ICU #ARDS Secrets: Our body's organs do not care about the PF ratio #foamed #foamcc #meded #Medsky #emimcc #pulmsky

ICU #ARDS Secrets: Our body's organs do not care about the PF ratio #foamed #foamcc #meded #Medsky #emimcc #pulmsky

Mind the gap between research and real life #foamed #foamcc #meded #Medsky #emimcc

This is the cartoon depiction of the old ICU motto: "Nobody dies in the ICU without steroids" I actually use steroids very often, especially in septic shock and severe community-acquired pneumonia #foamed #foamcc #meded #Medsky #emimcc #steroids

This is the cartoon depiction of the old ICU motto: "Nobody dies in the ICU without steroids" I actually use steroids very often, especially in septic shock and severe community-acquired pneumonia #foamed #foamcc #meded #Medsky #emimcc #steroids

I respectfully disagree with the view that "liberal" use of crystalloids decrease the risk of acute kidney injury (AKI) in post-cardiac surgery patients #foamed #foamcc #meded #Medsky #emimcc

ICU Snapshots: Patient presented to the ED with ECG #1 & 7 hours later an ECG #2 was obtained:

ICU Snapshots: Young patient with multiple medical problems presented to ED for evaluation of "weakness". Decompensated; had to be intubated & placed on pressors (norepinephrine) before being transferred to our ICU

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

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

Who would imagine? Louisiana officials waited months to warn public of whooping cough outbreak www.wwno.org/npr-news/202...

Yeah, right...

Yeah, right…

Life in the #ICU is not always fun... #Medsky #emimcc

Updated the IBCC chapter on pancreatitis Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good) Lets talk about some updates… #1/6🧵 (chapter: emcrit.org/ibcc/pancrea...) #EMIMCC

ICU Secrets: Hope is not a strategy #foamcc #foamcc #meded #Medsky #emimcc

ICU Facts: For patients receiving prolonged mechanical ventilation (>21 days), the mortality within 6 months as well as the readmission rate are close to 50% #foamed #foamcc #meded #medsky #pulmsky #emimcc

ICU Facts: For patients receiving prolonged mechanical ventilation (>21 days), the mortality within 6 months as well as the readmission rate are close to 50% #foamed #foamcc #meded #medsky #pulmsky #emimcc

Public Health secret: Are you partaking in the frenzy around Kombucha, the fermented drink made from tea, sugar, “healthy”bacteria & yeast? Its worldwide sales have exploded to $ billions. Research on what kombucha truly does for your health is limited. But you should know that

Just updated the IBCC chapter on cholecystitis & cholangitis. These patients are often initially triaged to the ICU. Understanding these diseases can help us direct patients to interventions they need. Let’s talk about four pearls 😁 chapter: emcrit.org/ibcc/biliary... #EMIMCC

Trials coming up at #esicm #lives2025 I am by far most interested in #andromedashock2. The usual yearly sweepstakes apply ping @avkwong.bsky.social @redneeraj.bsky.social I think all of those trials will be “positive”. Your thoughts?

#4/4) ascenting cholangitis generally IS infected & OFTEN causes septic shock be wary of patients w/ ascending cholangitis who seem OK (may crash) source control is usually obtained via ERCP. this should be done regardless of how sick the patient is (nobody is “too sick” for source control).

Public Health secret: Are you partaking in the frenzy around Kombucha, the fermented drink made from tea, sugar, “healthy”bacteria & yeast? Its worldwide sales have exploded to $ billions. Research on what kombucha truly does for your health is limited. But you should know that

Personal bias (no strong data yet): When does a patient with high-risk or massive #PE should be considered for catheter-based intervention? 1. When *stable enough* to make it to Interventional Radiology or Cath Lab 2. When already on ECMO #foamed #foamcc #meded #medtwitter

#PE stories: How it started: 50 yo with solid cancer presented with dyspnea & bilateral leg edema. Hemodynamics: OK (BP: 155/70, HR: 80/min). O2 sat 97% on room air. US showed bilateral popliteal vein thrombosis. CT chest angio showed:

