Strong opinion of the day: there seems to be a trend for presenting slideshows online in 'normal view' (I.e. in editing mode) Please stop doing this!🙏🙏🙏 It's just awful

Seems open evidence is no longer available in Europe 😭 Anyone have suggestions for a suitable replacement- reliable and transparently-evidenced medical AI

Only just learned this great fact- the white crust on cheeses like brie and camembert is actually penicillium mold! Only produces trivial amount of penicillin so cross reactive allergies are very rare en.wikipedia.org/wiki/Penicil...

Fresh blog on the HI-PEITHO trial 😁 🔊 ~18 mg alteplase over 7 hrs is safe (no ICH, no difference in bleeding rates) 🔊 Alteplase reduces the risk of cardiopulmonary decompensation and poor functional outcomes #1/2 #EMIMCC

There are lots of ongoing studies The PRECARE study from Sydney suggested malposition 89% of the time pubmed.ncbi.nlm.nih.gov/40090608/m

#TEElovers @drfreeze.bsky.social @thinkingcc.bsky.social @load-dependent.eurosky.social any thoughts ? jamanetwork.com/journals/jam...

The plot thickens @pulmcrit.bsky.social

Any consultants who find their sympathy for resident doctors waning in the wake of the newly announced strike action would do well to read the conditions of their current student loan repayments. If you don't find it monstrously unjust, you don't understand it.

I wonder if it means that when PCT tells us the high NEWS2 is not sepsis, we think a bit harder. The need for more study into the outcome won’t identify this unless we have sufficient granularity (of clinical reason). “When the PCT is ⬇️, we find ⬆️ time is spent with the patient, with more DDxs”

This study is a real headscratcher. None of the other studies of PCT in ED have shown any benefit so my priors lean towards not believing it. But even so... www.thelancet.com/journals/lan...

Presented at #ISICEM: In a multicenter trial involving patients with acute hypoxemic respiratory failure, 28-day mortality with high-flow oxygen was not significantly different from that with standard oxygen. Full SOHO trial results: www.nejm.org/doi/full/10.... @isicem.bsky.social

commentary by @zentensivist.bsky.social in @jamanetworkopen.com on the safety of peripheral pressors: "PIV administration of vasopressors likely can be accomplished safely, with perhaps less discomfort and harm, compared with conventional CVC-based approaches in some critically ill patients."

Paediatric and adult Neuro POCUS: The UK Accreditation Pathway New article demonstrating the latest addition to #FUSIC in the UK journals.sagepub.com/doi/10.1177/... #POCUS #medsky

Found on the other place Terrifyingly accurate davetriska.substack.com/p/the-long-s...

Link to fresh blog below The trial surely has limitations, but it's been increasingly clear that catheter-directed thrombolysis is silly for over a decade now TBH, this is a wild story about device manufacturers using sponsored RCTs to torture EBM emcrit.org/pulmcrit/cdt/

The enormous unfairness in the current system is demonstrated by the modeling done by the IFS here. Many medical students have loans of £70-100k and won't actually start paying down their loans for many years ifs.org.uk/articles/how...

It may well remain the most realistic medical TV show….

⚠️ Despite all the hype, chatbots still make terrible doctors. Out today is the largest user study of language models for medical self-diagnosis. We found that chatbots provide inaccurate and inconsistent answers, and that people are better off using online searches or their own judgment.

There are few absolute rules in medicine but «never treat sinus tachycardia, treat the cause» has extremely few exceptions. #emimcc #cardiosky #medsky

Refractory septic shock: our pragmatic approach AKA the “Tommy’s Tonic” Now updated for 2026 link.springer.com/content/pdf/... Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social

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