It’s been a while, #MedSky Been busy with a top-priority project 🥰

Fabulous little thread on #LungUltrasoung Agree with all of these! 🙌 #emimcc

A quick #VEXUS thread 🧵- 3 reasons why the portal vein is the most useful single venous doppler waveform 🥇 (if you're only going to do ONE site to look for venous congestion, this is probably the most useful one!) #emimcc

Non-invasive positive pressure ventilation - BiPAP and CPAP, for example - can be a bit of a black box to most of us ⬛️ Once it's started, the nuances of how to adjust it to optimize each patient's physiology takes skill, experience, and often, a bit of trial and error 🔎 #emimcc

We've all been there: a Saturday on call in the hospital, with a list of 30 patients to round on 😵‍💫 Ward rounding can seem like an endless task - but it doesn't have to be! ⏰ Here are my top 10 tips for ward rounding efficiency 🧵- #emimcc

Love;y thread with take-home top tips Honestly, learn lung US. It is *such* a useful skill in the assessment of the critically ill!

1/ One of the BIGGEST #POCUS misconceptions is that B lines 🟰 pulmonary edema 🤦‍♀️ Did you know that there is actually a wide DDx for B lines? Check out my latest video about #LungUltrasound for interstitial syndromes 👀; or read on for the highlights 👇 🧵 #emimcc www.youtube.com/watch?v=eSuA...

Doppler ultrasound for venous congestion - #VEXUS - has truly been game-changing in my clinical #POCUS practice. Here's the TL;DR on the concept of #VEXUS - 🧵 #emimcc

Sometimes, being a good doc isn't about knowing EVERYTHING about a disease; it's about knowing when to involve experts 🤓 Prime example? Staph aureus bacteremia 🦠 ☠️ Did you know that involving your ID colleagues early actually ⬇️ mortality?? 🤯 #emimcc www.sciencedirect.com/science/arti...

Truly one of the best conference ! Amazing program! Check it out 👇 #emimcc

The elusive volume status has got to be one of the most ubiquitous questions in medicine - and the most widely misunderstood 😕 It's my favourite soapbox 🎙️ - so much so, that I've made a 20-min video highlighting the 5 key rules of volume status Video link ⬇️, but here's the TLDR: 🧵 #emimcc

The explosion of immunotherapy in the oncology world means that we’re increasingly seeing patients with associated toxicities: pretty much every “-itis” you can think of 🤕 #emimcc

Wow so much #dogmalysis in one🧵 Brilliant education from @katiewiskar.bsky.social

Thanks so much for this Katie! ☺️ Wanted to add another concept to your list of great tips!! Something I learned & keep in mind. bsky.app/profile/alau...

confession: i LOVE my upstairs colleagues who manage hypona my ED mgt: 3%? (ie sz, coma; ie: no) resist the urge to give fluid (can make Na go up too fast or go down; obscures labs) order ALL of the labs so the very smart and hardworking upstairs experts ie @katiewiskar.bsky.social can fix it

Confession: I LOVE hyponatremia 🤓 (I know, I know. What can I say, I'm a true internist!) HypoNa is often feared, maligned, and misunderstood - but I promise it doesn't have to be scary! Here are my top 10 hyponatremia tips and tricks - a 🧵 #emimcc

Want to learn about VA coupling? (I promise only mild-mod use of calculus.) Do you like Montreal, specifically on May 22-23, 2025? Check out the H&R Conference! ccusinstitute.wixsite.com/ccus/events/... @thinkingcc.bsky.social, @katiewiskar.bsky.social

Next to fluids, IV diuretics are some of the most commonly mis-prescribed medications in acute medicine 💉🩸 Let's unpack 5 common diuretic prescribing mistakes, and how to correct these 🧵 #emimcc

I am SO thrilled to share this paper, which has truly been a labour of love on a topic I care about deeply. "Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework," now published online in @accpchest Let us know what you think! #emimcc journal.chestnet.org/article/S001...

#FluidTolerance is one of the hottest topics in acute medicine going into 2025 🔥 In the words of @marcogarrone.bsky.social - an EM doc with a self-professed case of #POCUSmania - "You want to know when to assess for fluid tolerance? The sooner the better! Come check it out at #HR25!"

And we are so thrilled to have you there!! 🙌 Come join us #HR25 - May 22-23 in beautiful Montreal 🇨🇦

Suggested New Year's Resolution: more mindful prescribing of IV fluids 🫧 Far too often I see IV fluids thrown around with minimal consideration; meanwhile, we'll deliberate for hours about a dose of lasix 🤦‍♀️ Here are the 10 most common fluid prescription mistakes I see 🧵 #emimcc

#hr2025 will be an absolutely excellent event. I’m looking forward to joining in and talking about ventilation, ECMO, and POCUS. It would be great to see as many of you there as possible. Register here: ccusinstitute.wixsite.com/ccus/events/hr… @katiewiskar.bsky.social @thinkingcc.bsky.social

All heart failure is NOT the same; and diuretics are NOT always the answer ‼️ In the very wise words of Dr. Frederik Verbrugge - "Elevated cardiac filling pressures and fluid overload are both important, yet grossly different features of acute decompensated heart failure." #emimcc

Excited to be giving a talk @ #HR25: Top 10 Infectious Diseases Mistakes for Non-ID Clinicians to Avoid 🦠🧫 Hope to see you there for some cool ID pearls!