#PE stories: How it started: 50 yo with solid cancer presented with dyspnea & bilateral leg edema. Hemodynamics: OK (BP: 155/70, HR: 80/min). O2 sat 97% on room air. US showed bilateral popliteal vein thrombosis. CT chest angio showed:

Six surgeons general warn about RFK Jr. #medsky

Six surgeons general warn about RFK Jr. #medsky

ICU Snapshots: Assessment/Plan (ICU Edition): Day #1: Start Colace qd Day #2: Change to Colace bid Day #3: Add Senna Day #4: Add Miralax Day #5: The next intensivist comes on service #medsky #foamed #foamcc #meded #emimcc

Amazon is trying to get a piece of the pie, aka the multi-trillion dollar US health care industry #Medsky #Healthcare

🤔😳🫣

Friendly reminder: Science does not progress by popular vote #meded #foamed #foamcc #Medsky

Nice review on the role of right-sided heart dysfunction (#RHD) on acute respiratory distress syndrome (#ARDS). The review is covering RHD's pathophysiology, diagnosis & potential treatments:

Nice review on the role of right-sided heart dysfunction (#RHD) on acute respiratory distress syndrome (#ARDS). The review is covering RHD's pathophysiology, diagnosis & potential treatments:

Refresher on Spectral Doppler assessment of the hepatic veins in tricuspid valve disease:

This systematic review included 65 studies & 17,008 patients with #sepsis. The occurence rate of each one of the three #echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), LV diastolic dysfunction (LVDD), & RV dysfunction (RVD) peaked at 48h:

Refresher on Spectral Doppler assessment of the hepatic veins in tricuspid valve disease:

This systematic review included 65 studies & 17,008 patients with #sepsis. The occurence rate of each one of the three #echocardiographic phenotypes, namely left ventricular systolic dysfunction (LVSD), LV diastolic dysfunction (LVDD), & RV dysfunction (RVD) peaked at 48h:

Public health message: We don’t directly absorb NAD (nicotinamide adenine dinucleotide) from the diet. Don't waste your money! #Medsky

Friendly reminder: The decision to administer iv fluids is more complex than whether the patient is fluid-responsive or not. Fluid-intolerance and tissue perfusion entered the chat... #foamed #foamcc #meded #Medsky #emimcc #cccsky #hemodynamics

Friendly reminder: During an intra-arrest #POCUS, the finding of RV dilation alone is generally insufficient to conclude the presence of a pulmonary embolism & justify the administration of thrombolytics. After a few min of CPR, RV tends to dilate due to

Friendly reminder: During an intra-arrest #POCUS, the finding of RV dilation alone is generally insufficient to conclude the presence of a pulmonary embolism & justify the administration of thrombolytics. After a few min of CPR, RV tends to dilate due to

Friendly reminder: The decision to administer iv fluids is more complex than whether the patient is fluid-responsive or not. Fluid-intolerance and tissue perfusion entered the chat... #foamed #foamcc #meded #Medsky #emimcc #cccsky #hemodynamics

From lab to jab: In 1882, Koch discovered the bacteria that cause tuberculosis (TB) but until now no vaccine effectively prevents TB in adults In contrast, COVID-19 was identified in Jan 2020. By December 2 of that year a vaccine developed by BioNTech & Pfizer was approved in 🇺🇸

#foamed #medsky #emimcc Next week: how to manage the airway of a crashing critically ill patient with RV failure and severe ARDS

Let’s not forget this famous Public Health quote from the past #Medsky #Tylenol

Reye’s syndrome has entered the chat 😫

#foamed #medsky #emimcc Next week: how to manage the airway of a crashing critically ill patient with RV failure and severe ARDS

Medical factoid: A genetic test called MyPhenome can help predict how a person will respond to GLP-1 agonists (semaglutide-tirzepatide) It classifies patients into one of two phenotypes: "hungry-gut" (+) and "hungry-gut" (-) (or should I say: "hungry-brain" (+)?)

In case you wonder about the health effects of *just* 1 night of #sleepdeprivation, in this study of 15 healthy participants (age, 22.3±0.5 y; BMI, 22.6±0.5 kg/m2), the researchers found that