The evolution of acute pulmonary embolism classification (including the recently published 2026AHA/ACC/ACCP/ACEP/CHEST/ SCAI/SHM/SIR/SVM/SVN Guideline): #foamed #foamcc #meded #Medsky #emimcc

Albumin (A) replacement therapy in septic shock In a multicenter RCT, 440 pts w septic shock were treated w A aiming to keep serum A > 3.0 g/dL or w standard fluid therapy. 90-day mortality did not differ between the A group (43.3%) & controls (45.9%) jamanetwork.com/journals/jam...

Mom of 7-year-old hospitalized with measles encephalitis: "I still wouldn’t have given my son the vaccine" #PublicHealth #Medsky www.independent.co.uk/news/health/...

Mom of 7-year-old hospitalized with measles encephalitis: "I still wouldn’t have given my son the vaccine" #PublicHealth #Medsky www.independent.co.uk/news/health/...

Albumin (A) replacement therapy in septic shock In a multicenter RCT, 440 pts w septic shock were treated w A aiming to keep serum A > 3.0 g/dL or w standard fluid therapy. 90-day mortality did not differ between the A group (43.3%) & controls (45.9%) jamanetwork.com/journals/jam...

In science, the most beautiful theory can be slayed by an ugly fact. In medicine, a beautiful therapy can be killed by an ugly trial

Public Health message:

Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts: The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):

#Bronchoscopy: Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients? The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings

ICU Secrets: “If you aren’t escalating care, you should start de-escalating”...

The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc

The United States has the highest incarceration rate in the world: nearly 2 million people locked up in 1,566 state prisons, 98 federal prisons, 3,116 local jails, 1,277 juvenile correctional facilities, 133 immigration detention facilities, 80 Indian country jails etc

ICU Secrets: “If you aren’t escalating care, you should start de-escalating”...

#Bronchoscopy: Besides setting the peak pressure alarm to its maximum (~100cmH2O), do you use any specific ventilator settings during fiberoptic bronchoscopy (FB) in intubated patients? The VentSetFib study showed that using specific "bronchoscopy-optimized" ventilator settings

This is an amazing book #Gene

This is an amazing book #Gene

Obesity hypoventilation syndrome/obstructive sleep apnea (OSH/OSA) - Some thoughts: The following are some issues I have frequently encountered in the management of patients with OSH/OSA (I will intentionally combine them herein for the sake of the discussion):

“If you know the question, you know half” H. Boyer

Temporary MCS: Abiomed issued an Urgent Medical Device Correction with updated use instructions for all Impella RP with SmartAssist and Impella RP Flex with SmartAssist devices www.fda.gov/medical-devi...

On a separate note, the American Society of Echocardiography @ASE360 has one of the least user-friendly websites. In order to either find relevant educational material or claim MOCE/CME credit for completing National Board of Echo requirements, you have to spend 30'... #pocus

This is how it's done!

This is how it's done!

According to the guidelines: "initiating antiplatelet therapy within 24 h after thrombolysis might be considered in pts w concomitant conditions where such treatment is known to provide substantial benefit or where withholding it could pose significant risks"

What do you think #cardiosky?

ICU Scenarios: A 45 yo patient on dual antiplatelet therapy following high-risk PCI with a drug-eluting stent 3 weeks ago presents today with ischemic stroke and receives TNK thrombolysis. Should antiplatelets be given in the first 24 hours after thrombolysis? Yes No

I know you know but as a friendly reminder: For patients who are "NPO after midnight" in preparation for a "procedure" the following morning, maintenance IV fluids are generally not indicated... Even the "NPO" is usually an overkill, but this is for another tweet... #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?

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?

