Great discussion here that reminds me of the old medtwitter

This year's scoring matrix for ICM ST3 applications contains 3 references to POCUS. Looks like we think this is important for the practice of ICM and maybe should be on the curriculum? 🤔

Fantastic to see this published at last An objective assessment of the efficacy of home pulse oximeters on different skin tones Ping @iwashyna.bsky.social Open to comments from all #foamed #medsky www.bmj.com/content/392/...

I mean we are absolutely in a place now where the only solution to this information disorder is for everyone to constantly evaluate the source of information. Never trust a chatbot, but also don't believe a video unless you know and trust where it comes from. Unfortunately... that's a lot of work.

I used to think lung was quite widespread Then I looked at NEAT-ECHO again and did the math Remember that with FUSIC heart any cardiac physiologist can be a supervisor- this hugely increases the pool…

Am I alone in being surprised by how dominant Heart is over all the other FUSIC modules? I feel like Lung is the low hanging fruit, accessible to a wider range of professionals esp AHPs. Is there better provision of Heart mentors or is it just sexier? #pocus #emimcc

It really is remarkable how much better flow through the hospital is on strike days. Maybe having a few more senior decision makers around on normal days will pass a cost benefit analysis?

In a randomized trial involving critically ill patients undergoing intubation in EDs or ICUs, the use of ketamine for the induction of anesthesia did not lead to significantly lower in-hospital mortality than etomidate. Full trial results: nej.md/44EOlxB @criticalcarereviews.com

Trimethoprim-sulfamethoxazole carries a very low (but real) risk of causing ARDS. Duration of therapy is a risk factor (>7 days). Could likely be minimized by avoiding unnecessarily long courses. TMP-SMX is usually well tolerated, but can wreak havok (SJS, ARDS, drug-induced meningitis). #EMIMCC

www.fraserhealth.ca/news/2025/No... V interesting- spinal anaesthesia still seems to work in microgravity! I look forward to the full publication of these results

A short video that started as a bluesky post a few weeks ago. For clarity, I am actually quite optimistic about AI being useful in many areas of medicine. I’m just saying being a “diagnostic machine” really won’t move the modern healthcare needle that much youtube.com/shorts/hRv5K...

UK facing long, tough flu season, NHS chiefs warn www.bbc.com/news/article... We desperately need more evidence on how best to manage flu. Even the most basic questions- we don't really know if oseltamivir is benefical or if steroids help or harm in severe flu. I think REMAP CAP is looking at this?

MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP Mortality benefit easier to demonstrate w/ less resources available to salvage pts Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered) www.nejm.org/doi/pdf/10.1... #EMIMCC

Among patients with early #SepticShock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, driven by a lower duration of vital support. #LIVES2025 @esicm.bsky.social ja.ma/3L9m7EB

New blog: Fresh dueling guidelines about post-arrest care from the AHA and ESICM 💔 BP targets 💔 Who needs an emergent cath? 💔 O2 targets 💔 pan-CT scans 💔 temp targets 💔 neuroprognostication Which guideline do I love? 😍 You'll have to read the post to find out. emcrit.org/pulmcrit/202... #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

A simple shift in NHS critical care practice is set to save more lives from #Sepsis. The @ICS_updates & @BritInfectAssoc now recommend continuous infusion for key antibiotics over intermittent dosing. Evidence shows increased 90-day survival. We urge all hospitals to adopt this practice immediately

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?

New post just out: "On the edge" On my unexpected week in hospital and five things I learnt about the state of the NHS. (Free to read) open.substack.com/pub/samf/p/o...

ICU diagnostic conundrums (conundra?) are great to exercise the brain cells but they comprise maybe 5% of all our cases? The greater bulk of medicine is routine management of common disease

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.

In 2016 Geoffrey Hinton said “we should stop training radiologists now" since AI would soon be better at their jobs. He was right: models have outperformed radiologists on benchmarks for ~a decade. Yet radiology jobs are at record highs, with an average salary of $520k. Why?

I believe that Dr Imelda Müller may be the first anaesthetist to become an astronaut? ts2.tech/en/nasas-new...

Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky

I am delighted to announce CACTUS has launched its cardiac #ultrasound module for accreditation, following the successful launch of Lung #POCUS Suitable for anyone caring for sick kids #PedsICU @ics-updates.bsky.social @pccsociety.bsky.social @rcpch.bsky.social 👇 ics.ac.uk/learning/cac...

Underappreciated medical occupational perk: the lid from many brands of antibiotic ampoule unlocks most supermarket/airport trolleys across Europe

"Thank you for calling the ICU cardiology hotline. Your patient has had a type 2 MI. Please perform serial ECGs, check a troponin and request an inpatient echocardiogram. Goodbye!" *click*

What diagnosis should immediately spring to mind when you see this CXR?

What do you think of this ECG and how would you treat it? BP is normal

Average consultant NHS salary is £160k ?!!!! Can someone please tell me what I’m doing wrong if this is the ‘average’ ? 😆😆😆

the distinction between “bactericidal” vs “bacterostatic” antibiotics is some irrelevant BS. this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC

For a practice that is fairly ubiquitous, adding an aminoglycoside to a beta lactam for sepsis has surprisingly little evidence to back it up www.cochranelibrary.com/cdsr/doi/10.... #emimcc

Mervyn Singer reflects on 40 years of ICU Including 40 years of ICU trials His thoughts are interesting…ping @redneeraj.bsky.social #soa25

To a Gen X'er like me, this is an A-ha moment. But to the rest of the world, "Aha moments are sudden flashes of insight; instances of "Eureka" where, abruptly, the solution to a problem presents itself. A new study suggests we can actually game the system... here's how: 🧵

We are searching for physicians who use #VExUS #POCUS regularly. Become a collaborator for this important research project that aims to understand how venous Doppler influence medical decision making.

Very interesting results of the PROMIZING trial. Negative result overall but a lot of interesting points have come from the discussion. Control group weaning was probably much better than most ICUs! www.nejm.org/doi/full/10....

Conservative oxygen therapy with a target SpO2 of 90% did not reduce 90-day all-cause mortality compared to usual oxygen therapy in mechanically ventilated adult patients. #CCR25 @criticalcarereviews.com https://ja.ma/4kG5gWK

This was version 1 and then 2. I don’t know if anyone has any insight from the authors as to why it was changed mind?

We need to normalise declaring ideological as well as financial conflicts of interest because everyone's internal EBM hierarchy actually looks like this:

Imaging quiz for the day! What do we have here and what should this make you do next? #emimcc

This is a great article on the current state of specialty training applications in the U.K. www.bmj.com/content/389/...

That was the (not strongly-evidenced) impression we came to after our scoping review doi.org/10.1186/s130...

REMAP CAP was too underpowered to show anything or add substantially to the existing evidence base. the reason it’s getting so much press is recency bias. we have a natural tendency to get jazzed up about the newest, hottest trial while ignoring the previous dozens of trials… #1/2 #EMIMCC

www.londonsairambulance.org.uk/news-and-sto... This should be interesting. ECPR is currently undergoing a consultation with NICE too www.nice.org.uk/guidance/ind...

So recently I was at the Manchester Critical Care Symposium where I presented my polemic: “Dedicated intensive care medicine exams are a waste of time” It brought up some interesting opinions, which I will share here in this thread 🧵

3.2% of OHCA patients presenting to ED with a non-shockable rhythm have occult VF 😳. Half of these were detected on subsequent ECGs but half weren't... www.jacepopen.com/article/S268...

Referrer: "Do you have any ICU beds?" Me:

Have your say - an invitation to complete this important survey to inform UK implementation sespsis patient care research in PCT-guided antibiotic duration. www.qualtrics.manchester.ac.uk/jfe/preview/... @benmorton.bsky.social @ics-updates.bsky.social @criticalcarereviews.com

Even if you don't POCUS yourself, more and more of the newer generation of doctors do. Everyone in acute care needs to know what clinical questions are relevant to different accreditation modules and the basics of POCUS governance to effectively supervise these residents.