1/ Day 16 of Pharmacy Advent: Let’s talk hyponatremia—seeing it more frequently in ED. Why is hypokalemia risk factor for Na overcorrection & risk of ODS? We’ll briefly review recent SRMA on slow vs fast Na correction too. Here we go, let’s dive in!👇 #medsky #pharmsky #EMsky #HMsky #nursesky #emimcc

1/ Time for another #POCUS pitfalls thread: the infamous IVC 🤩 I have MANY thoughts on the IVC 💭 When I first started teaching POCUS, I actually disliked the IVC because it was often poorly done or incorrectly interpreted ❌ I have now come to love the IVC, BUT you have to do it right! #emimcc

Agree 100%% I am a huge #VEXUS nerd but I do NOT find reporting a numeric score to be useful. Describe what you’re seeing in each waveform 👌🏻 #emimcc

I’ll put my neck out here: I’m an avid venous doppler user, I find it immensely useful, especially when vena cava is unrelible. I never ever score VExUS though, I report individual components and my interpretation of them in the particular setting. #emimcc #pocus #echosky

Superb LUS-skytorial. „The spleen is always more posterior and superior than you think“ is just one gem. Anyone doing #echofirst should aspire being a good lung-sonographer as well.

The ROI for lung ultrasound in terms of times it changes management compared to easiness of mastery is a no brainer My ¢.02 There is no better bedside test for LVEDP assessment AND it can liberate you from relying on this crappy AP CXRs

1/ On the topic of #LungUltrasound - You absolutely CANNOT talk about #LUS without talking about Dr Daniel Lichtenstein. He is the undisputed father of lung ultrasound, and he's been working in this field since before many of us were born! 🤯 And - he's coming to #HR25!! 🤩 #emimcc

1/ I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆 It's time for another #POCUS basics #skeetorial 🧵 Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️ #emimcc

If the LV of the patient with sepsis is «hyperdynamic» when on noradrenaline, then EF dropps and the LV looks poorly when vasopressin is added, but recovers to normal with dobutamine, you likely haven’t «uncovered hidden LV dysfunction» or septic cardiomyopathy. #emimcc #pocus #echofirst 1/

Great 🧵 here on the multi-talented olanzapine. Pearl: it’s a rare anti-emetic without QTc effects! 🙌

1/ Back to the basics today: let's talk about common pitfalls in obtaining cardiac #POCUS images ❤️ Here are some very common image acquisition errors in basic views, as well as the simple moves to correct them ✅ 🧵 #emimcc #POCUSky #echosky #MedSky

Let's inaugurate my #echosky posts with this video of a partial rupture of the anterolateral (!) papillary muscle (1) of the mitral valve, resulting in severe MR and requiring emergency MV surgery. (Optional quiz: what is the LV apical mass with the label 2?) #echofirst #cardiosky #ansky

1/ So much of medicine is about telling a story 📖 Like anything, building your story and presenting it is a skill that comes with practice 🎖️ 🧵 - Here are 5 common mistakes I see when trainees are presenting consults 👩‍⚕️⚕️🩺 #emimcc

Somewhat unsurprisingly @pulmcrit.bsky.social and @emcrit.bsky.social has a blog post on it. emcrit.org/pulmcrit/pne...

1/ We talked about #POCUS for paracentesis last week; so it seems appropriate today to talk about POCUS tips for #thoracentesis 🧵 This is another procedure that I can't believe used to be done blind! 🙈 #emimcc

This looks FANTASTIC 🎉 This is exactly the kind of resource that I wish existed when I was a resident ✨ Huge kudos to @zentensivist.bsky.social and the authors!

This is a really interesting study on #LungUltrasound for pneumothorax. TLDR: LUS significantly underperformed CXR for detection of traumatic PTX, with high specificity (99%) but very low sensitivity (27%). I have a few thoughts 🧵 -

For my fellow #MedTwitter refugees from the other place 🐣 - I used @blueark.app to migrate my old posts over here. Quite seamless! #MedSky

Done! Added to go.bsky.app/9WQtZh6

USG abdominal and thoracic paracentesis is an absolute fundamental part of our #POCUS course. I 💯 agree with @katiewiskar.bsky.social that blind needling of a collection of fluid is for those wishing to practice medicine in the last millennium.

Pimping the renal team on drug induced hyperkalemia: ACEi: 👍🏼 ARB: ✅ NSAIDs: 👏 K-Sparing diuretics: 🔨(nailed it) Finerenone: 🎉 Heparin: 🤓 Tacro: 👩🏻‍🎓 Trim Sulfa: 🤜🏼 Potassium chloride: 🤨

Who decided that the default setting for Adobe was to disable scrolling Like - yes, I’d like to feel a jarring, disjointed sensation every time I try to view a multi-page document

in 24 hours, the Acute Medicine feed has already attracted a lot of awesome content! if you see great acute medicine content, reply to the post with a post containing "emimcc" and that will push the original post into the feed. #MedSky bsky.app/profile/did:...