Watching Miller / Trump use the Kirk Memorial to divide, sow malice and show how much they hate anyone who stands for democracy, equity and free society is jarring. I've never been more scared, nor more proud to stand on my beliefs. They show how afraid they are of us, and what we can do.

updated IBCC chapter on anaphylaxis, some new additions: 🆕 methylene blue for anaphylaxis refractory to epi & fluid 🆕 sugammadex for anaphylaxis 2/2 roc or vec 🆕 nebulized epi (in combination with IV) for upper airway edema? Don't bank on it but might help? (emcrit.org/ibcc/anaphyl...) #EMIMCC

It's time to start building. Building community. Building resiliency. Building the world we want to see. When the state demands we step in line and maintain social order-- an order that robs our most vulnerable-- it is our duty, to raise the🖕with one hand, and use the other to lift each other up.

I have a small number of rules for my trainees in ED and ICU: 1) Don't lie. 2) Treat the unit and the people in it like you're a guest in their home. 3) Don't violate the Geneva Convention. (Sedate paralyzed patients with drugs with sufficient t1/2) pubmed.ncbi.nlm.nih.gov/33485698/ #emimcc

Still chuckling from an angry phone call I fielded earlier in the ICU. Mid-yelling at my residents/apps/nurses. "I'm tired of talking to these 30 something year old infant residents! We will only talk to the much more experienced and older attending physicians". My 32 year old ass...

scout images for CT scans are hidden gold the scout often gives you high-resolution images of a LOT of the body (FAR beyond the body part getting the CT scan) for example, the scout of a CT C-spine may be great to confirm ET tube position #EMIMCC

🆕💫PROTECT RCT Ceftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT) #IDsky #EMIMCC @pulmcrit.bsky.social journal.chestnet.org/article/S001...

Escaped the US for a second ... Fingers crossed they let me back in ...

As a new resident of the area I have been waiting for my first haboob. Did not disappoint. Rolled in as I pulled into the taco shop. Spent the evening sipping margaritas waiting for the dust to settle.

Louder for the nephrons in the back

Health and wealth inequality generated by decades of vacuous greedy profiteering at the expense of an unprotected working class, a targeted erosion of trust in our institutions, and a rising populism driven not by seeking a greater good, but by a destructive nihilism --will be our downfall.

There are 3 pillars of #academicmedicine. 1) Patient care 2) Education 3) Research The irony: the people who get paid the most are administrators who do none of those things.

1/n I finally read the Interstitial Pneumonias #AlphabetSoup update. Principally, I have an aversion to guidelines because of my concerns for the wellness of those who participate in writing them. But. This one (while not perfect) has substantial ➕ aspects publications.ersnet.org/content/erj/...

Does anyone else find it cringe when people "talk" to AI, or try to explain something to AI? Or is this just me...

First week of nights in the books. Out to the mountains to refocus and recenter as I find my new zen-point in this new chapter of my career.

Shift one as an attending intensivist in the books. Thanks for the encouragement y'all. Shout out to @pbafuma.bsky.social for putting up with the new shift jitters and orienting.

Any words of wisdom you would tell yourself before your first day as a brand new attending at an unfamiliar academic medical center? . . Asking for a friend. . . The friend is me. #emimcc #icusky #emsky

In a time when we need more thought leaders to emerge and speak their power. Thank you for your voice @iwashyna.bsky.social

standard approaches to dosing hypertonic therapy are flawed 🧂for hyponatremia, reviews often recommend homeopathically low doses (eg 100cc of 3%) 🧂for elevated intracranial pressure, common practice is to use fixed doses (eg 30 cc 23.4% saline for everyone) can we do better?... 🧵 #1/2 #EMIMCC

Not gonna lie.... I thought this was satire but they're serious... Great insight! De-recruitment is rapid and unforgiving

Last night shift as a fellow is in the books! Just goes to show there are so many ways to be the loudest in the room without raising your voice.

Love how terrible this is for Tesla. At their own demo. Manage to demonstrate that their car will break driving laws (bus with flashing reds)--smack a child running to said bus-- run it over-- and continue driving. Nailed it. S/O to the "oh my God" lady.

It's the photo of the marine detaining the army veteran while in front of two rent-a-cops for me.. hilariously depressing that this is how we break this seal.

When a morning setback becomes some morning art...

RFK Jr. spouted dangerous vaccine falsehoods on national TV. As a parent and infectious diseases doctor, I couldn't stay silent. Here's what the data actually shows. 🧵

There are some dreams that can only be realized at 2am during your last string of nights as a fellow.

