA, CHF) NLR >~20: yikes territory (sepsis?) NLR >40: super yikes (Gram neg rods?)

New Substack post! IM + Hospital Medicine Recap Clinical Reviews - October, Part 1 The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women! See the post and subscribe here: rokeefemd.substack.com/

New paper out! 🚀 This study presents a model combining B-mode ultrasound (BMUS) and CEUS for accurate prediction of the macrotrabecular-massive (MTM) subtype of HCC, and explores its potential to predict recurrence-free survival (RFS).

If you have to remember one thing today, this is it: #foamed #foamcc #meded #Medsky #emimcc

There’s now a “Google for doctors.” OpenEvidence is fast, eerily good, and sometimes confidently wrong — so still needs supervision. Here’s how it works, and how it compares to the existing 10,000 Pound Gorilla of Medical Information, UpToDate. #IDSky open.substack.com/pub/paulsaxm...

TRUE ‼️ Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids! www.coreimpodcast.com/2023/06/28/s...

It feels like there has been a sea change in studies on PRBC transfusion, with newer studies often tending to favor more liberal transfusion. I wonder if this might relate to better modern management of volume overload, or improvements in transfusion safety over time? #EMIMCC

“Antibiotic stewardship-induced syncope. It's a new diagnosis.” The latest video in our partnership with @glaucomflecken.bsky.social summarizes a recent trial investigating whether a single dose or multiple doses of benzathine penicillin G is needed for early syphilis. 👉 nej.md/DrG28

A man in his 80s visits the ED because of epigastrialgia. The resident sends him home with a diagnosis of gastritis (even though CRP was 30). Comes back 2 days later, CRP now 250. Diagnosis was not hard at that point. #POCUS #EMIMCC

Hypotensive and hypoxic. Next step? #POCUS #MedEd #MedSky

This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.

Sent to the ED by PCP for fever and “left lower lobe consolidation”. Was still waiting for chest X-Ray. ~ 1 lt of purulent fluid drained. #POCUS #POCUSFirsr #USFirst #ButterflyIQ

⚕️September IM and Hospitalist Recap!⚕️ Hypothyroidism: A Review (JAMA) This one is absolutely LOADED with pearls! Read on for some of my favorite lessons for clinical practice! - Thread 🧵 - #MedEd #IMRecaps