Short skytorial about a fresh IBCC chapter covering all things methylxanthine-related (caffeine & theophylline). This is a niche topic that we don't encounter in everyday practice, but it ties together some loose ends. (chapter is here: emcrit.org/ibcc/caffeine/) #EMIMCC

proposal: all types of bradykinin-mediated angioedema involve a common vicious spiral 👇 tranexamic acid or aminocaproic acid should be universally effective in blocking this cycle & aborting attacks there's no need for super-expensive drugs (icatibant et al.) thoughts? criticism? #EMIMCC

hi, medical toxicologist that knows a lot about Tylenol here👋 Claiming that tylenol use in pregnancy causes autism is fearmongering here's what you need to know 🧵

How many of us working in the ICU use the term "stress dose steroids" daily but are unsure where the term comes from? For me, I learned how to order hydrocortisone well before I understood “why” these doses were used. Read below for a quick thread on stress dose steroids! 1/8

Therefore, hydrocortisone dosing (or equivalent) may be labeled as follows: Low-dose: 25-200 mg/day Stress-dose: 200-350 mg/day Supra-physiologic dose: 351 to 1,000 mg/day High-dose: >1,000 mg/day 7/8

Droperidol vs haloperidol: what is the fairest butyrophenone of them all? This is largely based on receptor affinity rather than RCT data Mechanistically, droperidol has more multimodality elegance, whereas haloperidol is a D2-receptor blocking hammer Thoughts? emcrit.org/ibcc/deliriu... #EMIMCC

just added a new section on RIC lines (rapid infusion catheters) to the IBCC a RIC line basically involves up-sizing an 18-20G PIV to a 13G PIV using a Seldinger technique we just got these, so I'd love to hear folks' opinions on them & any pearls/pitfalls #EMIMCC emcrit.org/ibcc/mtp/#ra...

Fresh IBCC chapter: Cannabis use & complications 🌿 Legalization, higher %THC products, & edibles are making this an increasingly common issue 🌿 Cannabis withdrawal is an overlooked cause of misery & patient-directed discharges 🌿 Cannabinoid hyperemesis syndrome emcrit.org/ibcc/cannabis/ #EMIMCC

"Books break the shackles of time, proof that humans can work magic." - Carl Sagan, Cosmos

Ask courageous questions. Do not be satisfied with superficial answers. Be open to wonder and at the same time subject all claims to knowledge, without exception, to critical scrutiny. Be aware of human fallibility. Cherish your species and your planet. - Carl Sagan.

Les océans recouvrent ~70% de la surface de la Terre, mais l'eau reste rare. La grosse bulle représente toute l'eau sur Terre. A côté, toute l'eau douce liquide (souvent sous Terre). Le minuscule point bleu c'est toute l'eau douce des lacs et rivières : celle que l'on peut boire.

How much science cares whether you "believe in it" #MedSky @jakescottmd.bsky.social

agitation alone is usually not a reason to keep a patient intubated *extubation* usually improves the agitation a lot (often resolves completely off vent) if otherwise ready for extubation: extubate, reassess off the vent, treat any residual agitation PRN #CowboyExtubation #AlwaysBeExtubating

I would add that fomepizole, in addition to inhibiting CYP2E1, blocks the cascade of increasing oxidative damage that eventually leads to hepatocyte death. This suggests fomepizole may add benefit even when the acetaminophen level is low or undetectable and there's no more drug left to metabolize.

Updated the acetaminophen toxicity chapter based on 2023 guidelines. These are solid guidelines by multiple 🇺🇸 & 🇨🇦 tox societies. The guidelines clarified some grey areas, allowing the chapter to be a lot crisper. Also added fomepizole for high-risk ingestions 😁 emcrit.org/ibcc/acetami... #EMIMCC

🆕💫Navigating the Muddled Middle: A Case-Based Exploration of Oral β-Lactams for Systemic Gram-Negative Infections The authors explore the utility of oral β-lactams for treatment of systemic GN infections through 3 hypothetical case scenarios #idsky #EMIMCC academic.oup.com/ofid/article...

new IBCC section on diphenhydramine toxicity 😁 ☠️ very common ☠️ can be severe ☠️ management can get complex (hybrid of anticholinergic tox & Na-blocker tox) would be interested in any feedback on this (like all things toxicological, there's not a ton of data) emcrit.org/ibcc/anticho... #EMIMCC

"Think of the rivers of blood spilled by all those generals and emperors so that, in glory and triumph, they could become the momentary masters of a fraction of a dot."

Imagination will often carry us to the worlds that never were, but without it we go nowhere.

Carl Sagan on science, astrology, and mainstream media in 1987. "Short-term advantages for the network, long-term disaster for the country."