Protesters Urged Not To Give Trump Administration Pretext For What It Already Doing

Art. An integral part of any people led resistance

for an intubated asthmatic whose bronchospasm won't break: high-dose ketamine is good, but it should be given with an anticholinergic. why give glycopyrrolate? 🤤reduces secretions from ketamine 👊it causes bronchodilation! so this is a sneaky way to start *two* IV bronchodilators. boom. #EMIMCC

This was a fun article to work on. Hope you enjoy it. Things We Do for No Reason™: Avoiding IV iodinated contrast material in patients with acute kidney injury or chronic kidney disease Journal of Hospital Medicine shmpublications.onlinelibrary.wiley.com/doi/10.1002/...

An excellent read for anyone-- but especially trainees.

Couldn't have started it any more simply or concisely.

A great high yields tip sheet for budding users of the magic crystals

The psychological challenge of delivering the news to a now awake/aware patient previously in extremis-- they have an irreparable life ending process. But the beautiful opportunity they now have the time to process and have their moments with family and pass with dignity and comfort. #emimcc

Corny T-Shirt design idea for the "ideal intensivist": Cowboy enough to put you on ECMO. Palliative enough to let you go comfort. #emimcc #icusky

Spending 3 weeks with my palliative care colleagues is such a refreshing and validating experience. To watch and learn from these experts while navigating difficult EoL questions with such patient centeredness is incredible. If you're in training, please consider spending dedicated time with them.

Having to give/receive "reprimands" for what boils down to hospital politics is making actively unwell. Especially when it places the feelings of a provider/surgeon over the need to deliver timely, transparent, patient-centered care. How have others navigated this as leaders/providers? #EMIMCC #icu

In the largest published cohort (n = 449) rapid correction occurred in ≈ 30% In the 78 pts who corrected >12 mmol/L per day, 0 cases of cerebral oedema were identified In fact, there was a trend towards lower mortality in the group who corrected more rapidly 2/ pubmed.ncbi.nlm.nih.gov/30948456/

Doing an EMR biopsy of our CXR use in the various ICUs. Found 20 CV/SNICU patients who collectively had more CXRs done on them than the entire MICU had done in Q1 of 2025 (600+). Everyday in ICU: 70% odds of receiving a CXR in the CV/SNICU compared to 30% in the MICU. #EMIMCC #ICUSKY

When I'm out of ICU beds I always signpost that, and finish the statement with "How can we help Mr/Ms __ today?" Gives the ED/OSH doc knowledge that I don't want to waste THEIR time with the presentation/workup as I can't accept, but reinforces that I can be a resource to them and their patient

Philosophical sap for the morning: Somewhere along the way in our pursuit of knowing everything about health and life, physicians become further removed from the uncertain art of and practice of living. Hope one day we embrace the deep work of connecting and understanding why we do what we do.

Half dose DOAC maintenance noninferior to full DOAC. Potential practice changing paper to reduce the risk of bleeding in patients who are rec. to receive >6mo anticoagulation. Take typical caution in industry funded research with a non-inferiority design, and low incidence of primary outcome.

Diuresis and fluid status comes up on almost every single ICU patient (especially in a cardiac ICU🫀) It’s very important to understand how each diuretic works, how they can be combined to augment urine output & their limitations Check out my starter guide for diuresis in the ICU #MedSky #Nephsky

Potentially unpopular opinion: The raw and reflexive anger towards a trained LIP manipulating the IV pumps or ventilator is an unhelpful baseline dynamic. That being said NEVER do things and not inform your colleagues with what you're doing-- that is objectively dangerous. Thoughts? #emimcc #icusky

A hard hitting but incredibly important piece by @sethina.bsky.social in the @bmj.com Anaesthesia and Intensive Care Medicine in the UK has work to do to ensure PoC (esp Black Drs) have an equal shot at specialty recruitment and career progression #emimcc www.bmj.com/content/388/...

Don't be afraid to fight for love, justice, and life. Support one another. Make eye contact. Smile. Connect.

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

I sincerely hope this doesn't come to pass... But having read a lot of RFK Jrs brain worms rantings for well over the last decade.... I'm concerned. It's up to the rest of the world now to lead the medical frontier.

A beautiful morning to cap off a busy night.

If you're not doing VEXUS you're either missing out... Or you're lucky and arent needing objective data to wave at consultants/primary teams as to why you need to diurese despite "AKI"...