Updated the acute ischemic stroke chapter based on 2026 ASA/AHA guidelines Chapter focuses on supportive care (*not* who gets lysis/EVT) This has not changed very much Top blue numbered section is designed to be used as a checklist when you settle these pts into ICU emcrit.org/ibcc/ais/ #EMIMCC

#Minocycline therapy initiated within 72 h of acute ischemic #stroke provided a significant functional outcome benefit compared with placebo at 90 days #foamed #foamcc #meded #Medsky #emimcc @pulmcrit.bsky.social has to update the chapter! www.thelancet.com/journals/lan...

Not good: 734 rural hospitals across the US, which represent one-third of all rural facilities nationwide, are at risk of closing due to severe financial problems, according to the Center for Healthcare Quality and Payment Reform’s most recent analysis www.beckershospitalreview.com/finance/734-...

The (2026) Guidelines for the Early Management of Patients With Acute Ischemic Stroke (AIS) were just published When managing a patient with AIS, what do you use for thrombolysis? Alteplase (tPA) Tenecteplase (TNK)

The new 2026 AHA/ASA stroke guidelines include this table 👇 for the management of thrombolytic-induced angioedema. There is NO discussion or any additional text about this topic. I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC

ICU Secrets: Although tachypnea is a concerning clinical finding, it is important to note that respiratory rate alone does not reliably reflect the degree of respiratory effort #foamed #foamcc #meded #medsky #emimcc

Nice review (and a refresher) on community-acquired pneumonia (CAP): In the United States, CAP is estimated to be responsible for 1.2 million emergency department visits & 41,210 deaths annually

ICU (ABIM) Board Review Questions:

I am reading this old study of 16 out-of-hospital PEA patients. The researchers used #POCUS plus stable PetCO2 during #CPR pauses to identify pseudo-PEA & administered vasopressin. This led to improved outcomes Does anybody have any experience with this strategy? #foamed #foamcc #medsky #emimcc

Sending my warmest wishes to everyone working in the 🏥 today as we deal w this snowstorm. Please drive carefully! My commute to the ICU took >90 min this am. If you're heading in, leave🏠earlier than usual to make sure u arrive safely & on time. Stay safe & thank u for all u do! #medsky

Half of what we know (and do) in medicine is wrong. Unfortunately, we don’t know which half... #foamed #foamcc #meded #Medsky #emimcc

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

No surprise here: news.bloomberglaw.com/white-collar...

Pareto Principle - Cardiac arrest edition: Although defibrillation is indicated in approximately 20% of cardiac arrest cases, more than 80% of individuals who survive present with shockable rhythms... #foamed #foamcc #meded #medsky #emimcc

#foamcc #emimcc

The recent NEJM study found cardiovascular collapse was more common with ketamine than etomidate after rapid sequence intubation, especially with the high ketamine doses used. Should we be more cautious about the hemodynamic effects of ketamine/propofol ("ketofol") as well? 🤔

Observation Post-Epi in Anaphylaxis -Epi 0.5 mg IM: only critical med in anaphylaxis. If A, B or C, give E -Biphasic rxn extremely rare: 0.18% (PMID: 24239340) + can occur days out -I typically observe X 2 hours. Key is to ensure access to epi autoinjector youtube.com/shorts/-rL6J... #EMIMCC

I love ESICM but no more SOFAs, please:

The recent NEJM study found cardiovascular collapse was more common with ketamine than etomidate after rapid sequence intubation, especially with the high ketamine doses used. Should we be more cautious about the hemodynamic effects of ketamine/propofol ("ketofol") as well? 🤔

#foamcc #emimcc

Pareto Principle - Cardiac arrest edition: Although defibrillation is indicated in approximately 20% of cardiac arrest cases, more than 80% of individuals who survive present with shockable rhythms... #foamed #foamcc #meded #medsky #emimcc

ICU/ID Board Review: 70 yo ♀ w DM2, HTN, & obesity transferred from ED to the ICU. Presented w 8 h of weakness, L leg pain & edema. Vitals: BP 110/47, HR 105, RR 22. Exam: 1 cm plantar ulcer under 2nd metatarsal, dusky skin up to mid-calf, diffuse tenderness, ? crepitus