𝐂𝐂𝐑 𝐁𝐥𝐨𝐠 - 𝐓𝐡𝐞 𝐄𝐭𝐨𝐦𝐢𝐝𝐚𝐭𝐞 𝐂𝐨𝐧𝐮𝐧𝐝𝐫𝐮𝐦 Induction for rapid sequence intubation in the critically ill often feels like the swing of a pendulum. What's your take on the etomidate - ketamine dichotomy? Here's ours. ➡️ https://criticalcarereviews.com/blog/current

Delirium Related to Sedation: Prevention Strategies and Patient Perspectives CCR Journal Watch - tracking the critical care literature daily https://criticalcarereviews.com/latest-evidence/journal-watch

"Tesseract" can mean many things: an OCR engine, a 4D hypercube in geometry, the Space Stone’s container in Marvel, a British metal band, or a premium e-scooter by Ultraviolette. One word, many dimensions.

"You go talk to kindergartners or first-grade kids, you find a class full of science enthusiasts... You go talk to 12th graders and there's none of that. They've become incurious. Something terrible has happened between kindergarten and 12th grade."

Carl Sagan explains the 4th dimension

"The cosmos is within us. We are made of star-stuff. We are a way for the universe to know itself."

People like us who believe in physics know that the distinction between past, present, and future is only a stubbornly persistent illusion. Time, in other words, he said, is an illusion. — A. Einstein (1879-1955)

Sine wave shown beautifully .

Most people inherit their beliefs. They rarely examine them.

"The first principle is that you must not fool yourself—and you are the easiest person to fool.” — Richard Feynman

Mixed Acid-Base Disturbances: Core Curriculum 2025 CCR Journal Watch - tracking the critical care literature daily https://criticalcarereviews.com/latest-evidence/journal-watch

Today's Paper of the Day is: The human gut microbiome in critical illness: disruptions, consequences, and therapeutic frontiers criticalcarereviews.com/latest-evide... Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025

Non-Invasive Positive Pressure Ventilation for Pre-Oxygenation of Critically Ill Patients Before Intubation CCR Journal Watch - tracking the critical care literature daily https://criticalcarereviews.com/latest-evidence/journal-watch

As I come to the end of my training, and my 27th and final rotation, I have reflected on this rotational aspect. It has made me extremely adaptable and provided a rich background of experience. But equally, it has broken me, prevented me from creating the social connections that are so... human.

I am pleased to share my published article on characteristics and outcomes of volatile anesthetics in near-fatal asthma in @ccejournal. journals.lww.com/ccejournal/f...

ECMO in adult trauma patients with refractory acute cardiopulmonary failure: guideline from the Chinese society of extracorporeal life support 2025 CCR Journal Watch - tracking the critical care literature daily https://criticalcarereviews.com/latest-evidence/journal-watch

Norepinephrine pharmacolexicology: a chronological review of dose reporting and the implications of salt formulations CCR Journal Watch - tracking the critical care literature daily https://criticalcarereviews.com/latest-evidence/journal-watch

I'm working on creating a critical care drug handbook (embedded into the IBCC, for free). Working version here: emcrit.org/ibcc/drugs/ Are there other drugs that you'd like to see included? (Apologies in advance for not including drugs that are exclusively available outside the USA) #EMIMCC

It’s not enough to declare rights on paper. A free society depends on citizens who are educated, who ask skeptical questions. Without that, power slips away from the people, and the government begins to rule, not serve.

“Tell people there's an invisible man in the sky who created the universe, and the vast majority will believe you. Tell them the paint is wet, and they have to touch it to be sure.” — George Carlin

"Exploration is in our nature. We began as wanderers, and we are wanderers still. We have lingered long enough on the shores of the cosmic ocean. We are ready at last to set sail for the stars."

Carl Sagan ~ Galaxies beyond our own 🎥 Royal Institution Lectures

It has taken medical science 200 years to advance humans to the point where people are so healthy and living so long that they can deny that science and medicine is what got us here.

🛰 Spotlight on Innovation: Paratus Goes to NASA! Our CEO, Dr. Lemaire, pitched A.D.A.M.S. to NASA, alongside Annie Martin from the @canadianspaceagency We believe space innovation can revolutionize healthcare here on Earth, and we’re just getting started. 🌍✨ Want to know more? 👉 ezresus.com/space

what are your preferred oral opioids? CYP2D6 is required to activate hydrocodone, tramadol, codeine, and oxycodone this study found more pain-related ED visits in patients prescribed these meds who: - were taking CYP2D6 inhibitors - have less active CYP2D6 genotypes 🧵 #1/3 #EMIMCC #Pharmsky

A great post and reminder of the importance of considering drug interactions (in this case, CYP2D6 metabolism for opioids!) and genetic polymorphism #medsky #pharmsky #EMsky #GPsky #FOAMed #emimcc

For the first time we have the power to decide the fate of our planet and ourselves. This is a time of great danger, but our species is young and curious and brave and shows much promise. - Carl Sagan